SLR - February 2018 - Isin Mustafa

Intramedullary and Intra-Osseous Arthrodesis of the Hallux Metatarsophalangeal Joint

Reference: Drampalos, E. Vun, S.H. & Fayyaz, I. (2016). Intramedullary and Intra-Osseous Arthrodesis of the Hallux Metatarsophalangeal Joint. Journal Of Orthopedic Surgery, 24(3):358–61.

Scientific Literature Review

Reviewed By: Isin Mustafa, DPM
Residency Program: Chino Valley Medical Center, Chino, CA

Podiatric Relevance: Arthrodesis of the hallux metatarsophalangeal joint (MTPJ) is a common procedure in the podiatric profession. Arthrodesis of the MTPJ has proven to be a successful procedure for patients with hallux valgus (HAV), rheumatoid arthritis (RA), hallux rigidus (HR), posttraumatic arthritis and as a salvage procedure. Successful outcomes depend on the proper preparation of the joint surfaces accompanied by stable fixation. Cross screws and plates have been the preferred fixation method. However, newer methods, including intramedullary and intra-osseous devices, both of which include a screw and post construction, have been developed. These devices claim to provide stable fixation with minimal disturbance to the periosteal circulation and reduce the risk of hardware impingement. If these newer methods prove to provide equal or greater success rates to the traditional methods, they may be a superior fixation choice.

Methods: Records of nine men and 14 women who underwent arthrodesis of the first MTPJ from December 2011 to January 2015 were reviewed. Patients had either an intramedullary or intra-osseous device and all surgeries were performed by the same surgeon. Patients were selected for surgical intervention if they had HAV, HR or RA. Outcomes were measured using the visual analogue score for pain, the American Orthopedic Foot and Ankle Society (AOFAS) hallux score, bone union, hallux valgus angle, dorsiflexion ankle, complications, revision and patient satisfaction. Pre- and postoperative variables were compared using a t-test. A p value of <0.05 was considered statistically significant.

Results: The mean follow-up was 19 months. The mean AOFAS score improved from 29 to 75.4 (p<0.0001), and mean VAS for pain improved from 8.1 to 2.4 (p<0.0001). Eighty percent of patients were satisfied with the outcomes. The mean HVA was 14 degrees, and mean DA was 22 degrees. Eighty-three percent of patients had well-aligned hallux. Ninety-one percent of patients achieved arthrodesis of the first MTPJ. Two patients underwent revision surgery for failed fusion or infected nonunion.

Conclusion: The 91 percent fusion rate of the patients in this study was similar to fusion rates from arthrodesis using traditional cross screws or plate fixation. Patient satisfaction rates were also comparable to rates described in the literature (78 percent to 93 percent). The intramedullary and intra-osseous devices for arthrodesis of the first MTPJ show promising reproducible results. Further postoperative and comparable studies with larger sample sizes and longer follow-up will be required to confirm the findings in this study. These newer methods may replace traditional fixation methods for arthrodesis of the first MTPJ.  

Educational Opportunities