Abstract
Category:
Midfoot/Forefoot
Introduction/Purpose:
Total joint replacement (TJR) and arthrodesis (A) are treatment options for severe osteoarthritis of the 1st metatarsophalangeal joint (MTP1). The aim of this study was to compare outcome (clinical and pedographic) of JTR (Roto-Glide, Implants International, Thornaby-On-Tees, UK) and A of MTP1.
Methods:
All patients that completed follow-up of at least 24 months after TJR and A of MTP1 before November 5, 2017 were included in the study. The data was extracted from a prospectively acquired database starting November 1, 2011 including all operatively treated patient at the authors´ institution. Exclusion criteria were bilateral treatment (n=24), additional procedures at other toes (n=34), A for revision of TJR (n=12), TJR exchange (n=5), and not completed minimum-24-month-follow-up (n=20). Preoperatively and at follow-up, radiographs and/or weight-bearing computed tomographies were obtained. Degenerative changes were classified in four degrees. Standard dynamic pedography was performed (percentage force at 1st metatarsal/1st toe from force of entire foot). Visual-Analogue-Scale Foot and Ankle (VAS FA) and MTP1 range of motion for dorsi-/plantarflexion (ROM) were registered. All parameters were compared between TJR and A and between preoperatively and follow-up.
Results:
From November 24, 2011 until October 31, 2015, 19 TJR and 38 A were performed. Parameters (average values if not stated otherwise) for TJR/A were preoperatively: mean age 59/60 years; 5(26%)/10(26%) male; height 167/166 cm; weight 73/74 kg; degree degenerative changes 3.3/3.1; ROM 10.3/0/18.8°//10.8/0/19.2°; percentage force 1st metatarsal/1st toe 7.8/14.5//8.4/15.2; VAS FA 45.5/44.9. Follow-up time on average 37.4/32.6 and range 25.3-71.3/24.1-67.1 months. VAS FA at follow-up was 71.7/69.4; percentage force 1st metatarsal/1st toe 15.6/5.5//16.5/10.5; ROM 35.4/0/20.5°//10.2/0/0. Parameters did not differ between TJR and A (each p>.05) except higher force percentage 1st toe and lower ROM for A at follow-up (each p<.05). VAS FA and pedography parameters improved for TJR and A between preoperatively and follow-up, ROM increased for TJR and decreased for A (each p<.05).
Conclusion:
TJR and A were performed in similar patient cohorts regarding demographic parameter, degree of degenerative changes, ROM, pathological pedographic pattern, and validated clinical scores (VAS FA). Both improved pathological pedographic pattern and VAS FA at minimum follow-up of 24 months. TJR additionally improved ROM and showed better pedographic pattern (and not different to physiological pattern) than A. TJR was similar to A except better ROM and better pedographic pattern. Survival rate of TJR was 100% up to 6 years. In this study, TJR was a valuable alternative to A for treatment of severe MTP1 osteoarthritis.