Comparison Total Joint Replacement with Arthrodesis of the 1st Metatarsophalangeal Joint

Abstract

Category: Midfoot/Forefoot; Other Introduction/Purpose: The aim of this study was to compare outcome (clinical, patient-reported outcome measures, radiological, joint motion and pedographic) of total joint replacement with Roto-Glide (RG) and arthrodesis (A) for severe osteoarthritis of the first metatarsophalangeal joint (MTP1). Methods: All consecutive patients with A and RG from January 23, 2011 until September 18, 2019 at the authors’ institution were considered for inclusion in the study. Preoperatively and at FU, radiographs and/or weight-bearing computed tomographic imaging were obtained. Standard dynamic pedography was performed. Visual-Analogue-Scale Foot and Ankle (VAS FA), European Foot and Ankle Society Score (EFAS Score), MTP1 range of motion for dorsi-/plantarflexion (DF/PF) were registered and compared pre- operatively and FU. Results: Seventy RG and 72 A were included. Preoperative VASFA/EFAS Score did not differ between RG and A (Average scores, VASFA, RG/A, 50.6/45,6; EFAS Score, RG/A, 10,7/10,6; each p>0.05). Wound healing delays without further operative measures were registered in 4 (6%) patients for RG and 5 (7%) for A (p=0.67), and 5 revisions in 5 (7%) for RG and 12 in 8 (11%) for A (p=0.05). The longest available FU was higher in RG than in A (RG/A, 47/37 months on average, p< 0.001). VASFA/EFAS Score at FU was higher in RG than in A (Average scores, VASFA, RG/A, 72,6/63,6; EFAS Score, RG/A, 16.1/14.1; each p< 0.05). DF/PF was only possible in RG (Average values DF/PF RG, 36.1/14.0) Conclusion: We found marginally lower revision rates and higher PROMs, joint motion (DF/PF) and more physiologic force distribution at slightly longer FU for the RG subgroup than the A subgroup. Longer follow-up and broader clinical reporting are needed to identify potential deficits of RG.