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

Abstract

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 Studies comprising outdated fixation techniques such as suture, metallic wire, external fixation, Rush rods or Steinmann pins were excluded.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.

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

“…This systematic review found a non-union percentage for moderate-to-severe hallux valgus of 7.7%, based on studies of overall medium quality. The results were higher than the 4.3-6.5% seen in other systematic reviews of first MTPJ arthrodesis due to hallux rigidus or hallux valgus combined (7,17,41). These findings are in line with our hypothesis that the difference in pathogenesis might explain this difference in non-union frequency.…”

Baseline and 1-Year Follow-Up Data of Patients with End-Stage Hallux Rigidus Treated with an Arthrodesis Reported to Swefoot

“…During the last decades several types of plate fixation systems have been available to use fusing the FMTPJ. Several authors have declared that plating techniques are superior to other fixation techniques including patient-reported outcome, union rate, early ambulation, and reduced complication incidence [36][37][38][39][40] . It is important to find out if this specific internal fixation technique significantly can reduce the cost of health services and increase the patient satisfaction.…”

Therapeutic option for patients with severe hallux rigidus

“…Either the cheilectomy or the MTP arthrodesis, focus on these factors and does not prevent the disease recurrence. The osteotomy presented decompresses the joint and improves the anatomical situation of the first metatarsal, trying to avoid this recurrence (13,14) .…”