Hallux Valgus surgery and 1st MTPJ fusion Outcomes from the BOFAS Registry

S Jha, L Mason, N Makwana, E Wood, BOFAS Registry Collaborative

Introduction: Utilising the BOFAS registry to examine hallux valgus surgery and 1st MTPJ fusion has the advantage of providing large volume data with favourable external validity relating to these common conditions.

Methods: BOFAS registry patients undergoing hallux valgus (HV) surgery (excluding tarsometatarsal fusion and isolated Akin osteotomy) and 1st MTP joint fusion surgery were identified.

Results: There were 1000 cases of HV surgery and 1508 cases of 1st MTPJ fusion surgery. Both groups had significant functional impairment (MOXFQ/VAS) at baseline. Whilst 1st MTPJ fusion patients had significantly (p<0.001) higher baseline scores for all MOXFQ parameters compared to the HV cohort, only the walking component of MOXFQ was greater than the MCID [1, 2]. 13.80% of patients in the HV group and 12.60% of patients in the 1st MTPJ fusion group had complete data to allow comparison of PROM score difference between baseline and 12 months. Of these patients both cohorts demonstrated a statistical and clinically significant improvement at 12 months in all components MOXFQ/VAS scores. Whilst at 12 months the MOXFQ/VAS scores remained significantly higher in the 1st MTPJ fusion cohort than the HV cohort this did not reach the MCID in any component.
Comparing the improvements in MOXFQ/VAS there was a greater improvement in scores from baseline to 12 months in the 1st MTPJ fusion group, however this was not statistically significant.

Conclusion: This data demonstrates hallux valgus leads to functional impairment similar to 1st MTP osteoarthritis; the MOXFQ walking component was the only domain in which 1st MTPJ fusion patients had clinically (MCID) worse baseline symptoms. Acknowledging the limitations of our low follow-up rates, our data demonstrates both types of surgery lead to clinically significant improvements in patient function. Furthermore offering 1st MTPJ fusion does not lead to a clinically worse outcome (MCID) than hallux valgus surgery.