Salvage of failed first metatarsophalangeal joint fusion utilizing custom 3D implant

Abstract

Failure to achieve union and proper alignment of the first metatarsophalangeal joint after arthrodesis can result in the need for revision of the attempted fusion. If further complications arise following revisional surgery, the risk of toe amputation increases. In recent years, there has been a rise in the utilization of patient specific implants, which have shown promise especially in revisional type surgeries. The following case report details a patient seeking evaluation as a second opinion of a painful first metatarsophalangeal joint after several attempts of fusion. As the patient declined toe amputation, an additive manufactured implant was utilized where the patient recovered and was able to return to pain free ambulation with proper alignment of the hallux. These outcomes suggest that a patient specific implant can be considered as a promising alternative to toe amputation in revisional type pathologies of the forefoot.

Keywords

• Metatarsophalangeal joint
• Limb salvage
• 3D printing
• Custom implant
• Revision
• Forefoot reconstruction