Arthrodesis of the first metatarsophalangeal joint with ball and cup reamers and osteosynthesis with pure titanium staples Radiological evaluation of a continuous series of 54 cases

Abstract

Background: In a continuous series of 54 MTP-1 arthrodeses using ball and cup reamers, fusion and great toe position were analyzed.

Materials and methods: The population was mainly female (46 versus 8). Mean age at operation was 61 years. Arthrodesis was for four conditions of symptomatic degenerative disease: 36 severe hallux valgus (>35 degrees ), 7 recurrences of hallux valgus, 9 hallux rigidus and 2 hallux varus. Arthrodesis used a medial approach, articular surface preparation by ball and cup reamers (plus perforation by Kirschner wire), and osteosynthesis with three titanium staples. Pre- and postoperative big toe positions were analysed with the Footlog semi-automated X-ray assessment software.

Results: All patients were followed up for a mean 38.6 months (22-56). Overall fusion rate was 94.4%, and 99% for primary arthrodesis. Mean time to union was 56 days (74% in 6 weeks), with 3 non-unions (5.6%), including 2 after hallux valgus recurrence. Mean pre-operative toe valgus was 40 degrees and 14.1 degrees at revision for all groups. 95% of arthrodeses fused at a mean lateral metatarsophalangeal angle of 22.6 (18-26 degrees ). Metatarsus varus exceeded 20 degrees in 8 cases, mainly in the severe hallux valgus group; at revision, the mean first intermetatarsal angle was 10.6 degrees (9-12 degrees ).

Conclusion: Arthrodesis of the first metatarsophalangeal joint with ball and cup reamers is a reliable and reproducible technique, giving total correction of big toe valgus. The first intermetatarsal angle was corrected without supplementary osteotomy. Using three pure titanium staples for fixation, rate and time of fusion were in line with reference techniques.