Early results of an intraosseous device for arthrodesis of the hallux metatarsophalangeal joint

Abstract

Background:

Arthrodesis of the hallux metatarsophalangeal (MTP) joint is commonly done as a primary procedure either to correct severe hallux valgus deformities or for rheumatoid arthritis, hallux rigidus, in patients with neuromuscular disorders and as a salvage procedure for failed bunion surgery or infection. Prominent metalwork frequently can cause soft tissue impingement and thus require removal. In contrast, osteosynthesis with a completely intraosseous implant has the advantage of less damage to the periosteal circulation. We describe a surgical technique and the early results of arthrodesis of the hallux metatarsophalangeal (MTP) joint using an intraosseous fixation device.

Materials and Methods:

Twelve consecutive patients operated with this method were retrospectively reviewed. The average age was 57 years (range 44–88 years). A retrospective review of radiographs and electronic medical notes was conducted. The patients were also asked to fill a satisfaction questionnaire.

Results:

Overall fusion rate was 91% with a mean hallux valgus angle of 15° (range 4–20°) and a mean dorsiflexion angle of 20° (range 7–30°). Complications included a case of failed fusion, a delayed union, and a case of persisting transfer metatarsalgia. At a mean followup of 14 months (range 5–28 months), the mean visual analog scale improved significantly from a mean of 8.4 (range 7–10) preoperatively, to a mean of 3.1 (range 0–7) postoperatively (P < 0.0001). The mean American Orthopaedic Foot and Ankle Society hallux score also significantly improved from 29.4 (range 10–54) to a mean of 73.3 (range 59–90) (P < 0.0001). The final result was satisfactory for 83% of the patients.

Conclusions:

The early results show intraosseous fixation to be a safe and efficient method for the fusion of the hallux MTP joint providing relief from pain and patient satisfaction.