First Metatarsal-Phalangeal Joint Arthrodesis

Roukis, Thomas S.

doi:10.1016/j.cpm.2017.02.002

Cited by 10 publications

(2 citation statements)

References 46 publications

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“…There is a rich body of literature that has consistently reported favorable surgical outcomes following arthrodesis procedures that have been durable and reliable over time with low complication rates [ 1 , 2 ]. Consequently, arthrodesis became the gold standard for a myriad of first metatarsal-phalangeal joint (1MTPJ) pathology and with recommendations informed by high-level evidence [ 3 - 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Surgical decision-making requires careful navigation of diagnostic and therapeutic challenges while considering the degree of uncertainty imposed by evidence limitations [ 4 , 6 ]. There is a dearth of literature investigating complications following a primary arthrodesis procedure [ 2 , 7 ] and fewer describe an approach to management ( Table 1 ) [ 2 , 8 - 11 ]. The most common complications are malunion/non-union and hardware-related complications [ 8 , 12 ] and limited in scope to factors implicated in the technical failure of surgery.…”

Section: Introductionmentioning

confidence: 99%

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Conversion of First Metatarsal-Phalangeal Joint Arthrodesis to Arthroplasty: A Case Report

Walsh,

Moyer,

McDermott

et al. 2023

jocr

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Introduction: Arthrodesis remains the gold standard for most first metatarsal-phalangeal joint (1MTPJ) pathologic conditions due to its high patient satisfaction, low complication rates, and consistent data. 1MTPJ arthroplasty remains a pursued procedure given the advantages described above, but the literature remains complicated and controversial as a primary surgical treatment. To the authors’ knowledge, there is no prior report describing utilization of arthroplasty as an approach to managing clinical failure of a successful fusion in the setting of a technically successful procedure without a post-operative complication. Case Report: We present a case report of a 70-year-old female patient who underwent a successful 1MTPJ arthrodesis for hallux valgus and hallux rigidus and extensive tarsometatarsal arthrodesis for midfoot arthritis. Although the patient had radiographic evidence of successful fusion and had no surgical complications, she presented with dissatisfaction and pain due to functional limitations imposed by the procedure sequelae. The patient was diagnosed with right foot hallux interphalangeus with painful retained hardware. Conservative management failed to improve dissatisfaction or symptoms, and the patient opted for surgical takedown of her fusion with conversion to metatarsal-phalangeal joint arthroplasty, removal of hardware, and second toe proximal phalanx exostectomy. A stepwise surgical technique is described for the procedure, which was successful in addressing the patient’s perceived clinical failure. Conclusion: Our case report describes a rare example of a patient who did not tolerate successful arthrodesis of the 1MTPJ, which was successfully revised to recreate the joint using a decellularized dermal allograft. The procedure resulted in fantastic patient satisfaction and long-term outcomes. This case report highlights a potential salvage option for patients who do not tolerate a 1MTPJ arthrodesis. Keywords: Case report, first metatarsal-phalangeal joint fusion, revision arthroplasty, interpositional arthroplasty, hallux interphalangeus.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Conversion of First Metatarsal-Phalangeal Joint Arthrodesis to Arthroplasty: A Case Report

Walsh,

Moyer,

McDermott

et al. 2023

jocr

View full text Add to dashboard Cite

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Rigid iatrogenic hallux varus: a decades’ worth experience with arthrodesis of the metatarsophalangeal joint

Belfiore,

Vaggi,

Vitali

et al. 2024

International Orthopaedics (SICOT)

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Purpose Arthrodesis of the first ray metatarsophalangeal joint (MPJ) is the gold standard in iatrogenic hallux varus (IHV) in the presence of stiffness and osteoarthritis. The purpose of this study is to collect clinical and radiographic results and complications of MPJ arthrodesis in rigid iatrogenic HV. Methods A retrospective evaluation of rigid iatrogenic HV undergoing arthrodesis with a minimum follow-up (FU) of two years was performed. The clinical parameters assessed were visual analog scale (VAS), the AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale score and the satisfaction scale. The radiological parameters evaluated the first to second metatarsal angle (IMA) and the angle of hallux valgus (HVA). Complications were also analysed. Result A total of 18 patients (19 procedures) with a mean FU of 5.5 ± 2.5 years were included. The mean VAS improved from 7.3 ± 1.6 to 1.3 ± 1.2 (p < 0.05) at the last FU. Similarly, the AOFAS Hallux Metatarsophalangeal-Interphalangeal scale score significantly improved to 82 ± 9.2 (p < 0.05). Radiological evaluation demonstrated a 1–2 IMA improvement from 4.4 ± 2.2° preoperatively to 8.9 ± 2.4° at 3 months post-operatively. Similarly, there was a significant (p < 0.05) improvement of the HVA from − 22.7 ± 4.1° to 13.1 ± 4.1° at three months post-operative (p < 0.05). No signification loss of correction was noted at the last follow-up (p > 0.05). In one case, a delayed fusion at the arthrodesis site required surgical revision to promote fusion. No patient experienced pain with stress from the first MTP joint arthrodesis site or identified the arthrodesis site as a source of pain. No patient required implant removal. Re-operation and revision rates were 5.3%. The overall complications rate was 15.8%. Conclusions MPJ fusion effectively corrects Iatrogenic Hallux Varus in cases of rigid and fixed deformities in the medium- to long-term follow-up, with lasting improvements in AOFAS and VAS scores. The procedure is characterised by a non-negligible risk of complications, reoperations and revisions. Level of evidence Level IV, case series.

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