Achieving high union rates after first metatarsophalangeal joint arthrodesis: Radiographic outcomes and technical pitfalls

ARTICLE HIGHLIGHTS

Research background

Fusion of the first metatarsophalangeal joint (MTP1) is a common surgery performed to correct hallux rigidus, hallux rigidus et valgus and other painful degenerative diseases of the MTP1. High patient satisfaction and union rates have been reported in the literature with union rates ranging from 77% to 100%. In our own cohort we were also able to show high fusion rates.

Research motivation

Analyze our own cohort regarding union rate and radiologic outcome.

Research objectives

The main objective of this study as to asses our own patient collective regarding fusion rate and radiologic outcome including degree of correction.

Research methods

Out of the institution’s database every MTP1 arthrodesis that was executed between September 2011 and November 2020 was identified. The consecutive cohort consisted of 9 male patients and 62 female patients with 34 left and 38 right feet. Patients were followed and pre and postoperatively weight bearing radiographs (anterior-posterior, oblique and lateral) were analyzed for fusion rate and various radiologic parameters.

Research results

Of 71 patients showed a fused arthrodesis (98.6%) at the latest follow-up with one patient suffering from malunion. One patient finally fused after 18 months showing a delayed union while being asymptomatic throughout the whole period. The preoperative Hallux-valgus angle was in average 25.2 (range 14-64) with a correction down to 12 in average (range 2-27) while the preoperative intermetatarsal angle was 13.48 (range 4.5-24) with a postoperative correction to 9.2 in average (range 3.5-15). The preoperative MT1-P1 angle was 8.7 (range -28.05 to 55) with postoperative values of in average 16.89 (-4.05 to 34.5) which was already shown.

Research conclusions

We were able to show that with our surgical technique, high union rates (98%) can be achieved using a compression screw and a dorsal variable-angle locking plate to treat degenerative diseases of the MTP1 even in diabetic and smoking patients.

Research perspectives

Future studies should particularly correlate radiological data with clinical scores to confirm their clinical relevance and superiority.