Does the IOFix implant improve union rates?

Abstract

Background First metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. Methods We have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies. Results Thirty patients were included in the study. The mean age was 60.36 ± 9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2 ± 12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5 ± 10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%. Conclusions This is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices. Level of evidence 4

Intraosseous device for arthrodesis in foot and ankle surgery: Review of the literature and biomechanical properties

“…There have been 9 publications on this topic[ 5 - 13 ] (Table 1 ). Six of these were clinical studies (5 on 1 st MTP joint and 1 on TN joint).…”

“…Segal et al [ 5 ] from Tel Aviv, Israel, conducted a retrospective review on union rates following the use of IOFIX. Standard operative technique was used.…”

“…In the series of studies reviewed, IOFIX appears to be safe and effective in achieving arthrodesis of the first MTPJ and immediate weightbearing can be allowed. Concerns have been raised about the cost of the IOFIX implant[ 5 ]. However, with the reduced requirement for further surgery and excellent union rates, the pros could outweigh the cons.…”

“…There have been a number of publications in literature regarding the use of the Intraosseous devices in different joint arthrodesis[ 5 - 12 ]. The aim of this article is to review these publications, assess the overall efficacy of the device across the various joints that are commonly arthrodesed in foot and ankle surgery and correlate the results with its biomechanical properties.…”