A Multicenter Retrospective Cohort Study of First Metatarsophalangeal Joint Arthrodesis

Kannan, Sudhir; Bennett, Adam; Chong, Han Hong; Hilley, A; Coorsh, Jonathan; Murty, A.; Townshend, David; Kakwani, Rajesh; Bhatia, Maneesh

doi:10.1053/j.jfas.2020.05.015

Cited by 13 publications

(9 citation statements)

References 14 publications

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“…1 . We requested missing patient data by emailing the authors of seven articles but the only data available was from Füssenich et al , 2020 ( 18 , 23 , 24 , 25 , 26 , 27 , 28 ). The other articles were therefore excluded.…”

Section: Resultsmentioning

confidence: 99%

“…In general, studies on first MTPJ arthrodesis do not distinguish clearly between hallux rigidus and moderate-to-severe hallux valgus. This made it difficult to determine the outcomes for this specific group and resulted in the exclusion of seven articles ( 18 , 23 , 24 , 25 , 26 , 27 , 28 ). In addition, not every study identified age, sex, and HVA in the subgroups.…”

Section: Discussionmentioning

confidence: 99%

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Non-union incidence of different joint preparation types, joint fixation techniques, and postoperative weightbearing protocols for arthrodesis of the first metatarsophalangeal joint in moderate-to-severe hallux valgus: a systematic review

et al. 2023

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Purpose A systematic review to determine the effect of different types of joint preparation, joint fixation, and postoperative weight-bearing protocols on non-union frequency in first metatarsophalangeal joint (MTPJ) arthrodesis in patients with moderate-to-severe hallux valgus. Material and methods A systematic literature search (PubMed and EMBASE), adhering to PRISMA guidelines. Data on MTPJ preparation, fixation, weight-bearing, and non-union in patients with moderate-to-severe hallux valgus were collected. Quality assessment was performed using the Coleman Methodology Score. Results Sixteen studies (934 feet) were included, generally of medium quality. Overall non-union rate was 7.7%. At 6.3%, convex/concave joint preparation had the lowest non-union rate vs 12.2% for hand instruments and 22.2% for planar cuts. Non-union of 2.8% was found for joint fixation with a plate combined with a lag screw vs 6.5% for plate fixation, 11.1% for crossed screw fixation, and 12.5% for a plate with a cross plate compression screw. A 5.1% non-union frequency was found following postoperative full weight-bearing on a flat shoe vs 9.3% for full weight-bearing on a heel weight-bearing shoe and 0% for a partial weight-bearing regimen. Conclusion Based on medium-quality papers, joint preparation with convex/concave reamers and joint fixation with a plate using a lag screw show the lowest non-union rate. Full postoperative weight-bearing in a stiff-soled postoperative shoe is safe and not associated with non-union vs a more protective load-bearing regimen. Further research should focus on larger sample sizes, longer follow-ups, and stronger study designs.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Non-union incidence of different joint preparation types, joint fixation techniques, and postoperative weightbearing protocols for arthrodesis of the first metatarsophalangeal joint in moderate-to-severe hallux valgus: a systematic review

et al. 2023

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“…However, earlier weight bearing was allowed in the plate group at 2 weeks versus 5 weeks with screws, which may be an important consideration when discerning between the 2 fixation techniques. Likewise, a multicenter retrospective study performed by Kannan et al 9 showed an overall union rate of 91.4% and no difference in the union between screws and plates. Donegan et al 10 only investigated 3.0 mm crossing screw fixation in 228 feet resulted in 96.2% fusion, with 87% of the patient's reporting little to no pain on long-term follow-up.…”

Section: Historical Perspectivementioning

confidence: 88%

“…In fact, 1 study estimated, based on their internal operational cost analysis, that the equivalent of $46,000 USD could be saved per year by using crossing screws in comparison with plates for fixation. 9 The objective of this technical guide is to propose a reproducible technique to first MPJ fusion with 2 crossing, cannulated screws. This can be helpful, especially, in an academic setting where more novice surgeons are often assisting with surgeries.…”

Section: Historical Perspectivementioning

confidence: 99%

“…Hyer et al12 found that the mean implant cost in crossed screws versus dorsal plating was $374.05 USD versus $603.57 USD, respectively, showing a nearly 40% reduced cost with crossing screws. In fact, 1 study estimated, based on their internal operational cost analysis, that the equivalent of $46,000 USD could be saved per year by using crossing screws in comparison with plates for fixation 9…”

Section: Historical Perspectivementioning

confidence: 99%

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Cross Screw Fixation for First Metatarsophalangeal Joint Arthrodesis: A Technical Guide

Sikora

Blazek

2022

Techniques in Foot &Amp; Ankle Surgery

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Background: First metatarsophalangeal joint (MPJ) arthritis, treatments, and fixation methods have been well described in the literature. Indications for the fusion of the first MPJ include hallux rigidus, severe hallux valgus, failed bunionectomy, failed joint arthroplasty, rheumatoid arthritis, and neuromuscular disorders. Crossing screw fixation has been found to be a stable construct that provides reliable outcomes with high patient satisfaction, specifically for those patients with hallux rigidus and minimal hallux valgus deformity. Crossing screw fixation has also been found to be reliable and more cost-effective than other fixation techniques. However, this method may pose some challenges to novice surgeons and those at academic training institutions. Objective: The objective of this technical guide is to propose a reproducible technique to first MPJ fusion with 2 crossing, cannulated screws. This technique is designed to increase the reliability and speed of the crossing screw technique. Conclusion: Overall, using this technique with cross screw fixation, we have found decreased operative times, better reproducibility of results, efficiency with use in training with resident learners, and reduced hardware costs. Levels of Evidence: Level V, expert opinion

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Orthopedic Hardware

Chong¹,

Bhatia²

2023

Imaging of the Foot and Ankle

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A Multicenter Retrospective Cohort Study of First Metatarsophalangeal Joint Arthrodesis

Cited by 13 publications

References 14 publications

Non-union incidence of different joint preparation types, joint fixation techniques, and postoperative weightbearing protocols for arthrodesis of the first metatarsophalangeal joint in moderate-to-severe hallux valgus: a systematic review

Non-union incidence of different joint preparation types, joint fixation techniques, and postoperative weightbearing protocols for arthrodesis of the first metatarsophalangeal joint in moderate-to-severe hallux valgus: a systematic review

Cross Screw Fixation for First Metatarsophalangeal Joint Arthrodesis: A Technical Guide

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