First Metatarsophalangeal Joint Arthrodesis
First metatarsophalangeal (MTP) joint fusion is performed to address debilitating pain or functional impairment as a result of a variety of pathologic conditions. It is routinely performed after nonoperative interventions fail for later-stage hallux rigid
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First Metatarsophalangeal Joint Arthrodesis Justin Tsai and Steven M. Raikin
Background Arthrodesis of the first metatarsophalangeal (MTP) joint was first described by Clutton in 1894, in which an ivory peg was used for internal fixation [1]. Since then, many different techniques have been described in the literature, with variations in the approach used, method of joint preparation, and fixation construct. Regardless of technique used, arthrodesis is considered the gold standard for addressing pain and deformity at the first MTP joint that has failed conservative management, with most long-term studies reporting high patient satisfaction and low complication rates [2–14]. Alternative procedures to address severe arthritis of the first MTP joint reported in the literature include hemiarthroplasty [15–17] and total arthroplasty [18–20]. Raikin et al. retrospectively compared the results of arthrodesis with hemiarthroplasty, in which the base of the proximal phalanx is resected and replaced with an implant that articulates with the native metatarsal (MT) head [17]. Arthrodesis was found to be superior to hemiarthroplasty in alleviating pain, restoring function, and achieving patient satisfaction. Almost one-quarter of the hemiarthroplasties performed had to be revised at an average of 13 months secondary to failure of the implant. Similarly, results of total arthroplasty have been shown to be less than
J. Tsai Department of Orthopedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA S.M. Raikin (*) Jefferson Medical College, Philadelphia, PA, USA Foot and Ankle Service, Orthopedic Foot and Ankle Fellowship Program, Rothman Institute, Philadelphia, PA, USA e-mail: [email protected] © Springer International Publishing AG 2018 C.P. Chiodo, J.T. Smith (eds.), Foot and Ankle Fusions, https://doi.org/10.1007/978-3-319-43017-1_9
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optimal. Gibson and Thomson performed a randomized controlled trial to compare the outcomes of total arthroplasty with an unconstrained device to arthrodesis [20]. The arthroplasty group experienced higher complication rates, higher cost to the healthcare system, and lower satisfaction with their functional result. Most recently, a small synthetic cartilage implant has been proposed as an alternative to the above procedures, and its efficacy in comparison to arthrodesis was described in a prospective, randomized, multicenter trial [21]. Results were encouraging for the synthetic implant group, with comparable postoperative pain and functional scores and complication rates to the arthrodesis group. Improvements in range of motion in the implant group was found to be maintained at 24 months, but 9% required conversion to arthrodesis within this time period. No long-term results evaluating this synthetic cartilage implant are currently available.
Indications Arthrodesis of the first MTP joint is most commonly performed for hallux rigidus, which is characterized by stiffness and degenerative disease of this j
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