Functional Outcome Following First Metatarsalphalangeal Arthrodesis 27th Annual AOFAS Summer Meeting July 14, 2011 Functional Outcome Following First Metatarsalphalangeal Arthrodesis

Alejandro E. Pino, MD Elizabeth Young, BS Lucas J. Bader, MD Chloe Cheng, BS Andrew J. Elliott, MD1 Matthew M. Roberts, MD David S. Levine, MD Jonathan T. Deland, MD2 Martin O’Malley, MD 1)Financial relationship with Bacterin 2)Financial relationship with Zimmer, Arthrex and Tornier

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

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

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

Hypothesis Arthrodesis for the treatment of severe degeneration of the first MTPJ yields good functional outcomes regardless of fixation technique. Principles of arthrodesis upheld

Methods HSS Dept of Foot/Ankle Surgery patient database CPT code 2006-2009 Five different surgeons

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

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

Inclusion Failed conservative treatment Minimum 1-year follow-up

Exclusion Concomitant lesser metatarsal head resections Age less than 18

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

Previous Procedures 22 patients

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

Concomitant Procedures

Results Preop Postop p-value SF score 69.9 (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) Symptoms* 61.6 (21.4-100) 86.6 (41.7-100) Activity* 75.3 (25-100) 95.8 (79.4-100) VAS (Pain) 5.5 (2-9) 2.5 (0-10) *FAOS

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

Functional Outcomes

Functional Outcomes

Radiographic Evaluation 82% Union rate Plate/screw Cross screw p Value Union 93% 62% 0.021 Satisfaction 85% 95% ROH 14% 4% screw younger than plate, equivalent outcome scores, of those not satisfied the majority c/o symptomatic plate/screw and c/o shoewear limitations.

Solitary Procedure Equivalent outcome scores Similar union rate sol younger than mult, no difference in union rate, even b/w construct groups

Prior Procedure Equivalent outcome scores Union rate 90% vs 68%

Limitations Lack of standardization Concomitant procedures Postoperative protocol Technique Concomitant procedures calc bone graft 75% plate/screw 57% cross screw

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

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