Is Arthrodesis The Answer For First MPJ Arthritis?

By Brian McCurdy, Associate Editor

What is the best treatment approach for seniors who have painful arthritis in the first MPJ? Arthrodesis may provide significant pain relief for these patients, according to the results of a recent 29-patient study presented at the annual meeting of the American College of Foot and Ankle Surgeons (ACFAS).
A retrospective analysis revealed that 100 percent of 19 patients who responded to a survey said they were satisfied with the results of the arthrodesis, which involves fusing arthritic bones to inhibit motion and eliminate the arthritis. These patients also noted they would undergo the procedure again if necessary.
Lawrence A. DiDomenico, DPM, one of the study’s authors, says MPJ arthrodesis can help facilitate a better quality of life for seniors with arthritis.
“When the MPJ area becomes arthritic, it is very uncomfortable as this area propels the foot when walking,” explains Dr. DiDomenico. “Therefore, walking short distances — even across a room — can be a painful experience. By eliminating this joint motion, arthrodesis surgery allows the patient to walk pain free and pursue a more active lifestyle.”
There are an array of other possible treatment modalities (such as a Keller bunionectomy or an implant) that DPMs can use to treat this condition. While Dr. DiDomenico concedes that he usually opts for a bunionectomy when these patients are over 65, he refutes the perception that arthrodesis may be a risky proposition for seniors due to possible osteoporosis.
“Patients over 65 can handle (arthrodesis) just as effectively,” notes Dr. DiDomenico. “The success rate of MPJ fusion surgery exceeds 90 percent and one of the patients in our study was 86.”
Harold D. Schoenhaus, DPM, says he uses arthrodesis as a “last resort,” but prefers procedures that maintain motion. Like Dr. DiDomenico, he also uses implants and Keller bunionectomies to treat these patients. When attempting fusion, however, Dr. Schoenhaus says there is a risk of patients experiencing mal-, non- or delayed union.
“It’s a tricky process. There’s a certain learning curve to doing fusions,” says Dr. Schoenhaus, the Chief of Foot And Ankle Surgery at the Graduate Hospital of Philadelphia.
Dr. Schoenhaus questioned the long-term results in those who have undergone the fusion technique. He wondered if patients would transfer their weight to the other foot after the surgery and experience metatarsalgia.
“There’s nothing to indicate any of that” in the study, says Dr. Schoenhaus, “but I would suspect that you may see some of that.”

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