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Outcomes after total first metatarsophalangeal joint arthroplasty for hallux rigidus: a systematic review and
Karthik Chinnaswamy1, Archisha Marya2, Anand Pillai3,2
1Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK. kkchinnaswamy12@gmail.com.
Background:
The role of first metatarsophalangeal (MTP) joint arthroplasty in hallux rigidus remains controversial. Although used as a motion-preserving alternative to arthrodesis, outcomes vary between studies and implant designs. This systematic review and meta-analysis evaluated clinical outcomes, range of motion (ROM), and implant survivorship following total first MTP arthroplasty.
Methods:
A systematic review identified studies reporting pre- and postoperative outcomes following total first MTP arthroplasty for hallux rigidus. Pooled outcomes were the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI) score, visual analogue scale (VAS) pain score, and ROM. One postoperative timepoint per study was selected using a prespecified rule, prioritising the timepoint closest to 24 months, or follow-up between 12 and 36 months where discrete timepoints were not reported. Random-effects pre-post meta-analysis used an assumed pre-post correlation of 0.5. Heterogeneity, prediction intervals, leave-one-out analysis, and sensitivity analyses were performed.
Results:
Twelve studies were included in the AOFAS-HMI meta-analysis, seven in the VAS meta-analysis, and thirteen in the ROM meta-analysis. Arthroplasty was associated with a pooled improvement in AOFAS-HMI of 42.76 points (95% CI 38.44-47.09; p < 0.001), a pooled reduction in VAS pain of 5.24 points (95% CI 3.82-6.67; p < 0.0001), and a pooled improvement in ROM of 27.02° (95% CI 17.19-36.86; p < 0.001). Heterogeneity was high. Prediction intervals remained wholly positive for AOFAS-HMI and VAS, but crossed zero for ROM, indicating less consistent motion gain. Secondary complication outcomes were reported as crude observational frequencies across studies with variable follow-up durations. Radiographic failure occurred in 14.5% of reported feet and revision in 10.0%; these figures are not annualised incidence rates or formal meta-analytic survivorship estimates. Longer follow-up cohorts suggested reduced implant durability over time.
Conclusions:
Total first MTP arthroplasty is associated with improvement in pain and function, but these benefits should be interpreted alongside appreciable revision and radiographic failure rates. ROM improves on average, although restoration of motion remains inconsistent and non-physiological. Current evidence therefore supports total arthroplasty as an option in select patients rather than a uniformly reliable alternative to arthrodesis and highlights the need for further implant development and longer-term evaluation of newer designs.
