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Comparison of 4 different techniques in first metatarsophalangeal joint arthrodesis

  • Farshid Maleki
  • Ashwanth Ramesh
  • Adrian J. Cassar-GheitiEmail author
  • Ciara Fox
  • Paula Kelly
  • Michael M. Stephens
  • Johnny V. McKenna
Original Article
  • 21 Downloads

Abstract

Aims

The aim of this study was to evaluate outcomes and fusion rates of 4 different methods of first metatarsophalangeal joint (MTPJ) arthrodesis.

Methods

We performed a retrospective analysis of first MTPJ fusion using Bold® and Acutrak® compression screws, universal 1/3 tubular plate and Hallu®-S non-locking plate in 6 hospitals in Dublin over 4 years. A cohort of 300 patients (351 feet) was operated on by 3 feet and ankle fellowship trained orthopaedic surgeons (PK, MMS, JVMcK) over 4 years. Mean age was 62.4 years. There were 261 females and 39 males. One hundred three patients had a fusion of first MTPJ using two Acutrak® screws and 90 with two Bold® screws. Sixty-five were fused with the Hallu-S® plate and 42 with the universal 1/3 tubular plate. Patients were evaluated clinically and radiographically at 6 weeks, 3 months and 12 months.

Results

Functional outcome scores performed using Manchester-Oxford Foot Questionnaire (MOXFQ). Failure rate in those fused with the Hallu®-S plate was 0%, Acutrak® screws 2.4%, Bold® screws 9.5% and universal 1/3 tubular plate 12.5% (p > 0.12). All treatment groups demonstrated significantly reduced MOXFQ scores (p value < 0.05).

Conclusion

In this retrospective study for first MTPJ fusion, a low profile, pre-contoured plate in combination with a screw mode had the best results with no failure rates and improved MOXFQ scores.

Level of clinical evidence: IV, retrospective study.

Keywords

Fusion Metatarsophalangeal joint Osteoarthritis 

Notes

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This is a retrospective study formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Hueter C (1877) Klinik der Gelenkkrankheiten mit Einschlus der Orthopa .die. Vol 2. Verlag Von F. C. W. Vogel, Leipzig, p 10–1Google Scholar
  2. 2.
    Mann RA, Coughlin MJ (1981) Hallux valgus—etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res 157:31–41Google Scholar
  3. 3.
    Broca P (1852) Deformities of the anterior foot caused by various types of shoes. Bull Soc Anat 27:60–67Google Scholar
  4. 4.
    Clutton HH (1894) The treatment of hallux valgus. St Thomas Hosp Rep 22:1–12Google Scholar
  5. 5.
    McKeever DC (1952) Arthrodesis of the first metatarsophalangeal joint for hallux valgus, hallux rigidus, and metatarsus primus varus. J Bone Joint Surg Am 34-A(1):129–134CrossRefGoogle Scholar
  6. 6.
    Shereff MJ, Baumhauer JF (1998) Hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint. J Bone Joint Surg Am 80(6):898–908CrossRefGoogle Scholar
  7. 7.
    Kim PJ, Hatch D, Didomenico LA, Lee MS, Kaczander B, Count G et al (2012) A multicenter retrospective review of outcomes for arthrodesis, hemi-metallic joint implant, and resectional arthroplasty in the surgical treatment of end-stage hallux rigidus. J Foot Ankle Surg 51(1):50–56CrossRefGoogle Scholar
  8. 8.
    Coughlin MJ, Shurnas PS (2003) Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int 24(10):731–743CrossRefGoogle Scholar
  9. 9.
    Smith RW, Joanis TL, Maxwell PD (1992) Great toe metatarsophalangeal joint arthrodesis: a user-friendly technique. Foot Ankle 13(7):367–377CrossRefGoogle Scholar
  10. 10.
    Politi J, John H, Njus G, Bennett GL, Kay DB (2003) First metatarsal-phalangeal joint arthrodesis: a biomechanical assessment of stability. Foot Ankle Int 24(4):332–337CrossRefGoogle Scholar
  11. 11.
    Besse JL, Chouteau J, Laptoiu D (2010) Arthrodesis of the first metatarsophalangeal joint with ball and cup reamers and osteosynthesis with pure titanium staples radiological evaluation of a continuous series of 54 cases. Foot Ankle Surg 16(1):32–37CrossRefGoogle Scholar
  12. 12.
    Shah K, Augustine A, Carter R, McFadyen A (2012) Arthrodesis of the first metatarsophalangeal joint: comparison of three techniques. J Am Podiatr Med Assoc 102(1):13–17CrossRefGoogle Scholar
  13. 13.
    Foote KM, Teasdall RD, Tanaka ML, Scott AT (2012) First metatarsophalangeal arthrodesis: a biomechanical comparison of three fixation constructs. J Surg Orthop Adv 21(4):223–231CrossRefGoogle Scholar
  14. 14.
    Aslam WJR (2005) First metatarsophalangeal joint arthrodesis using a vitallium plate with a mean two year follow up. Foot Ankle Surg 11(4):197–201CrossRefGoogle Scholar
  15. 15.
    Ellington JK, Jones CP, Cohen BE, Davis WH, Nickisch F, Anderson RB (2010) Review of 107 hallux MTP joint arthrodesis using dome-shaped reamers and a stainless-steel dorsal plate. Foot Ankle Int 31(5):385–390CrossRefGoogle Scholar
  16. 16.
    Hyer CF, Scott RT, Swiatek M (2012) A retrospective comparison of four plate constructs for first metatarsophalangeal joint fusion: static plate, static plate with lag screw, locked plate, and locked plate with lag screw. J Foot Ankle Surg 51(3):285–287CrossRefGoogle Scholar
  17. 17.
    Hunt KJ, Barr CR, Lindsey DP, Chou LB (2012) Locked versus nonlocked plate fixation for first metatarsophalangeal arthrodesis: a biomechanical investigation. Foot Ankle Int 33(11):984–990CrossRefGoogle Scholar
  18. 18.
    Goucher NR, Coughlin MJ (2006) Hallux metatarsophalangeal joint arthrodesis using dome-shaped reamers and dorsal plate fixation: a prospective study. Foot Ankle Int 27(11):869–876CrossRefGoogle Scholar
  19. 19.
    Flavin R, Stephens MM (2004) Arthrodesis of the first metatarsophalangeal joint using a dorsal titanium contoured plate. Foot Ankle Int 25(11):783–787CrossRefGoogle Scholar
  20. 20.
    Kumar S, Pradhan R, Rosenfeld PF (2010) First metatarsophalangeal arthrodesis using a dorsal plate and a compression screw. Foot Ankle Int 31(9):797–801CrossRefGoogle Scholar
  21. 21.
    Hyer CF, Scott RT, Swiatek M (2012) A retrospective comparison of first metatarsophalangeal joint arthrodesis using a locked plate and compression screw technique. Foot Ankle Spec 5(5):289–292CrossRefGoogle Scholar
  22. 22.
    Curtis MJ, Myerson M, Jinnah RH, Cox QG, Alexander I (1993) Arthrodesis of the first metatarsophalangeal joint: a biomechanical study of internal fixation techniques. Foot Ankle 14(7):395–399CrossRefGoogle Scholar
  23. 23.
    Faraj AA, Naraen A, Twigg P (2007) A comparative study of wire fixation and screw fixation in arthrodesis for the correction of hallux rigidus using an in vitro biomechanical model. Foot Ankle Int 28(1):89–91CrossRefGoogle Scholar
  24. 24.
    Dening J, van Erve RH (2012) Arthrodesis of the first metatarsophalangeal joint: a retrospective analysis of plate versus screw fixation. J Foot Ankle Surg 51(2):172–175CrossRefGoogle Scholar
  25. 25.
    Mohammed R, Gadgil A (2012) Molded arthrodesis of the hallux metatarsophalangeal joint using the crossed-screw technique: surgical technique, results and functional outcomes. Foot Ankle Surg 18(2):132–135CrossRefGoogle Scholar
  26. 26.
    Watson AD, Kelikian AS. Cost effectiveness comparison of three methods of internal fixation for arthrodesis of the first metatarso- phalangeal joint. Foot Ankle Int 1988;19(5):304–10.CrossRefGoogle Scholar
  27. 27.
    Morley D, Jenkinson C, Doll H, Lavis G, Sharp R, Cooke P, Dawson J (2013) The Manchester-Oxford foot questionnaire (MOXFQ): development and validation of a summary index score. Bone Joint Res 2(4):66–69CrossRefGoogle Scholar
  28. 28.
    Rochwerger A, Curvale G, Sbihi A, Pinelli P-O, Groulier P (2001) Non-fusion des arthrodeses metatarso-phalangiennes du gros orteil: influence du type d'avivement. Rev Chir Orthop Reparatrice Appar Mot 87(6, Supp):34Google Scholar
  29. 29.
    Blitz NM, Lee T, Williams K, Barkan H, DiDimenico LA (2010) Early weight bearing after modified lapidus arthodesis: a multicenter review of 80 cases. J Foot Ankle Surg 49(4):357–362CrossRefGoogle Scholar
  30. 30.
    Storts EC, Camasta CA (2016) Immediate weightbearing of first metatarsophalangeal joint fusion comparing buried crossed Kirschner wires versus crossing screws: does incorporating the sesamoids into the fusion contribute to higher incidence of bony union. J Foot Ankle Surg 55(3):562–566CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  1. 1.Orthopaedic DepartmentSt. James’s HospitalDublinIreland
  2. 2.Orthopaedic DepartmentTallaght University HospitalDublinIreland
  3. 3.Orthopaedic DepartmentCappagh National Orthopaedic HospitalDublinIreland

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