Outcomes Following First MTPJ Replacement Using the Roto-Glide Prosthesis

Abstract

Background:

Is first metatarsophalangeal joint replacement a viable alternative to arthrodesis for the treatment of end-stage hallux rigidus? There are few studies evaluating the medium- to long-term outcomes of the Roto-Glide prosthesis.

Methods:

This study prospectively analyses the medium- to long-term outcomes of consecutive patients who underwent first metatarsophalangeal joint replacements using the Roto-Glide prosthesis from 2014 to 2020 at 2 centers in the United Kingdom. The inclusion criteria were (1) patients over the age of 18 years with stage 3 or stage 4 hallux rigidus, (2) failed conservative measures, and (3) patients who had consented for arthroplasty after shared decision making. Patients with less than 18 years of age, active infection, hallux valgus of more than 25 degrees, and those with a follow-up of less than 24 months were excluded from the study. The primary objectives were to assess for patient-reported functional outcomes and medium- to long-term implant survivorship with total prosthetic joint explantation to fusion as the end point. Functional outcomes were assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ) scores preoperatively and postoperatively at multiple time points. Implant failure was assessed by weightbearing radiographs, which were taken preoperatively and at multiple time points during follow-up. Intraoperative and postoperative complications were evaluated.

Results:

Forty total joint replacements using the Roto-Glide prosthesis were performed in 35 patients over a 6-year period (2014 to 2020). Two patients were lost to follow-up, and 2 died because of unrelated causes. One patient had the prosthesis removed in the first month because of infection and subsequently got lost to follow-up. Thirty-five total joint replacements in 30 patients were included in the study. The mean age was 57.9 years (range 41-80). The mean follow-up period was 95 months (range 24-122 months). There was a statistically significant improvement in MOXFQ scores from 47.0 (SD 8.1, 95% CI 43.1-48.8) preoperatively to 21.0 (SD 11.8, 95% CI 16.9-25.1) at 6 months (P < .001). At 1 year, the mean was 12.9 (SD 11.8; 95% CI 8.6-17.3; P < .001), at 2 years 6.4 (SD 7.6, 95% CI 3.6-9.3; P < .001), and at final follow-up 6.3 (SD 11.5, 95% CI 1.8-10.7; P < .001). At the average follow-up of 8 years, the implant survivorship was 89.2% (95% CI 79.2-99.2). Four patients (11.4%) had first MTP joint stiffness postoperatively requiring further procedures. Five patients (14.3%) had prosthesis explantation to fusion during the follow-up period for infection (1 patient), aseptic loosening (3 patients), or persistent subluxation (1 patient). One patient had intraoperative FHL injury.

Conclusion:

First metatarsophalangeal joint replacement using Roto-Glide prosthesis results in statistically and clinically significant improvement in patient-reported outcome measures in the medium to long term. We found overall good implant survivorship in the medium term. However, postoperative surgical complications were relatively high. With marked reduction in surgical complications, first MTP joint replacement may be considered an alternative for patients with end-stage hallux rigidus who want to retain joint motion. Further comparative studies with longer-term follow-up are required to compare the outcomes of arthroplasty to arthrodesis, which is considered the gold standard.

Level of Evidence:

Level IV, prospective series of one operation with no control.