Total Joint Replacement of the First Metatarsophalangeal Joint with Roto-Glide as Alternative to Arthrodesis

Abstract

Category:Midfoot/ForefootIntroduction/Purpose:Total joint replacement (TJR) and arthrodesis (A) are treatment options for severe osteoarthritis of the first metatarsophalangeal joint (MTP1). The aim of this study was to compare outcome (clinical and pedographic) of TJR (Roto- Glide) and A of MTP1.Methods:All patients that completed follow-up of at least 24 months after TJR and A of MTP1 before November 5, 2018 were included in the study. Preoperatively and at follow-up, radiographs and/or weight-bearing computed tomographies (WBCT) were obtained. Degenerative changes were classified in four degrees. Standard dynamic pedography was performed (percentage force at first metatarsal head/first toe from force of entire foot). Visual-Analogue-Scale Foot and Ankle (VAS FA) and MTP1 range of motion for dorsi-/plantarflexion (ROM) were registered and compared pre-operatively and follow-up. From November 24, 2011 until October 31, 2016, 25 TJR and 49 A were performed that completed follow-up.Results:Parameters (average values if not stated otherwise) for TJR/A were preoperatively: age 59/60 years; 7(28%)/14(29%) male; height 168/169 cm; weight 71/72 kg; degree degenerative changes 3.3/3.1; ROM 19.4/0/9.8°//20.3/0/9.2°; percentage force first metatarsal/first toe 7.9/14.6//8.5/15.3; VAS FA 45.9/46.2. Six wound healing delays were registered (TJR 2, A 4) as only complications. Follow-up time on average 45.7/46.2 and range 25.0-80.3/24.1-81.1 months. VAS FA at follow-up was 73.4/70.2.; percentage force first metatarsal/first toe 15.8/5.8//12.3/10.8; ROM 35.6/0/10.5°//10.5/0/0. Parameters did not differ between TJR and A (each p>.05) except higher force percentage first toe and lower ROM for A at follow-up (each p<.05). VAS FA and pedography parameters improved for TJR and A between preoperatively and follow-up, ROM increased for TJR and decreased for A (each p<.05).Conclusion:TJR and A were performed in similar patient cohorts regarding demographic parameter, degree of degenerative changes, ROM, pathological pedographic pattern, and VAS FA. TJR and A improved pathological pedographic pattern and VAS FA at minimum follow-up of 24 months. TJR additionally improved ROM and showed better pedographic pattern (and not different to physiological pattern) than A. Survival rate of TJR was 100% up to 6 years. In this study, TJR was a valuable alternative to A for treatment of severe MTP1 osteoarthritis.