Forefoot Surgery in Elderly Compared With Younger Patient Populations: Complications and Type of Procedure

Do We Need to Approach the Elderly Hallux Valgus Differently?

In the past, it had been stated that hallux valgus correction is not advisable for elderly patients. Their limitation of "elderly" refers to 50 years of age. A 50 year old from the 1990s is from his health situation probably not comparable to a 50 year old from 2023. Nowadays, patients approaching their 80s increasingly express their wish to have the hallux valgus deformity corrected.

Effect of co-morbidities on outcomes of first metatarsophalangeal joint fusion: A systematic review

Introduction

The pre-existing co-morbidities have a major impact on the outcomes of Orthopaedic procedures as shown by the several studied in various contexts. However, the specific influence of these co-morbidities on first metatarsophalangeal joint fusion remains relatively underexplored. This study aims to address this gap by examining the association between co-morbidities such as obesity, smoking, diabetes, advancing age, and rheumatoid arthritis, and the outcomes of first metatarsophalangeal joint fusion.

Methods

A comprehensive search was conducted across multiple databases, including MEDLINE, EMBASE, and CINAHL. Relevant articles were identified and processed using Covidence, with independent assessment conducted to ensure inclusion criteria were met. The focus of the review was on analysing the effects of specific co-morbidities on fusion outcomes.

Results

Seven qualifying studies were identified for full-text extraction, revealing significant heterogeneity across the literature, which hindered direct statistical comparisons. The findings presented inconclusive effects of obesity on fusion outcomes, with ambiguous impacts observed for diabetes mellitus and smoking. Additionally, no discernible variance was observed in functional outcomes across different age groups. Furthermore, steroid usage in rheumatoid arthritis cases demonstrated delayed fusion in revision procedures, while primary outcomes remained uncertain.

Conclusion

This systematic review highlights the need for further research with standardised methodologies to better understand the correlation between pre-existing co-morbidities and outcomes in first metatarsophalangeal joint fusion. By elucidating these relationships, clinicians can better tailor treatment approaches and optimise patient care in this specific Orthopaedic context.

Level of evidence

Level III.

Effect of Age on Clinical and Radiological Outcomes of Hallux Valgus Surgery

BACKGROUND

The prevalence of hallux valgus increases with age. However, no studies have compared the effectiveness of surgical correction among different age groups. This study investigated the influence of age on clinical and radiological outcomes following hallux valgus surgery.

METHODS

Patients who underwent correction for hallux valgus at an academic hospital were stratified into 3 age groups: younger (<50 years), middle-aged (50-59 years), and older (≥60 years). Functional outcomes and satisfaction questionnaires were collected preoperatively and at 6 months and 2 years postoperatively. Radiological recurrence and reoperations were recorded at follow-up. There were 193 patients (93% female): 34 younger, 74 middle-aged, and 85 older.

RESULTS

The preoperative hallux valgus angle was significantly greater in older patients (P < .001). The older group had 3 perioperative complications (P = .144) and showed a trend toward a longer hospital stay (P = .083). There was no difference in visual analog scale, American Orthopaedic Foot & Ankle Society score, or SF-36 among the groups at 6 months or 2 years. Using multiple regression, age was not associated with any outcome score. The satisfaction rates were 82%, 78%, and 83% in the young, middle-aged, and older groups, respectively (P = .698). There was no difference in the number of reoperations at a mean follow-up of 9.2 ± 2.2 years (P = .778), and no patients underwent reoperation for recurrent hallux valgus. The risk of recurrence was 5 times higher in older patients compared with younger patients (OR, 5.15; 95% CI, 1.10-24.03; P = .037).

CONCLUSION

Age did not influence the perioperative, functional, or subjective outcomes following hallux valgus surgery. However, older patients should be counseled on the higher risk of recurrence following surgical correction.

LEVEL OF EVIDENCE

Therapeutic, level III, retrospective comparative series.