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Surgeons frequently utilize first-TMT PFBB arthrodesis to treat instability of the medial longitudinal arch. This procedure combines the mechanical benefits of the Lapidus and Cotton techniques to address structural incompetence of the first ray. However, recent midterm data suggests that clinicians should approach this technique with significant caution. Specifically, the study evaluated outcomes of using precontoured allograft wedges in patients with progressive collapsing foot deformity or hallux valgus.
A retrospective review of 49 patients undergoing this surgery between 2020 and 2023 provided alarming insights. Researchers used weightbearing CT (WBCT) scans to assess radiographic union across a two-year follow-up period. Unfortunately, the findings revealed a nonunion rate of 42.3% among the cohort. Furthermore, nearly 27% of feet required at least one revision surgery. Consequently, these statistics represent a substantial risk for postoperative failure compared to standard column stabilization methods.
In addition to union challenges, clinicians observed new-onset plantar sesamoid overload pain in over 15% of cases. This complication typically results from overlengthening or overcorrecting the first-ray position during the bone block placement. Therefore, meticulous patient selection and detailed preoperative counseling are vital before proceeding. Surgeons must discuss the potential for high reoperation rates and sesamoid symptoms with their patients. Overall, while the procedure aims for better biomechanical correction, its high complication profile requires careful clinical management.
The most significant complications include a high nonunion rate (42%) and a notable revision rate (27%). Additionally, some patients experience sesamoid overload pain caused by overcorrection of the first ray.
Orthopedic fellowship-trained surgeons recommend using weightbearing CT (WBCT) for the most accurate assessment of radiographic union or nonunion at the tarsometatarsal joint interfaces.
Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Refer to the latest local and national guidelines for clinical practice.
References
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A retrospective study highlights a 42% nonunion rate and 27% revision rate for first-TMT PFBB arthrodesis using allograft wedges, urging clinical caution....
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