Clinical Outcomes of First Metatarsophalangeal Joint Arthrodesis Using the BOFAS Registry: A Prospective Cohort Study

This study investigated the quality and clinical outcomes of the British Orthopaedic Foot and Ankle Society (BOFAS) registry first metatarsophalangeal joint (MTPJ) arthrodesis pathway.

A prospective cohort study using data derived from the BOFAS registry. Adults aged ≥ 18 years with a record of undergoing first MTPJ arthrodesis in the UK from 29/08/2014 to 31/10/2019. The pre- and post-treatment pathway was evaluated by analysing Patient Reported Outcome Measures (PROMs) at baseline, 6 months and 12 months intervals. Consistency of data capture and completeness were explored using means, SD, medians and IQR for continuous variables and frequencies for categorical variables.

The mean age of the study population (n = 459) was 64.1 (± 12.1) years and 98.9% of the study cohort were female. Completeness of data collection was low for some items (e.g., medication 46%, surgical procedures 52%). Baseline completion of PROMs was moderate with 52.5% of participants providing MOXFQ (Manchester-Oxford Foot Questionnaire) pain and walking/standing scores at baseline. However, follow-up response rates declined substantially to 27.2% at 6 months and 15.7% at 12 months. Improvement in PROMs by 12 months following surgery was statistically and clinically significant (p < 0.001), with median scores of 10 [IQR: 0-20] for MOXFQ pain, 5.5 [0-21] for walking/standing, 0 [0-19] for social interaction, 5 [1-31] for NRS pain and 0.8 [0.7-1.0] for EQ-5D-5L.

The analysis highlights the clinical benefits of first metatarsophalangeal joint (first MTPJ) fusion surgery, with improvements in pain intensity, walking/standing ability, social interaction and quality of life. The BOFAS registry serves as a valuable tool for collecting patient-reported outcome measure (PROM) data, providing important insights into treatment effectiveness and participant well-being. Strengthening the data collection capabilities of the BOFAS registry could further enhance our understanding of the benefits of first MTPJ fusion and inform future treatment strategies.