High complication rates following revision first metatarsophalangeal joint arthrodesis: a retrospective analysis of 79 cases

Prat, Dan; Haghverdian, Brandon A.; Pridgen, Eric M.; Lee, Wonyong; Wapner, Keith L.; Wen, Chuangyu; Farber, Daniel C.

doi:10.1007/s00402-022-04342-3

Cited by 10 publications

(8 citation statements)

References 62 publications

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“…The union rate obtained (100%) is similar to other studies, 18 , 21 , 25 but lower fusion rates are reported too, for the arthrodesis of the first MTPJ (81%-99% 4 , 8 , 14 , 15 , 22 , 28 , 31 ). Tobacco use increased the time to union by 10 days in our study, but because there were only 4 smokers in the patient cohort, it did not reach statistical significance.…”

Section: Discussionsupporting

confidence: 88%

“…This is in agreement with the literature. 28 Pain during physical activity can be significantly reduced by arthrodesis of the first MTPJ. 4 , 14 , 23 …”

Section: Discussionmentioning

confidence: 99%

“…This is in agreement with the literature. 28 Pain during physical activity can be significantly reduced by arthrodesis of the first MTPJ. 4,14,23 The AOFAS hallux score 19 showed significantly higher values postoperatively throughout the follow-up, accompanied by satisfying clinical results.…”

Section: Discussionmentioning

confidence: 99%

“… 4 , 14 , 37 However, Massimi et al 22 reported union rates as low as 53%. Prat et al 28 reported a correlation between nonunion after first MTPJ arthrodesis and diabetes mellitus.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Radiologic Outcome of First Metatarsophalangeal Joint Arthrodesis Using a Human Allogeneic Cortical Bone Screw

Hanslik-Schnabel¹,

Flöry²,

Borchert

et al. 2022

Foot & Ankle Orthopaedics

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Background: Different fixation techniques are established for first metatarsophalangeal joint (MTPJ) arthrodesis, including compression screws, plates, Kirschner wires, metal- and bioabsorbable screws as well as staples. The purpose of this study was to investigate and present first clinical and radiologic results using a novel human, allogeneic cortical bone screw for arthrodesis of the first MTPJ. Methods: Arthrodesis of the first MTPJ was performed in 31 patients with hallux rigidus. Percentage union and time to union were the first outcomes; visual analog scale for pain, hallux valgus angle (HVA), intermetatarsal angle, and American Orthopaedic Foot & Ankle Society (AOFAS) hallux score were secondary outcomes. Results: Median time to union was 89 days, and union was observed in all patients. There were 4 complications (2 osteolysis margin, 1 cystic brightening, and 1 severe swelling at the first follow-up) all of that resolved at last follow-up. Pain significantly decreased from visual analog scale 8.0 to 0.2 points ( P < .0001). The HVA decreased from 30.4 to 10.2 degrees in the patient group with deformities. The total AOFAS score increased significantly from 48 to 87 ( P < .0001). Conclusion: Primary and revision arthrodesis of hallux rigidus with the human, allogeneic cortical bone screw reveals satisfying results similar to clinical and radiologic outcomes of other surgical techniques. Within 1 year, the human, allogeneic cortical bone screw is fully remodeled to host bone. Level of Evidence: Level IV, retrospective case series without control group.

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Section: Discussionsupporting

confidence: 88%

“…This is in agreement with the literature. 28 Pain during physical activity can be significantly reduced by arthrodesis of the first MTPJ. 4 , 14 , 23 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“… 4 , 14 , 37 However, Massimi et al 22 reported union rates as low as 53%. Prat et al 28 reported a correlation between nonunion after first MTPJ arthrodesis and diabetes mellitus.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Radiologic Outcome of First Metatarsophalangeal Joint Arthrodesis Using a Human Allogeneic Cortical Bone Screw

Hanslik-Schnabel¹,

Flöry²,

Borchert

et al. 2022

Foot & Ankle Orthopaedics

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“…Patients with rheumatoid arthritis may have the dangerous liaison with osteoporosis, causing a reduction in bone mineral density (BMD) and bone remodelling [43]. Regarding smoking, Prat et al [44] showed that tobacco use is associated with significantly higher complication rates following FMPJ arthrodesis due to nicotine increasing blood viscosity, activating vasoconstriction and reducing blood flow impeding optimal healing to occur Therefore, it is paramount to explain to patients that smoking cessation can lead to better postoperative outcomes. Nevertheless, plating techniques have been shown to provide superior stability to other techniques even in cases with poor bone stock [18,46], allowing early full weightbearing and making them the current technique of choice in FMPJ arthrodesis for many surgeons [40,47].…”

Section: Discussionmentioning

confidence: 99%

First metatarsophalangeal joint arthrodesis/fusion: a systematic review of modern fixation techniques

Kang

Bridgen

2022

Journal of Foot and Ankle Research

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Background First metatarsophalangeal joint arthrodesis is commonly performed for symptomatic end-stage hallux rigidus. It has been postulated to produce good results in the literature. Various fixation techniques offer differences in union rates, complications and functional outcomes, stirring debates about which produces the best outcomes for patients. Therefore, this review aims to synthesise and compare the outcomes of modern fixation techniques used for first metatarsophalangeal joint (FMPJ) arthrodesis. Methods The electronic database searched were PubMed, CINAHL, Cochrane Library, and Google Scholar. The critical appraisal skills programme tool for cohort study was used. The interventions consisted of screw(s), plate(s), and staple(s). Studies comprising outdated fixation techniques such as suture, metallic wire, external fixation, Rush rods or Steinmann pins were excluded. Participants were adults over 18 years, undergoing FMPJ arthrodesis in the UK. Studies with the population consisting primarily of revision cases, patients with rheumatoid arthritis or diabetes were excluded. Results Seven UK studies included 277 feet and a 95.7% overall union rate at a mean union time of 83.5 days. Staples had the highest union rate of 98.2% at mean union time of 84 days, followed by plates (95.2%, 92 days), and finally screws (94.9%, 71 days). The overall complication incidence is 5.8%. All of the fixation techniques produced good functional outcomes postoperatively. Conclusions Whilst staple techniques showed the highest union rate, plating techniques are preferable over screws or staples for better results across several outcome measures, including reduced complication incidence, stability, early ambulation, and good functional outcome. The Manchester-Oxford Foot Questionnaire and EuroQol-5Dimensional are recommended as measurement tools to assess functional outcomes following FMPJ arthrodesis.

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The First Metatarsophalangeal Joint

Sebag

Clements

Togher

et al. 2023

Clinics in Podiatric Medicine and Surgery

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High complication rates following revision first metatarsophalangeal joint arthrodesis: a retrospective analysis of 79 cases

Cited by 10 publications

References 62 publications

Clinical and Radiologic Outcome of First Metatarsophalangeal Joint Arthrodesis Using a Human Allogeneic Cortical Bone Screw

Clinical and Radiologic Outcome of First Metatarsophalangeal Joint Arthrodesis Using a Human Allogeneic Cortical Bone Screw

First metatarsophalangeal joint arthrodesis/fusion: a systematic review of modern fixation techniques

The First Metatarsophalangeal Joint

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