Synthetic Cartilage Implant Hemiarthroplasty for Second MTP Joint Osteoarthrosis

Synthetic cartilage hemiarthroplasty has been used successfully in the first metatarsophalangeal (MTP) joint and might also provide an alternative surgical intervention for second MTP joint osteoarthritis and Freiberg disease. Synthetic cartilage implant hemiarthroplasty was performed on 23 consecutive patients for the treatment of painful second MTP joint disease. Joint damage ranged from mild to severe. Mean follow-up period was 43 months ± 17.6 (range, 28-79 months). Mean age at the time of surgery was 55 years ± 16 (range, 20-73 years). Each participant attended for clinical assessment and an interview which included completion of 2 patient-reported outcome measures: the Manchester-Oxford Foot Questionnaire (MOXFQ) and the Foot and Ankle Ability Measure (FAAM). The implant failed in 2 participants (9%) and required removal and revision. Four participants (17%) reported dissatisfaction with the surgery because of continued pain. Nine participants (43%) reported second MTP joint stiffness; however, this was symptomatic in just 5 cases. Sixteen participants (70%) were pain free and totally satisfied with their outcome. Eleven of 21 participants (52%) reported an improvement in all 3 categories of the MOXFQ. FAAM scores demonstrated good overall function and activity, with a mean score of 91 ± 16 (range, 44-100). There were no postoperative infections, transfer metatarsalgia, or floating toe deformity. In preserving metatarsal and phalanx length as well as the collateral ligaments of the joint, synthetic cartilage implant hemiarthroplasty avoids some of the important risks of metatarsal osteotomy and basal phalangectomy. A range of alternative surgical options are still available if the synthetic cartilage implant fails to resolve symptoms.