Foot & Ankle International - September 2020 - 1094

1094	

Foot & Ankle International 41(9)

Table 1.  Patient Demographics, Prior Procedures, Surgical Procedures Performed, and Postoperative Events.
Patient

Sex

Diagnosis

Previous procedures
2nd MT debridement, closing
wedge osteotomy (11
months prior)

Concurrent procedures

1

F

Freiberg

2

F

3

F

2nd MTP arthritis,
2nd hammertoe
2nd MTP arthritis

2nd MT cheilectomy
2nd MT PVA implant
Longus-to-brevis tendon transfer
2nd MT PVA implant
2nd PIP arthroplasty
2nd MT PVA implant

4
5

F
F

6

F

7
8

F
F

Freiberg
Hallux valgus, 2nd 1st MT osteotomy, Akin,
MTP arthritis,
2nd Morton's neuroma
lesser toe
resection, 2nd/3rd hammer
contractures
toe correction (1 year prior)
2nd MT OCL
Subchondral drilling, 2nd MT
Weil osteotomy (2 years
prior)
Freiberg
Hallux rigidus,
Freiberg

2nd MT PVA implant
HWR
2nd MT PVA implant
3rd MT PVA implant
2nd, 3rd, 5th MTP release
HWR
2nd MTP release
2nd MT PVA implant
2nd MT PVA implant
1st MT PVA implant
2nd MT PVA implant

9

F

2nd MTP arthritis

10

F

2nd MTP arthritis

11

F

2nd MT OCL

HWR
Lapidus
2nd MT PVA implant
HWR
2nd PIP arthroplasty
2nd MT PVA implant
2nd MT PVA implant

12

F

Freiberg

2nd MT PVA implant

13

F

3rd MTP arthritis

Hallux valgus diaphyseal
osteotomy, 2nd MT Weil
osteotomy (1 year prior)
2nd MT Weil osteotomy (2
years prior)

3rd MT shortening, rotational
osteotomy (3.5 years prior)

HWR
3rd MT PVA implant

Postoperative events
 
 
Persistent pain requiring
ultrasound-guided injection
(7 months postoperatively)
Persistent pain
 

Periprosthetic fracture
(4 months postoperatively),
revision recommended
 
Postoperative imaging
(2 years postoperatively)
shows recurrent AVN
but patient remains
asymptomatic
 
Persistent pain
Revision with implant
removal and bone grafting
of 2nd MT head (1 year
postoperatively)
Persistent pain requiring
ultrasound-guided injection
(7 months postoperatively)
 

Abbreviations: AVN, avascular necrosis; HWR, hardware removal; MT, metatarsal; MTP, metatarsophalangeal joint; OCL, osteochondral lesion;
PIP, proximal interphalangeal; PVA, polyvinyl alcohol.

Results
Clinical Outcomes
Indications for PVA implantation and past surgical history
varied across patients in the cohort (Table 1). Of the 5 patients
who presented with Freiberg's infraction, PVA implantation
was indicated in 1 patient after failed operative management
with second MT debridement and closing wedge osteotomy
performed 11 months prior, and in 4 patients after failed conservative management. Of the 6 patients who presented with
advanced arthritis, 4 patients had previous procedures of the
second and/or third MT, including second MT Weil osteotomy, second and third hammertoe corrections, and second
MT shortening with rotational osteotomy. Of the 2 patients

who presented with an OCL of the second MT, 1 patient had
previous subchondral drilling with Weil osteotomy.
Five patients experienced a postoperative complication.
One patient developed recurrent AVN following PVA
implantation for Freiberg's disease but remained asymptomatic. One patient developed a symptomatic periprosthetic fracture and was indicated for a future revision. One
patient developed persistent postoperative pain that required
a revision surgery with implant removal and bone grafting
of the second MT head. Two patients developed persistent
pain requiring ultrasound-guided cortisone injections to the
second MT. Two additional patients reported persistent pain
at a minimum of 6 months postoperatively but were not
indicated for additional treatment.
Foot & Ankle International - September 2020

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