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Outcome following first metatarsophalangeal joint replacement using TOEFIT-PLUS™: A mid term alert
Andrew G Titchener1, Nicholas S Duncan1, Rohan A Rajan1
1Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK.
Summary
First metatarsophalangeal joint replacement for hallux rigidus shows medium-term AOFAS score improvement in unrevised cases. However, the high revision rate necessitates discontinuing the Toefit-Plus™ prosthesis.
Area of Science:
- Orthopedic Surgery
- Foot and Ankle Reconstruction
Background:
- Hallux rigidus is a common degenerative condition affecting the first metatarsophalangeal joint.
- First metatarsophalangeal joint (MTPJ) replacement is a surgical option for managing hallux rigidus.
Purpose of the Study:
- To evaluate the mid-term outcomes of Toefit-Plus™ first MTPJ replacement in a single-surgeon series.
- To assess the efficacy and complication rates associated with this implant for hallux rigidus.
Main Methods:
- Prospective study of 86 toes in 73 patients undergoing first MTPJ replacement.
- Utilized the American Orthopaedic Foot & Ankle Society (AOFAS) Hallux-Metatarsus Iulliage (HMI) score for outcome assessment.
- Included radiological follow-up with a mean follow-up period of 33 months.
Main Results:
- A 24% revision rate was observed, with 18 joints requiring revision or listed for revision.
- Intraoperative fractures or impending fractures occurred in 8 patients, necessitating circlage wiring.
- Unrevised patients demonstrated significant medium-term improvement in AOFAS scores.
Conclusions:
- First MTPJ replacement can provide significant functional improvement for hallux rigidus in the medium term for unrevised patients.
- The Toefit-Plus™ prosthesis demonstrated an unacceptably high revision rate, leading to its discontinuation.
- Future implant designs should focus on improving osteointegration, particularly on the phalangeal side.
