Long-term Survival of the TOEFIT Plus First-Metatarsophalangeal Joint Replacement for End-Stage Hallux Rigidus

Abstract

Background:

End-stage hallux rigidus is currently being treated by total joint arthrodesis rather than arthroplasty more commonly. However, there is an advancing number of joint prosthesis being employed either as hemiarthroplasty or total joint replacement. One such total joint replacement is the ToeFit Plus joint.

Methods:

A retrospective cohort study over 20 years was undertaken to assess functional outcomes. Seventy total joint replacements were performed between 2006 and 2013. Fifty-seven patients (46 females, 11 males), mean age 62.1 years (range 42-82). Thirteen patients had bilateral replacements. Mean follow-up was 98.2 months (range 13-216, SD 61.3). Survival analysis used Kaplan-Meier methodology with best-case (excluding lost to follow-up) and worst-case (assuming all lost to follow-up were failures) scenarios.

Results:

Mean Manchester-Oxford Foot Questionnaire score at the latest follow-up telephone consultation was 7.4 (range 0-59, SD 14). Twelve of 70 joints were revised to arthrodesis because of phalangeal component loosening, with 24 joints lost to follow-up. Best-case scenario showed 81% survival at mean 11.0 years, whereas worst-case scenario showed only 48.2% survival. The mean age of patients who had revision surgery was 62.5 years (range 51-73, SD 6.9). The mean age for nonrevised patients was 62.0 years (range 42-82, SD 9.0), with no significant correlation between patients' age and the implant longevity or revision. In the first 5 years following TJR, there was a 15% chance of revision.

Conclusion

Revision was mainly caused by phalangeal component loosening. Even in the best-case scenario, the 19% revision rate at 10 years is concerning, but the potential 52% failure rate in worst-case analysis is unacceptably high. We recommend discontinuing the use of the ToeFit Plus arthroplasty.

Keywords

end-stage hallux rigidus first metatarsophalangeal joint fusion ToeFit 1st MTPJ total joint arthroplasty

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References

Ahn

Kitaoka

Luo

. Kinematics and contact characteristics of the first metatarsophalangeal joint. Foot Ankle Int. 1997;18(3):170-174.

Barták

Heřt

Štědrý

Popelka

Jr Popelka

Hromádka

. Long-term results of total joint arthroplasty and phalangeal hemiarthroplasty of the first metatarsophalangeal joint using the ToeFit Plus™ system. Foot Ankle Surg. 2022;28(1):56-61. doi:10.1016/j.fas.2021.01.014

Berlet

Hyer

Lee

Philbin

Hartman

Wright

. Interpositional arthroplasty for the first MTP joint using a regenerative tissue matrix for the treatment of advanced hallux rigidus. Foot Ankle Int. 2008;29(1):10-21. doi:10.3113/FAI.2008.0010

Brodsky

Passmore

Pollo

Shabat

. Functional outcome of arthrodesis of the first metatarsophalangeal joint using parallel screw fixation. Foot Ankle Int. 2005;26(2):140-146. doi:10.1177/107110070502600205

Callaghan

Insall

Greenwald

, et al. Mobile-bearing knee replacement: concepts and results. J Bone Joint Surg Am. 2000;82(7):1020.

Conti

Dhawan

. Arthrodesis of the first metatarsophalangeal and interphalangeal joints of the foot. Foot Ankle Clin North Am. 1996;1(1)33-53. doi:10.1016/S1083-7515(23)00176-6

Cook

Rosenblum

Landsman

Giurini

Basile

. Meta-analysis of first metatarsophalangeal joint implant arthroplasty. J Foot Ankle Surg. 2009;48(2):180-190. doi:10.1053/j.jfas.2008.10.009

Coughlin

Shurnas

. Soft tissue arthroplasty for hallux rigidus. Foot Ankle Int. 2003;24(9):661-672. doi:10.1177/107110070302400902

Dawson

Boller

Doll

, et al. The MOXFQ patient-reported questionnaire: assessment of data quality, reliability and validity in relation to foot and ankle surgery. Foot. 2011;21(2):92-102. doi:10.1016/j.foot.2011.02.002

10.

DeFrino

Brodsky

Pollo

Crenshaw

Beischer

. First metatarsophalangeal arthrodesis: a clinical, pedobarographic and gait analysis study. Foot Ankle Int. 2002;23(6):496-502. doi:10.1177/107110070202300605

11.

Duncan

Farrar

Rajan

. Early results of first metatarsophalangeal joint replacement using the ToeFit-Plus™ prosthesis. J Foot Ankle Surg. 2014;53(3)265-268. doi:10.1053/j.jfas.2014.01.008

12.

Fadel

Rowley

Abboud

. Hallux metatarsophalangeal joint arthrodesis: various techniques. Foot. 2002;12(2):88-96. doi:10.1054/foot.2002.0724

13.

Gaudot

Colombier

Bonnin

Judet

. A controlled, comparative study of a fixed-bearing versus mobile-bearing ankle arthroplasty. Foot Ankle Int. 2014;35(2):131-140.

14.

Glazebrook

Younger

Daniels

, et al. Treatment of first metatarsophalangeal joint arthritis using hemiarthroplasty with a synthetic cartilage implant or arthrodesis: a comparison of operative and recovery time. Foot Ankle Surg. 2018;24(5):440-447. doi:10.1016/j.fas.2017.05.002

15.

Gregory

Childers

Higgins

Krych

Harkless

. Arthrodesis of the first metatarsophalangeal joint: a review of the literature and long-term retrospective analysis. J Foot Surg. 1990;29(4):369-374.

16.

Gupta

Mallya

. TOEFIT-PLUS™ replacement of the first metatarsophalangeal joint of the first toe: a short-term follow-up study. Foot. 2008;18(1):20-24. doi:10.1016/j.foot.2007.07.001

17.

Gupta

Masud

. Long term results of the Toefit-Plus replacement for first metatarsophalangeal joint arthritis. Foot. 2017;31:67-71. doi:10.1016/j.foot.2017.04.006

18.

Hamelynck

. The history of mobile-bearing total knee replacement systems. Orthopedics. 2006;29(9 suppl):S7-S12.

19.

Joyce

. Calculation of theoretical lubrication regimes in two-piece first metatarsophalangeal prostheses. Bio-med Mater Eng. 2008;18(1):45-51.

20.

Kofoed

Danborg

Grindsted

Merser

. The Rotoglide total replacement of the first metatarso-phalangeal joint. A prospective series with 7-15 years clinic-radiological follow-up with survival analysis. J Foot Ankle Surg. 2017;23(3):148-152.

21.

Nüesch

Mündermann

Horisberger

. Mid-term functional outcome of a total arthroplasty of the first metatarsophalangeal joint. Clin Biomech (Bristol). 2017;41:9–13. doi:10.1016/j.clinbiomech.2016.11.002

22.

Nunley

Adams

Easley

DeOrio

. Prospective randomized trial comparing mobile-bearing and fixed-bearing total ankle replacement. Foot Ankle Int. 2019;40(11):1239-1248.

23.

Shereff

Bejjani

Kummer

. Kinematics of the first metatarsophalangeal joint. J Bone Joint Surg Am. 1986;68(3):392-398.

24.

Swanson

de Groot Swanson

Maupin

, et al. The use of a grommet bone linear for flexible hinge implant arthroplasty of the great toe. Foot Ankle. 1991;12:149.

25.

Titchener

Duncan

Rajan

. Outcome following first metatarsophalangeal joint replacement using TOEFIT-PLUS™: a midterm alert. J Foot Ankle Surg. 2015;21(2):119-124. doi:10.1016/j.fas.2014.10.005

26.

Vanore

Christensen

Kravitz

, et al. Diagnosis and treatment of first metatarsophalangeal joint disorders section 2: hallux rigidus. J Foot Ankle Surg. 2003;42(3):124-136. doi:10.1016/S1067-2516(03)70015-5

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