Poster - #VH-19485 - Keywords: interpositional arthroplasty joint sparing first MPJ fusion

Analysis of Interpositional Arthroplasties as a Joint Sparing Primary Procedure When Compared with First Metatarsal Phalangeal Joint Fusions - A Single Center Preliminary 12 Year Longitudinal Study

Shalvi Prasad DPM [1], Andrew Ferguson DPM [1], Soran Azizi DPM [1], Anish Sharma DPM [1], Matthew Cobb DPM FACFAS [2], Zachary Haas DPM FACFAS [2]
[1] DVA – New Mexico Veterans Affairs Health Care System and Kaiser Foundation Hospital [2] Albuquerque Associated Podiatrists

ABSTRACT:
This study compares the effectiveness of interpositional arthroplasty (IPA) using acellular dermal matrix versus first metatarsal phalangeal joint (MTPJ) fusion in treating hallux rigidus (HR), based on pre-operative Coughlin and Shurnas (CS) scores. The aim is to determine if there is a difference in patient satisfaction between the two procedures and if CS scores can predict better satisfaction outcomes. HR is characterized by pain and limited motion in the first MTPJ. Gould et al. identified HR as a common foot issue in America. Butler et al. discussed IPA’s role as a joint-sparing option, with Berlet et al. showing positive outcomes using regenerative tissue matrices for advanced HR. Donegan, as well as Scheurer et al., reported long-term success with MTPJ fusion, particularly in severe cases. In this study, 67 patients underwent IPA and 122 underwent MTPJ fusion. Pre- and postoperative outcomes were assessed using VAS, FAOS, and FFI scores, with HR severity graded by CS scores. A total of 26 IPA and 12 MTPJ fusion patients were able to be contacted. Four IPA patients later required fusion. There was no statistically significant difference in patient satisfaction between IPA and MTPJ fusion when comparing CS scores. IPA appears to be a viable joint-sparing alternative, offering no significant difference in satisfaction or functional improvement compared to MTPJ fusion, regardless of CS scores. These findings challenge previous research suggesting better satisfaction with fusion for severe HR. Over the last 12 years, both procedures yielded comparable patient satisfaction, regardless of their preoperative CS scores.