Presentation on theme: "Functional Outcome Following First Metatarsalphalangeal Arthrodesis"— Presentation transcript:
1 Functional Outcome Following First Metatarsalphalangeal Arthrodesis 27th Annual AOFAS Summer MeetingJuly 14, 2011Functional Outcome Following First Metatarsalphalangeal Arthrodesis
2 Alejandro E. Pino, MD Elizabeth Young, BS Lucas J. Bader, MD Chloe Cheng, BSAndrew J. Elliott, MD1Matthew M. Roberts, MDDavid S. Levine, MDJonathan T. Deland, MD2Martin O’Malley, MD1)Financial relationship with Bacterin )Financial relationship with Zimmer, Arthrex and Tornier
3 IntroductionFirst Metatarsophalangeal Joint (MTPJ) Arthrodesis offers reliable pain reliefMany accepted techniquesStigma due to perceived functional limitation
4 Introduction Good functional outcomes described One technique Single surgeonHomogeneous patient population
5 Our Study Review functional outcomes after first MTPJ arthrodesis Multiple surgeonsDifferent fixation techniquesHeterogeneous population
6 HypothesisArthrodesis for the treatment of severe degeneration of the first MTPJ yields good functional outcomes regardless of fixation technique.Principles of arthrodesis upheld
7 Methods HSS Dept of Foot/Ankle Surgery patient database CPT code Five different surgeons
8 MethodsPre/Postoperative FAOS, SF-12/36, activity/shoe wear specific questionnaireBrodsky et al FAI 2005Radiographic evaluation
9 Methods Subgroup analysis Arthrodesis technique Previous surgery Cross screws versus Plate/lag screwPrevious surgeryConcomitant procedure
20 Radiographic Evaluation 82% Union ratePlate/screwCross screwp ValueUnion93%62%0.021Satisfaction85%95%ROH14%4%screw younger than plate, equivalent outcome scores, of those not satisfied the majority c/o symptomatic plate/screw and c/o shoewear limitations.
21 Solitary Procedure Equivalent outcome scores Similar union rate sol younger than mult, no difference in union rate, even b/w construct groups
22 Prior Procedure Equivalent outcome scores Union rate 90% vs 68%
23 Limitations Lack of standardization Concomitant procedures Postoperative protocolTechniqueConcomitant procedurescalc bone graft 75% plate/screw 57% cross screw
25 Discussion Union rate Satisfaction rate Shoe wear limitations Plate/screw vs Cross screwSatisfaction rateShoe wear limitationsDifference in union rates did not affect outcome scores. difference in satisfaction b/w plate and cross 85% vs 95%. most unsatisfied pts c/o shoe wear limitations. half had complication (prominent hardware)
26 References1. Baumhauer, JF; Nawoczenski, DA; DiGiovanni, BF; Wilding, GE: Reliability and validity of the American Orthopaedic Foot and Ankle Society Clinical Rating Scale: a pilot study for the hallux and lesser toes. Foot Ankle Int. 27: , Beertema, W; Draijer, WF; van Os, JJ; Pilot, P: A retrospective analysis of surgical treatment in patients with symptomatic hallux rigidus: long-term follow-up. J. Foot Ankle Surg. 45: , Bennett, GL; Sabetta, J: First metatarsalphalangeal joint arthrodesis: evaluation of plate and screw fixation. Foot Ankle Int. 30: , Bennett, GL; Kay, DB; Sabatta, J: First metatarsophalangeal joint arthrodesis: an evaluation of hardware failure. Foot Ankle Int. 26: , Brodsky, JW; Passmore, RN; Pollo, FE; Shabat, S: Functional outcome of arthrodesis of the first metatarsophalangeal joint using parallel screw fixation. Foot Ankle Int. 26: , Button, G; Pinney, S: A meta-analysis of outcome rating scales in foot and ankle surgery: is there a valid, reliable, and responsive system? Foot Ankle Int. 25: , Chen, L; Lyman, S; Do, H; Adam, S; Young, E; Deland, J; Ellis, S: Validation of the Foot and Ankle Outcome Score for Hallux Valgus. Hospital for Special Surgery Fellow Presentation, Coughlin, MJ; Shurnas, PS: Hallux rigidus. J. Bone Joint Surg. Am. 86-A Suppl 1: , Coughlin, MJ; Shurnas, PS: Hallux rigidus. Grading and long-term results of operative treatment. J. Bone Joint Surg. Am. 85-A: , 2003.
27 References10. DeFrino, PF; Brodsky, JW; Pollo, FE; Crenshaw, SJ; Beischer, AD: First metatarsophalangeal arthrodesis: a clinical, pedobarographic and gait analysis study. Foot Ankle Int. 23: , Fuhrmann, RA: First metatarsophalangeal arthrodesis for hallux rigidus. Foot Ankle Clin. 16:1-12, Goucher, NR; Coughlin, MJ: Hallux metatarsophalangeal joint arthrodesis using dome-shaped reamers and dorsal plate fixation: a prospective study. Foot Ankle Int. 27: , Hope, M; Savva, N; Whitehouse, S; Elliot, R; Saxby, TS: Is it necessary to re-fuse a non-union of a Hallux metatarsophalangeal joint arthrodesis? Foot Ankle Int. 31: , Kumar, S; Pradhan, R; Rosenfeld, PF: First metatarsophalangeal arthrodesis using a dorsal plate and a compression screw. Foot Ankle Int. 31: , Poggio, D; de Retana, PF; Borda, D; Hortua, P; Asuncion, J; Rios, J: Analysis of the clinical score progressions during the first year after first MTPJ fusion. Foot Ankle Int. 31: , Raikin, SM; Ahmad, J; Pour, AE; Abidi, N: Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint. J. Bone Joint Surg. Am. 89: , User's Manual for the SF-36v2 Health Survey, Second Edition, Chapter 3: van Doeselaar, DJ; Heesterbeek, PJ; Louwerens, JW; Swierstra, BA: Foot function after fusion of the first metatarsophalangeal joint. Foot Ankle Int. 31: , Womack, JW; Ishikawa, SN: First metatarsophalangeal arthrodesis. Foot Ankle Clin. 14:43-50, 2009.