Effect of joint pathology, surface preparation and fixation methods on union frequency after first metatarsophalangeal joint arthrodesis: A systematic review of the English literature

Korim, M.T.; Mahadevan, Devendra; Ghosh, Arijit; Mangwani, Jitendra

doi:10.1016/j.fas.2016.05.317

Cited by 36 publications

(31 citation statements)

References 34 publications

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“…Various studies have shown the biomechanical superiority of plates to other fixation devices such as Steinmann pins and variable pitch screws, though there is no significant difference in union rates between fixation with the different varieties of plates and screws [11,17,28,31]. After the success of plating techniques at large in the field of orthopaedics, locking plates were developed and began to rapidly increase in popularity in the early-to-mid 2000s due to their advantages of built-in compression, establishing rigidity, and minimizing screw loosening as well as causing less disruption of the underlying cortical bone (Figure 4).…”

Section: Platesmentioning

confidence: 99%

“…As a result of successful outcomes, first MTP arthrodesis has become a standard procedure in the treatment of disorders of the forefoot and first ray [11][12][13][14][15][16]. Various recent studies have reported fusion rates ranging from 88% to 100% with low revision rates and patient satisfaction scores ranging from 73% to 100% [1,17]. Over time, there has been an evolution in the types of implants used in first MTP arthrodesis as the procedure's use and popularity have increased, from simple screw fixation to more recently developed plates with continuous compression.…”

Section: Introductionmentioning

confidence: 99%

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First Metatarsophalangeal Joint Arthrodesis: A Narrative Review of Fixation Constructs and Their Evolution

LaCoste¹,

Andrews²,

Ray³

et al. 2021

Cureus

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First metatarsophalangeal (MTP) joint arthrodesis is a surgical procedure in which the first metatarsal head is fused to the proximal phalanx of the great toe in order to permanently stiffen the first MTP joint. It was originally proposed as a treatment for severe cases of hallux valgus deformity, but the procedure's indications and utilization have expanded since its initial development. Despite a wide variety of indications, first MTP arthrodesis has been shown to have reliable, satisfactory outcomes. As a result, the development of a wide array of surgical approaches, joint preparation techniques, and fixation devices used in the procedure has occurred. In this narrative review, we highlight the evolution of fixation constructs used in first MTP arthrodesis in order to provide a frame of reference for the various types of fixation constructs available.

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Section: Platesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

First Metatarsophalangeal Joint Arthrodesis: A Narrative Review of Fixation Constructs and Their Evolution

LaCoste¹,

Andrews²,

Ray³

et al. 2021

Cureus

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“…Roukis [ 15 ] performed a systematic review of 2818 FMPJ arthrodesis procedures finding an overall union rate of 94.6% and complication incidence of 6.1% for malunion and 8.5% for metalwork removal. Korim et al [ 17 ] also conducted a systematic review of 2059 FMPJ arthrodesis procedures obtaining an overall union rate of 93.5% and a 7.5% complication rate, consisting of only metalwork removal. Both systematic reviews focused only on union rate and complications, disregarding patients’ functional outcomes.…”

Section: Introductionmentioning

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 union frequency was 93.5 % (1923/2059). The union frequencies were significantly higher when low velocity joint preparation methods were used (p < 0.0001) and the pathology was HR (p = 0.002) [27].…”

Section: Discussionmentioning

confidence: 97%

Long-term functional results of first metatarsophalangeal joint arthrodesis for hallux rigidus

Ilchenko¹,

Korolev²,

Карданов³

2020

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Introduction First metatarsophalangeal joint (MTPJ) osteoarthritis hallux rigidus (HR) is the most common arthritic condition in the foot and occurs in 2.5-7.8 % of the population over 50 years. First MTPJ arthrodesis is currently considered to be the gold standard for the treatment of end-stage HR. When treating the advanced stage of HR, arthrodesis has long been established as an effective surgical procedure providing very predictable and satisfying results. Although the surgical authors prefer joint-sparing procedures first MTPJ fusion when required is the joint destructive procedure of choice in severe HR to eliminate or minimize pain, stabilize the first MTPJ and allow the hallux to bear weight. Functional outcomes achieved with fusion are also consistent with those from other surgical procedures. The purpose of this study is to evaluate long-term functional outcomes of first MTPJ arthrodesis. Material and methods Clinical and functional outcomes of MTPJ arthrodesis performed for 19 patients (25 feet) with grade 3 or 4 HR using the Coughlin and Shurnas Classification System between September 2010 and December 2017 were reviewed. The patients' mean age was 60 years (range, 35 to 86 years). The median interval between surgery and the last follow-up was 5 years (interquartile range, 1.5 to 8 years). Ultimately, outcome assessment relied on patient satisfaction, radiographic examination, visual analogue scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) and the Foot and Ankle Ability Measure (FAAM) scores. Results AOFAS score was rated as good in 92 % of the cases (23/25), as fair in 8 % (2/25) with neither excellent nor poor results recorded. The median AOFAS score increased from preoperative 43.0 to postoperative 85.0 that was statistically significant (p < 0.05). Postoperative median FAAM Activities of Daily Living (ADL) was 99 %, median subjective ADL was 90 %, median FAAM sport was 84 %, and median subjective sport was 80 %. Patient subjective assessment was scored as "excellent" in 36 % of cases (9/25), "good" in 56 % (14/25), "fair" in 8 % (2/25) with no "poor" results recorded. The median VAS pain score decreased from 6 at baseline to 1 point postsurgery (p < 0.05). Conclusion First MTPJ arthrodesis was shown to be a very effective, reliable and lasting primary procedure for severe HR that provided 92% of good outcomes in our series. The procedure can be advocated as a predictable and excellent option for Coughlin and Shurnas grades 3 and 4 HR facilitating high success rates in pain relief and restoration of function.

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Effect of joint pathology, surface preparation and fixation methods on union frequency after first metatarsophalangeal joint arthrodesis: A systematic review of the English literature

Cited by 36 publications

References 34 publications

First Metatarsophalangeal Joint Arthrodesis: A Narrative Review of Fixation Constructs and Their Evolution

First Metatarsophalangeal Joint Arthrodesis: A Narrative Review of Fixation Constructs and Their Evolution

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

Long-term functional results of first metatarsophalangeal joint arthrodesis for hallux rigidus

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