Ten-Year Minimum Follow-up Study of First Metatarsophalangeal Joint Fusion in Young vs Old Patients

Abstract

Background: Painful degenerative joint disease (DJD) of the first metatarsophalangeal joint (MTP I), or hallux rigidus, mainly occurs in later stages of life. For end-stage hallux rigidus, MTP I arthrodesis is considered the gold standard. As young and active patients are affected considerably less frequently, it currently remains unclear, whether they benefit to the same extent. We hypothesized that MTP I arthrodesis in younger patients would lead to an inferior outcome with decreased rates of overall with lower rates of patient postoperative pain and function compared to an older cohort. Methods: All patients aged <50 y ears who underwent MTP I arthrodesis at our institution between 1995 and 2012 were included in this study. This group was then matched and compared with a group of patients aged >60 years. Minimum follow-up was 10 years. Outcome measures were Tegner activity score (TAS), a “Virtual Tegner activity score” (VTAS), the visual analog scale (VAS), and the Foot Function index (FFI). Results: Sixty-one MTP I fusions (n = 28 young, n = 33 old) in 46 patients were included in our study at an average of 14 years after surgery. Younger patients experienced significantly more pain relief as reflected by changes in VAS and FFI Pain subscale scores. No difference in functional outcomes was found with change in the FFI function subscale or in the ability to have desired functional outcomes using the ratio of TAS to VTAS. Revision rate did not differ between the two groups apart from hardware removal, which was significantly more likely in the younger group. Conclusion: In patients below the age of 50 years with end-stage DJD of the first metatarsal joint, MTP I arthrodesis not only yielded highly satisfactory postoperative results at least equal outcome compared to an older cohort of patients aged >60 years at an average 14 years’ follow-up. Based on these findings, we consider first metatarsal joint fusion even for young patients is a valid option to treat end-stage hallux rigidus. Level of Evidence: Level III, a case-control study.

The Data Have Landed: You May Now Fuse the First MTP Joint in Young Patients

“…I think that the same methodology can also be applied to other conditions within foot and ankle (Lisfranc, bunion, flatfoot). If only I could travel back in time with the article by Scheurer et al, 11 I could have defended my case for MTP fusion in my young patient. I have already printed it out and will have it ready to give to my young patients as a data-driven guide to their likely future next week.…”

“…In the current issue of FAI , Scheurer et al 11 have added wonderfully to our knowledge of outcomes of first MTP fusion. Although a common topic, their new twist arms us with information to take to our patients and to base our surgical decisions.…”