First metatarsophalangeal joint arthrodesis with titanium cage implant to address iatrogenic deformities of the first ray

Abstract

First metatarsophalangeal joint arthrodesis with titanium porous lattice cage implant can be a feasible salvage procedure to restore length of the first ray, reestablish the metatarsal parabola, stabilize the first metatarsophalangeal joint and correct for positional deformity of the hallux. This case series describes the surgical technique and functional outcomes in 2 patients who underwent first metatarsophalangeal joint arthrodesis using a titanium porous lattice cage implant system secondary to significant deformities of the first metatarsal head. Patient 1 (N1) was diagnosed with avascular necrosis of the first metatarsal head and a significantly shortened first metatarsal, which subsequently developed from a previously attempted hallux valgus surgery. Patient 2 (N2) was diagnosed with a severe contracted mallet toe deformity of the hallux, which subsequently developed from a previous first metatarsophalangeal joint resection due to acute osteomyelitis of the first metatarsal head secondary to a puncture wound. Both patients achieved optimal surgical outcomes with complete radiographic and clinical osseous incorporation of the cage implant and arthrodesis site. No recurrence of any first metatarsophalangeal joint deformity was identified. Each patient eventually returned to regular shoe gear and preoperative activity levels, including full preoperative employment work status. Both patients expressed satisfaction in their surgical outcomes. Therefore, first metatarsophalangeal joint arthrodesis with titanium porous lattice cage implant can be utilized to address certain iatrogenic deformities of the first ray.

Keywords

• IV
• Case Series