Second-Generation Ceramic First Metatarsophalangeal Joint Replacement for Hallux Rigidus

Background: Ceramic first metatarsophalangeal (MP) joint replacement has been reported for treatment of hallux rigidus, but there are no published mid-or long-term studies available. We present our midterm results using a second-generation ceramic first MP joint implant. Methods: A retrospective review of clinical data and radiographs was performed for 31 feet (24 women; mean age at surgery, 55 +/- 6 years) who had first MP joint replacement with a second-generation ceramic prosthesis (primary, 29 feet; revision, 2 feet). Mean follow-up was 81 +/- 27 months after surgery Results: Mean first MP passive range of motion was 32 +/- 17 degrees (dorsi-and plantarflexion). Mean AOFAS score was 72 +/- 19 points and Foot Function Index was 27 +/- 26 points (all 31 feet). Clinical rating for 29 feet that had surgery as a primary procedure was excellent in 5 feet (17%), good in 8 feet (28%), fair in 3 feet (10%), and poor in 13 feet (45%). Patients were satisfied with the outcome in 24 feet (77%). Follow-up radiographs showed that radiolucency, change in angulation, sinkage, and malalignment of the metatarsal or proximal phalanx components were common. Complications included 1 superficial wound infection, and revision was performed in 5 feet (16%) because of loosening, sinkage, subluxation, pain, or fractured prosthesis. Implant survival was 92% at 5 years, 85% at 7 years, and 68% at 9 years. Conclusion: The results of second-generation ceramic first MP joint replacement in our series demonstrated poor clinical and radiological results with a high revision rate.