Total ceramic arthroplasty for painful, destructive disorders of the lesser metatarso-phalangeal joints

Abstract

Background Destructive disorders of the lesser metatarso-phalangeal joints (MTPJ) can present a challenging problem. There is little consensus with regard to the management of these lesions, partly due to their relative rarity, particularly in the case of the advanced lesion. We describe the use of a total ceramic arthroplasty in 9 such patients. Method Since May 2001, 9 patients have been treated with a Moje total ceramic arthroplasty. All were female with a mean age of 51 (range 25–66) and included eight second MTPJs and one-third MTPJ. The indications for surgery included primary and revision procedures for Freiberg's infraction and post-traumatic arthrosis. One case required a customized implant. Patients were followed up in a dedicated clinic using the AOFAS Lesser Metatarsophalangeal-Interphalangeal Scale. Results No patients were lost to follow-up, mean follow-up 23 months (range 6–46). Mean AOFAS score was 75 (range 42–92) with 8 patients reporting a good or excellent outcome. Conclusion The aims of surgery for these lesions are to provide pain relief whilst maintaining function, alignment, stability and length. A number of procedures have previously been described but treatment remains controversial. Our early results in a small group of patients with the Moje total ceramic arthroplasty have been encouraging.