First Metatarsophalangeal Arthrodesis Malunion Revision to Silicone Implant Arthroplasty

Abstract

A shortened first metatarsophalangeal joint (MTPJ) fusion can be a debilitating complication of arthrodesis surgery. The most commonly accepted treatment is revision of the first MTPJ revisional arthrodesis with lengthening utilizing bone graft. To our knowledge, there is no published literature on first MTPJ short malunion correction using monorail distraction and arthroplasty with a silastic implant. A case is presented of a young active 32-year-old individual who presented to our office following a first MPJ arthrodesis and first tarsometatarsal joint (TMTJ) arthrodesis with severe shortening of the metatarsal. The patient underwent a two-stage procedure consisting of a fusion take down with external monorail distraction fixator, followed by first MTPJ arthroplasty with a silastic implant.

Conversion of First Metatarsal-Phalangeal Joint Arthrodesis to Arthroplasty: A Case Report

“…There are several case reports highlighting conversion of 1MTPJ arthrodesis to arthroplasty in the case of nonunion, malunion, or ulceration ( Table 1 ) [ 14 - 16 ]. Lee et al, describe a case of arthrodesis takedown and conversion to interpositional arthroplasty due to chronic pressure ulceration presumed from hardware prominence and comorbidities 4 years following initial arthrodesis [ 14 ].…”

“…6-months following the procedure, the patient reported good satisfaction, resolution of the “cock-up” deformity, hallux lengthening, and improvement in range of motion [ 15 ]. Carroll and Sharpe describes a case of 1MTPJ arthrodesis malunion treated with a 2-stage procedure, silicone implant arthroplasty in a 32-year-old male [ 16 ]. 15-months following his procedure, he reported improvement of his pain, better gait pattern, satisfaction of his procedure, and returning to light military duties [ 16 ].…”

“…Carroll and Sharpe describes a case of 1MTPJ arthrodesis malunion treated with a 2-stage procedure, silicone implant arthroplasty in a 32-year-old male [ 16 ]. 15-months following his procedure, he reported improvement of his pain, better gait pattern, satisfaction of his procedure, and returning to light military duties [ 16 ]. While all the cases discussed above had successful short-term outcomes, none of the cases highlight outcomes >16 months following arthroplasty as a revision or salvage procedure.…”