Presentation on theme: "Functional Outcome Following First Metatarsalphalangeal Arthrodesis"— Presentation transcript:
1Functional Outcome Following First Metatarsalphalangeal Arthrodesis 27th Annual AOFAS Summer MeetingJuly 14, 2011Functional Outcome Following First Metatarsalphalangeal Arthrodesis
2Alejandro 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
3IntroductionFirst Metatarsophalangeal Joint (MTPJ) Arthrodesis offers reliable pain reliefMany accepted techniquesStigma due to perceived functional limitation
4Introduction Good functional outcomes described One technique Single surgeonHomogeneous patient population
5Our Study Review functional outcomes after first MTPJ arthrodesis Multiple surgeonsDifferent fixation techniquesHeterogeneous population
6HypothesisArthrodesis for the treatment of severe degeneration of the first MTPJ yields good functional outcomes regardless of fixation technique.Principles of arthrodesis upheld
7Methods HSS Dept of Foot/Ankle Surgery patient database CPT code Five different surgeons
8MethodsPre/Postoperative FAOS, SF-12/36, activity/shoe wear specific questionnaireBrodsky et al FAI 2005Radiographic evaluation
9Methods Subgroup analysis Arthrodesis technique Previous surgery Cross screws versus Plate/lag screwPrevious surgeryConcomitant procedure
20Radiographic 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.
21Solitary Procedure Equivalent outcome scores Similar union rate sol younger than mult, no difference in union rate, even b/w construct groups
22Prior Procedure Equivalent outcome scores Union rate 90% vs 68%
23Limitations Lack of standardization Concomitant procedures Postoperative protocolTechniqueConcomitant procedurescalc bone graft 75% plate/screw 57% cross screw
25Discussion 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)
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