EVALUATION OF A NEW TECHNIQUE FOR FUSION OF THE FIRST METATARSOPHALANGEAL JOINT

Abstract

Purpose of the study: The choice between preservation of the joint shape and straight cuts for arthrodesis of the metatarsophalangeal joint (MPJ) remains a subject of debate.

Material and methods: Sixty patients (74 feet), mean age 67 years, underwent fusion of the first MPJ. There were 52 women and 8 men. Follow-up was 38 months. The operation was performed with a tourniquet and locore-gional anesthesia. The procedure consisted in resection of the remaining cartilage and subchondral bone with preservation of the joint shape. Axial reduction was achieved with back-and-forth pinning the compression stapling on the dorsal aspect. The patient wore a postoperative boot for six weeks.

Results: mean time to healing was 15 weeks (rate of fusion 94.6%). The AOFAS score improved from 29.2/100 preoperatively to 77.1/100 postoperatively. 83% of patient resumed their normal activities. The mean M1P1 angle improved from 34.7° preoperatively to 23.8° postoperatively. Dorsal flexion was 26.8° postoperatively. 79.7% of patients were completely satisfied and 13.5% partially satisfied.

Conclusion: Arthrodeis of the first MPJ is a good technique for selected patients. Use of two dorsal staples for compression is more economical and gives the same rate of fusion as more sophisticated methods. Preservation of the joint shape has no influence on the rate of fusion. There is no mid-term impact on the interphalaneal joint.