First Metatarsophalangeal Joint Arthrodesis in Hallux Valgus Versus Hallux Rigidus Using Cup and Cone Preparation Compression Screw and Dorsal Plate Fixation

Abstract Background With continued loss of dorsiflexion of the 1st MTP, degenerative changes occur within the joint with severe restriction of movement and increase in pain, which leads to the condition known as hallux rigidus. The amount of dorsiflexion may be reduced to 0-10 degrees with pain on both active and passive motion. Objectives Systematically reviewing available evidence from published articles to assess the effectiveness of arthrodesis of first metatarsophalangeal joint by plate and screws in hallux rigidus. The assessment also would encompass safety, side effects, and complications of this mode of treatment. Materials and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results Previous results for arthrodesis have been favourable with a union rate of almost 96%. In the present systematic review and meta-analysis, the overall effect estimates showed that the union rates after plate and screw arthrodesis for 1st MTPJ was 96.2% (95% CI 94 – 98.4%). In addition, the overall effect estimates showed that the non-union rates after plate and screw arthrodesis for 1st MTPJ was 4.2% (95% CI 2.4 – 6.1%). Moreover, the overall effect estimates showed that the satisfaction rates after plate and screw arthrodesis for 1st MTPJ was 94.5% (95% CI 90 – 99%). In the present study, the overall effect estimates showed that the overall complications rate after plate and screw arthrodesis for 1st MTPJ was 7.2% (95% CI 2.5 – 12%). The overall effect estimates showed that the malunion rates after plate and screw arthrodesis for 1st MTPJ was 2.7% (95% CI 0 – 6.4%). Additionally, the overall effect estimates showed that the hardware removal and superficial infection rates after plate and screw arthrodesis for 1st MTPJ were 2% and 2.9%, respectively. Conclusion Our analysis showed that plate and screws fixation is effective techniques that can be used for first MTPJ arthrodesis in patients with hallux rigidus. We found that the screw and plate fixation has a significantly lower rate of nonunion compared with the screw alone, as reported by the literature. However, owing to the small group sizes and methodologic shortcomings, we were unable to identify the clinically superior fixation technique for first MTPJ arthrodesis arthrodesis.

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First Metatarsophalangeal Joint Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417752674 ◽

2018 ◽

Vol 3 (3) ◽

pp. 247301141775267 ◽

Cited By ~ 1

Author(s):

Paola Filomeno ◽

Julio López

Keyword(s):

Patient Satisfaction ◽

Plate Fixation ◽

Metatarsophalangeal Joint ◽

Functional Improvement ◽

Dorsal Plate ◽

Level Of Evidence ◽

First Metatarsophalangeal Joint ◽

Joint Fusion ◽

Vas Scores ◽

Satisfaction Rates

Background: First metatarsophalangeal (MTP) joint arthrodesis can be fixed using either a dorsal plate or crossed screws. However, there is considerable difference in the cost of these implants, and it is not known if there is sufficient difference in outcome that might justify this cost difference. Our aim was to compare the functional results and patient satisfaction rates after first MTP joint arthrodesis in a group of patients using the same surgical technique except for the fixation devices. Methods: A prospective cohort of 27 patients who underwent first MTP joint fusion by the same surgeon using 2 crossed screws or a single screw with a dorsal plate was recruited over a 3-year period. Demographic information, patient satisfaction rates, complications, and union rates were evaluated. American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scoring systems were used pre- and postoperatively to compare the functional outcomes. Thirty consecutive procedures (screws, n = 15; plate, n = 15) were performed. Age (55.8 ± 11.1 vs 63.3 ± 12.4 years for screws and plate respectively; P = .091) and female gender percentages (80% and 73%, P = .666) were similar between groups. Results: The overall union rate was 93% with no differences between groups. AOFAS and VAS scores improved significantly postoperatively for each technique, and no differences were found between the two in the improvement in AOFAS (42.4 ± 8.0 vs 44.3 ± 8.2, screws and plate respectively; P = .520) and VAS scores (66.0 ± 5.4 vs 69.0 ± 6.9; P = .195). The implant cost for screws was $40 and for dorsal plate, $328. Conclusions: First MTP joint fusion using either screws or plate fixation results in an improvement in AOFAS and VAS scores. Functional improvement and patient satisfaction did not differ between the 2 techniques, despite a considerable difference in cost between the two methods of fixation. Level of Evidence: Level III, prospective comparative study.

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ARTHRODESIS OF THE FIRST METATARSOPHALANGEAL JOINT FOR HALLUX VALGUS, HALLUX RIGIDUS, AND METATARSUS PRIMUS VARUS

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-195234010-00013 ◽

1952 ◽

Vol 34 (1) ◽

pp. 129-134 ◽

Cited By ~ 148

Author(s):

DUNCAN C. MCKEEVER

Keyword(s):

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

First Metatarsophalangeal Joint

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Silastic Ball Spacer Arthroplasty in the Management of Hallux Valgus and Hallux Rigidus

Foot & Ankle ◽

10.1177/107110078901000203 ◽

1989 ◽

Vol 10 (2) ◽

pp. 61-64 ◽

Cited By ~ 17

Author(s):

N. S. Broughton ◽

A. Doran ◽

B. F. Meggitt

Keyword(s):

Hallux Valgus ◽

Young Patients ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

New Bone Formation ◽

Great Toe ◽

First Metatarsophalangeal Joint ◽

Proximal Migration ◽

Original Concept

Sixty-two feet in 39 patients who were treated by insertion of a silastic ball spacer prosthesis into the first metatarsophalangeal joint for hallux valgus or hallux rigidus have been reviewed with a follow-up time of between 2 and 6 years. Twenty-one results (34%) were excellent, 27 (43%) were fair, 13 (21%) were poor, and one was revised. Seventeen feet (27%) had some metatarsalgia at followup. Results were disappointing in the young patients; in 19 cases of hallux valgus under the age of 45, 8 were either poor or had been revised. The original concept of the silastic ball spacer was to maintain great toe length and prevent proximal migration of the sesamoids. However 60% of these feet showed settling of the prosthesis or new bone formation around the prosthesis and 54% had more than 2 mm proximal migration of the sesamoid bones. The symptomatic results in these patients were similar to those in whom great toe length had been successfully maintained. The silastic ball spacer infrequently achieves its aims, however maintenance of hallux length does not seem to be important in the symptomatic result.

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The Influence of Patient Factors on the Outcome of Synthetic Cartilage Implant Hemiarthroplasty versus First Metatarsophalangeal Joint Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000045 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Andrew Goldberg ◽

Mark Glazebrook ◽

Timothy Daniels ◽

Gwyneth de Vries ◽

M. Elizabeth Pedersen ◽

...

Keyword(s):

Hallux Valgus ◽

Clinical Success ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

Success Rates ◽

Preoperative Pain ◽

Duration Of Symptoms ◽

First Metatarsophalangeal Joint ◽

Valgus Angle ◽

The Impact

Category: Midfoot/Forefoot Introduction/Purpose: Many studies have compared the outcomes of MTPJ1 hemiarthroplasty and arthrodesis, but there is a paucity of data on the influence of patient factors on clinical outcomes. A prior prospective, randomized, clinical trial compared the efficacy and safety of first metatarsophalangeal joint (MTPJ1) hemiarthroplasty with a synthetic polyvinyl alcohol hydrogel implant (Cartiva®) and MTPJ1 arthrodesis for moderate to severe hallux rigidus. The current study evaluated the data from this clinical trial to determine the impact of numerous patient variables, including osteoarthritis grade, hallux valgus angle, preoperative range of motion (ROM), gender, body mass index (BMI), preoperative duration of symptoms, and preoperative pain level, on the success or failure of MTPJ1 hemiarthroplasty and arthrodesis. Methods: Patients =18 years diagnosed with hallux rigidus grade 2, 3, or 4 were randomized and treated with synthetic cartilage implant MTPJ1 hemiarthroplasty (n=129) or arthrodesis (n=47). Outcome measures included a pain visual analogue scale (VAS), Foot and Ankle Ability Measure (FAAM) Sports and Activities of Daily Living (ADL) scores, and Short Form-36 Physical Functioning (SF-36 PF) subscore, obtained preoperatively and at 2, 6, 12, 24, 52 and 104 weeks postoperatively. Great toe active dorsiflexion motion, secondary procedures, radiographs and safety parameters were evaluated. A patient’s outcome was deemed successful if composite primary endpoint criteria for clinical success (pain, function and safety) were met at 24 months. Predictor variables included: osteoarthritis grade; hallux valgus angle; preoperative ROM; gender; body mass index (BMI); preoperative symptom duration; prior surgery; and preoperative pain level. Two-sided Fisher’s Exact test was used to assess the impact of these variables on success of surgery (p<0.05). Results: Standard patient demographics and baseline outcome measures were similar for both groups; both procedures demonstrated equivalent pain relief and functional outcomes.1 There was no significant difference (p>0.05) in success rates (i.e., VAS pain reduction ≥ 30%, maintenance/improvement in function, freedom from radiographic complications, and no secondary surgical intervention) between synthetic cartilage implant MTPJ1 hemiarthroplasty and arthrodesis when stratified by osteoarthritis grade, degree of preoperative hallux valgus, extent of preoperative ROM, gender, BMI, duration of symptoms, prior MTPJ1 surgery status, and preoperative pain VAS score (Table 1). Notably, patients with minimal ROM and mild hallux valgus had equivalent success rates for both procedures. Males tended to have greater clinical success with implant hemiarthroplasty versus arthrodesis, but this difference was not statistically significant. 1Baumhauer et al., FAI, 2016;37(5):457-69. Conclusion: Synthetic cartilage implant hemiarthroplasty is an appropriate treatment for patients with hallux rigidus of Coughlin grade 2, 3 or 4. Its results in those with associated mild hallux valgus (<20 degrees) and in those with a high degree of preoperative stiffness are equivalent to MTPJ1 fusion, irrespective of gender, BMI, osteoarthritis grade, or preoperative pain or duration of symptoms, in contrast to what might have been expected.

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Results of Hallux Metatarsophalangeal Joint Arthrodesis with and without Calcaneus Autograft

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00209 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0020

Author(s):

Fred T. Finney ◽

Philip Kaiser ◽

D. Anthony Barcel ◽

W. Hodges Davis ◽

Bruce E. Cohen ◽

...

Keyword(s):

Hallux Valgus ◽

Preoperative Diagnosis ◽

Donor Site ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

Administrative Database ◽

Fixation Method ◽

Dorsal Plate ◽

Foot And Ankle ◽

Local Bone

Category: Bunion; Other Introduction/Purpose: Hallux rigidus is the most common degenerative arthropathy of the foot. Primary hallux metatarsophalangeal (MTP) joint arthrodesis is the most common surgical treatment for end-stage hallux rigidus and can also be utilized for correction of hallux valgus. Though satisfaction rates following hallux MTP joint arthrodesis are very favorable, nonunion rates have been reported as high as 12%. Several studies have investigated how pathology, fixation techniques and joint preparation affect hallux MTP arthrodesis union rates. Many surgeons use orthobiologics and/or autograft to augment arthrodeses about the foot and ankle in an effort to increase union rates. The purpose of this study is to retrospectively compare union rates of hallux MTP joint arthrodesis with and without calcaneus autograft. Methods: A query of our institution’s administrative database was performed to identify patients who underwent a primary hallux MTP joint arthrodesis between February 2016 and February 2017. We compared patients who underwent arthrodesis with and without calcaneus autograft. Surgeon preference dictated use of autograft, as some in our group routinely use graft while others do not. Patients 18 years and older who underwent a primary hallux MTP arthrodesis were included. Patients were excluded if they had radiographic evidence of significant bone loss or if allograft or biologic therapies were used. Patient charts and final radiographs were reviewed. The primary outcome was successful union of the hallux MTP joint arthrodesis. Secondary outcomes included preoperative diagnosis, type of surgical fixation and surgical complications. Data was compared using a student T-test. Results: There were 130 feet included in the final analysis, and 55 underwent hallux MTP arthrodesis with calcaneus autograft. Mean follow-up time was 14.8 weeks. Among all patients, 90.8% had a successful union. There was no difference in union rates between those who underwent arthrodesis with calcaneus autograft (90.9%) compared to without autograft (90.7%; p = 0.96). Hallux valgus was the preoperative diagnosis in 46.1% of cases followed by hallux rigidus (34.6%). The most common fixation method was a lag screw with a dorsal plate (83.8%). Overall, 19 patients (14.6%) had a complication requiring a reoperation with painful hardware (10 patients) being most common. In the autograft group, there were no complications related to the calcaneus autograft donor site. Conclusion: As orthobiologics and local bone autograft gain popularity in foot and ankle surgery, it is important to report clinical outcomes and establish evidence-based guidelines for use. In this relatively large retrospective comparison, the use of calcaneal graft was noted to be safe (no complications from graft site). However, there was no difference in union rate when comparing hallux MTP arthrodesis with and without calcaneus autograft.

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Outcomes of First Metatarsophalangeal Joint Fusion Using a Precontoured Plate

Foot & Ankle Specialist ◽

10.1177/19386400211000594 ◽

2021 ◽

pp. 193864002110005

Author(s):

Michael Riediger ◽

Gerard A. Sheridan ◽

Rehan Gul

Keyword(s):

Hallux Valgus ◽

Short Form ◽

Metatarsophalangeal Joint ◽

Valgus Deformity ◽

Dorsal Plate ◽

Foot And Ankle ◽

First Metatarsophalangeal Joint ◽

Hallux Valgus Deformity ◽

Patient Reported ◽

The Mean

Background: The purpose of this study was to determine the results of an arthrodesis technique of the first metatarsophalangeal joint (MTPJ) using a precontoured dorsal plate to correct the hallux valgus deformity. Methods: This was a retrospective analysis of outcomes for first MTPJ arthrodesis performed using 2 precontoured dorsal plates. Radiographic outcomes (intermetatarsal angle [IMA] and hallux valgus angle [HVA]) and patient-reported functional outcome measures (Short-Form 12 and Foot and Ankle Outcome Score) were recorded and compared. Results: Fifty-five patients underwent 77 first MTPJ arthrodeses for severe hallux valgus deformity with associated degenerative changes at the first MTPJ. The mean reduction of the IMA was 5.67° ( P < .05) and the mean reduction of the HVA was 33° ( P < .05). The Short-Form 12 assessment of global health demonstrated a significant improvement in both the physical and mental health composite scores by 16.4 points and 10.4 points ( P < .05), respectively. The Foot and Ankle Outcome Score demonstrated a cumulative decrease of 35% (59.28; P < .05) in all domains. Conclusions: First MTPJ arthrodesis using a precontoured dorsal plate is a successful procedure with a high union rate, low complication rate, and a high level of patient-reported satisfaction. Levels of Evidence: Level III.

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Kinematics of the First Metatarsophalangeal Joint in Intact and Surgically Altered Cadavers

Foot & Ankle International ◽

10.1177/107110079701800304 ◽

1997 ◽

Vol 18 (3) ◽

pp. 132-137 ◽

Cited By ~ 3

Author(s):

Craig Nevin

Keyword(s):

Hallux Valgus ◽

Soft Tissues ◽

Proximal Phalanx ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

First Metatarsophalangeal Joint ◽

First Metatarsal ◽

Silicone Prosthesis

The kinematics of the first metatarsophalangeal joint were investigated in five embalmed cadaver feet (three normal, one hallux valgus, one hallux rigidus). Sagittal displacements of the first metatarsal relative to the proximal phalanx were measured during first metatarsophalangeal joint dorsiplantarflexion; first in intact cadavers, then with an intact capsule sans extracapsular soft tissues (hallux amputated at the first metatarsal cuneiform joint), and finally with a double-stem silicone prosthesis inserted. In the intact cadaver, the base of the metatarsal is raised by FMTP dorsiflexion in a manner similar to a cam. However, this effect ceased when the extracapsular soft tissues were removed. Silicone arthroplasty did not restore cam function.

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Safety and Efficacy of Medial Plate in First Metatarsophalangeal Joint Arthrodesis

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0014.9256 ◽

2021 ◽

Vol 23 (3) ◽

pp. 205-212

Author(s):

Leszek Kuik ◽

Piotr Łuczkiewicz

Keyword(s):

Soft Tissues ◽

Metatarsophalangeal Joint ◽

Clinical Results ◽

Dorsal Plate ◽

Pain Level ◽

Compression Screw ◽

First Metatarsophalangeal Joint ◽

Safety And Efficacy ◽

The Mean ◽

One Year

Background. Arthrodesis of the first metatarsophalangeal joint (MTP-1) is a recognized and effective procedure in advanced osteoarthritis of this joint. Fixation with a dorsal plate and a compression screw has been described as the most stable. Nevertheless, the frequency of revision procedures after MTP-1 arthrodesis has been reported to exceed 10% in some reports. The need for revision surgery is mostly related to the fixation material used and concern both its destabilization and a conflict between the implants and soft tissues. Therefore, there is still scope for developing new stabilization methods for the MTP-1 joint. Materials and methods. With the approval of the relevant Bioethics Committee, we conducted a pilot clinical trial to assess the safety and efficacy of the use of the medial plate in MTP-1 fusion. Twenty patients qualified for treatment due to osteoarthritis of the metatarsophalangeal joint were evaluated. The clinical results of the surgical treatment were assessed at least one year after the surgery. Results. The mean AOFAS MTP-IP score increased from 35.29±18.76 to 75.59±12.15. The mean EFAS score increased from 9.24±5.73 to 18.35±5.66. Pain level as per a VAS decreased from 6.24±1.48 to 1.59±2.58. A total of 18 patients were satisfied with the procedure, with the remaining 2 patients reporting the result as unsatisfactory. Two revision procedures were performed, both due to migration of the fixation material. Conclusions. 1. The clinical results of MTP-1 arthrodesis with the medial plate are comparable to the results in the literature. 2. It can be concluded that the use of the medial plate in arthrodesis of the MTP-1 joint is safe and effective, and is a valuable alternative to existing methods.

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Effect of Functional Foot Orthoses on First Metatarsophalangeal Joint Dorsiflexion in Stance and Gait

Journal of the American Podiatric Medical Association ◽

10.7547/0960474 ◽

2006 ◽

Vol 96 (6) ◽

pp. 474-481 ◽

Cited By ~ 22

Author(s):

Paul R. Scherer ◽

Jennifer Sanders ◽

Denten E. Eldredge ◽

Susan J. Duffy ◽

Ryan Y. Lee

Keyword(s):

Hallux Valgus ◽

Maximum Degree ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

Foot Orthoses ◽

First Metatarsophalangeal Joint ◽

First Ray ◽

And Gender ◽

Midtarsal Joint ◽

The Relationship

Reduction in first metatarsophalangeal joint maximum degree of dorsiflexion with dorsiflexion of the first ray has been proposed to be the predominant cause of hallux abducto valgus and hallux rigidus. We sought to determine whether orthoses made from a cast with the first ray plantarflexed and a 4-mm medial skive could increase the maximum degree of dorsiflexion in patients with functional hallux limitus in stance and gait. Forty-eight feet of 27 subjects were casted for orthoses with the first ray plantarflexed and in the customary neutral rearfoot position with locked midtarsal joint. First metatarsophalangeal joint maximum dorsiflexion was measured with and without orthoses in stance, and subhallux pressure was measured with and without orthoses at heel-off. Changes in mean maximum dorsiflexion in stance and in mean maximum subhallux pressure in gait with orthoses were significant. We investigated the relationship between this increase in dorsiflexion and gender, shoe size, resting calcaneal stance position, and change in resting calcaneal stance position with the use of orthoses. These correlations were not statistically significant. The biomechanical implication of increasing limited first metatarsophalangeal joint dorsiflexion with orthoses is discussed and related to the clinical treatment of deformities, including hallux valgus and hallux rigidus. The use of orthoses to decrease subhallux pressure is also discussed. (J Am Podiatr Med Assoc 96(6): 474–481, 2006)

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