Introduction Arthrodesis of the first metatarsophalangeal joint is the most reliable surgical option, with a low complication rate, for hallux rigidus from end-stage osteoarthritis.
Step 1: Surgical Approach Make a medial approach, following the mid-axis of the joint.
Step 2: Joint Preparation Using a cup-cone configuration provides excellent bone exposure, construct stability, and metatarsophalangeal joint congruity.
Step 3: Positioning of Arthrodesis Fix the toe in 5° to 10° of valgus and elevated 5 mm from the floor to achieve desired dorsiflexion.
Step 4: Application of Implants Achieve a stable construct with a crossed lag screw and a dorsal locking plate (a hybrid construct).
Step 5: Closure Perform a standard soft-tissue closure.
Step 6: Postoperative Care Allow weight-bearing as tolerated after two weeks and impact exercises only after bone healing has been shown on radiographs, which can take up to ten weeks.
Results Arthrodesis of the metatarsophalangeal joint in the hallux provides good results in terms of patient satisfaction and function, as demonstrated in many studies, most of them retrospective.
Pitfalls & Challenges
Introduction (Video 1)
Arthrodesis of the first metatarsophalangeal joint is the most reliable surgical option, with a low complication rate, for hallux rigidus from end-stage osteoarthritis.
Arthrodesis of the first metatarsophalangeal joint can be performed in many different ways—e.g., with use of wires, staples, sutures, crossed screws, parallel screws, intramedullary screws, screw(s) combined with plates, plates alone in various positions (medial or dorsal), different kinds of plates (nonlocking, hybrid, or locking), and external fixation. Biomechanical studies have shown that the most stable construct is a dorsal locking plate and a lag screw, followed by a lag screw and a nonlocking plate, screws alone, and a plate alone1,2. However, the clinical results do not necessarily agree with these biomechanical findings. In general, an extremely stable …
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