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27th Annual AOFAS Summer Meeting July 14, 2011. Alejandro E. Pino, MD Elizabeth Young, BS Lucas J. Bader, MD Chloe Cheng, BS Andrew J. Elliott, MD 1 Matthew.

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Presentation on theme: "27th Annual AOFAS Summer Meeting July 14, 2011. Alejandro E. Pino, MD Elizabeth Young, BS Lucas J. Bader, MD Chloe Cheng, BS Andrew J. Elliott, MD 1 Matthew."— Presentation transcript:

1 27th Annual AOFAS Summer Meeting July 14, 2011

2 Alejandro E. Pino, MD Elizabeth Young, BS Lucas J. Bader, MD Chloe Cheng, BS Andrew J. Elliott, MD 1 Matthew M. Roberts, MD David S. Levine, MD Jonathan T. Deland, MD 2 Martin OMalley, MD 1)Financial relationship with Bacterin 2)Financial relationship with Zimmer, Arthrex and Tornier

3 Introduction First Metatarsophalangeal Joint (MTPJ) Arthrodesis offers reliable pain relief Many accepted techniques Stigma due to perceived functional limitation

4 Introduction Good functional outcomes described One technique Single surgeon Homogeneous patient population

5 Our Study Review functional outcomes after first MTPJ arthrodesis Multiple surgeons Different fixation techniques Heterogeneous population

6 Hypothesis Arthrodesis 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 2006-2009 Five different surgeons

8 Methods Pre/Postoperative FAOS, SF-12/36, activity/shoe wear specific questionnaire Brodsky et al FAI 2005 Radiographic evaluation

9 Methods Subgroup analysis Arthrodesis technique Cross screws versus Plate/lag screw Previous surgery Concomitant procedure

10 Inclusion Failed conservative treatment Minimum 1-year follow-up

11 Exclusion Concomitant lesser metatarsal head resections Age less than 18

12 Demographics 51 patients (55 feet) Mean age 58.9 (42-74) M:F 11:44 Average f/u 32 months (16-73) 67% Hallux Rigidus

13 Previous Procedures

14 Fixation Technique Plate/lag screw 32 Patients Cross screw 23 Patients 32 Patients (34 Feet) Isolated procedure

15 Concomitant Procedures

16 Results PreopPostopp-value SF score69.9 (26.5-93)79.5 (32.5-98.1)0.0017 Sport*58.2 (0-100)77.6 (0-100)0.0002 QOL*38.2 (0-75)75.2 (6.25-100)<0.0001 Pain*61.7 (25-100)90.7 (55.6-100)<0.0001 Symptoms*61.6 (21.4-100)86.6 (41.7-100)<0.0001 Activity*75.3 (25-100)95.8 (79.4-100)<0.0001 VAS (Pain)5.5 (2-9)2.5 (0-10) *FAOS

17 Results 54% Denied shoe-wear limitations 89% Satisfied/highly satisfied

18 Functional Outcomes


20 Radiographic Evaluation 82% Union rate Plate/screwCross screwp Value Union93%62%0.021 Satisfaction85%95% ROH14%4%

21 Solitary Procedure Equivalent outcome scores Similar union rate

22 Prior Procedure Equivalent outcome scores Union rate 90% vs 68% p=0.067

23 Limitations Lack of standardization Postoperative protocol Technique Concomitant procedures

24 Discussion Good functional results Rarely limits daily activities In-line athletics Concomitant/Previous procedures

25 Discussion Union rate Plate/screw vs Cross screw Satisfaction rate Shoe wear limitations

26 References 1. 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. 27:1014-1019, 2006. 2. 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. 45:244-251, 2006. 3. Bennett, GL; Sabetta, J: First metatarsalphalangeal joint arthrodesis: evaluation of plate and screw fixation. Foot Ankle Int. 30:752-757, 2009. 4. Bennett, GL; Kay, DB; Sabatta, J: First metatarsophalangeal joint arthrodesis: an evaluation of hardware failure. Foot Ankle Int. 26:593-596, 2005. 5. Brodsky, JW; Passmore, RN; Pollo, FE; Shabat, S: Functional outcome of arthrodesis of the first metatarsophalangeal joint using parallel screw fixation. Foot Ankle Int. 26:140-146, 2005. 6. 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. 25:521-525, 2004. 7. 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, 2011. 8. Coughlin, MJ; Shurnas, PS: Hallux rigidus. J. Bone Joint Surg. Am. 86-A Suppl 1:119-130, 2004. 9. Coughlin, MJ; Shurnas, PS: Hallux rigidus. Grading and long-term results of operative treatment. J. Bone Joint Surg. Am. 85-A:2072-2088, 2003.

27 References 10. DeFrino, PF; Brodsky, JW; Pollo, FE; Crenshaw, SJ; Beischer, AD: First metatarsophalangeal arthrodesis: a clinical, pedobarographic and gait analysis study. Foot Ankle Int. 23:496-502, 2002. 11. Fuhrmann, RA: First metatarsophalangeal arthrodesis for hallux rigidus. Foot Ankle Clin. 16:1-12, 2011. 12. Goucher, NR; Coughlin, MJ: Hallux metatarsophalangeal joint arthrodesis using dome-shaped reamers and dorsal plate fixation: a prospective study. Foot Ankle Int. 27:869-876, 2006. 13. 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. 31:662-669, 2010. 14. Kumar, S; Pradhan, R; Rosenfeld, PF: First metatarsophalangeal arthrodesis using a dorsal plate and a compression screw. Foot Ankle Int. 31:797-801, 2010. 15. 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. 31:578-583, 2010. 16. Raikin, SM; Ahmad, J; Pour, AE; Abidi, N: Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint. J. Bone Joint Surg. Am. 89:1979-1985, 2007. 17. User's Manual for the SF-36v2 Health Survey, Second Edition, Chapter 3: 29-37 18. van Doeselaar, DJ; Heesterbeek, PJ; Louwerens, JW; Swierstra, BA: Foot function after fusion of the first metatarsophalangeal joint. Foot Ankle Int. 31:670-675, 2010. 19. Womack, JW; Ishikawa, SN: First metatarsophalangeal arthrodesis. Foot Ankle Clin. 14:43-50, 2009.

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