First metatarsophalangeal joint percutaneous arthrodesis

The aim of this work is to describe a percutaneous technique of first metatarsophalangeal (MTP1) joint fusion and to assess its preliminary results. Thirty-two percutaneous MTP1 joint arthrodeses were analysed in a prospective continuous series including 30 patients of mean age 66 years old. The indications for arthrodesis of the MTP1 joint were symptomatic hallux rigidus or hallux rigido-valgus in most of the cases. All patients underwent the same percutaneous procedure, as a one-day surgery for 26 cases. Clinical results were assessed using the functional AOFAS forefoot scoring system both preoperatively and at last follow-up. Radiographical analysis was focused on positioning and quality of the arthrodesis. No patient was lost to follow-up and the mean follow-up was 18 months. The functional AOFAS score improved in all cases from a mean 36/100 preoperatively to a mean 80/100 postoperatively (p = 0.02). In 30 cases, patients were satisfied or very satisfied with their final outcome, one patient was disappointed and one was dissatisfied. Satisfied or very satisfied patients could wear normal shoes after a mean 50-day period. Fusion was radiographically obtained in 31 cases out of 32. The mean postoperative dorsi flexion of the MTP1 joint arthrodesis was 21 degrees (min: 15 degrees, max: 35 degrees). One patient developed a deep surgical site infection, 3 weeks after the procedure. Percutaneous MTP1 joint fusion is a simple surgical technique that can achieve similar results to open techniques for MTP1 fusions, with very simple postoperative care requirements. Indications for percutaneous MTP1 joint arthrodesis are large and only major bone defects or severe osteoporosis can be considered as contraindications. Level of evidence: Level IV. (C) 2010 Elsevier Masson SAS. All rights reserved.