Emerging Insights On The First MPJ Arthrodesis
Fixation typically occurs with two crossing 3.5 mm cortical screws. Place one screw from proximal-medial to distal-lateral and the second from distal-medial in the phalanx into the proximal-lateral aspect of the first metatarsal. Place the screws using a lag technique. Be sure to provide considerable compression and stable fixation when placing the screws in a bicortical fashion. Stack the screws on top of one another to provide uniform fixation throughout the fusion site. Surgeons may utilize other types of screw fixation using a similar construct based on surgeon preference.
The senior author recommends capsular closure using a running 3-0 vicryl and skin closure using a 4-0 nylon stitch. One should ensure limited subcutaneous closure in order to prevent soft tissue irritation medially. Patients wear a controlled ankle motion (CAM) boot postoperatively and stay non-weightbearing for at least four weeks. In weeks four through eight, patients typically may bear weight on the heel only in a CAM boot. At or around eight weeks, the patient progresses to regular shoe gear based on radiographic healing.
When it comes to considering first MPJ arthrodesis in the management of hallux rigidus, one should carefully weigh the patient’s age, overall health status, prior surgeries and exhaustion of conservative efforts. For the active patient whose quality of life is deteriorating due to first MPJ osteoarthritis and for whom conservative treatments have failed, we recommend first MPJ arthrodesis with crossed screw fixation.
It is clear from the current literature that first MPJ arthrodesis is a cost-effective method of reducing first MPJ pain and gaining overall patient satisfaction. With constant advances in fixation techniques and materials, union rates are very high.
More importantly, first MPJ arthrodesis maintains postoperative function and quality of life, and the procedure offers reproducible and predictable results.
Ms. Swanson is a third-year podiatric medical student at the College of Podiatric Medicine and Surgery at Des Moines University in Des Moines, Iowa.
Ms. Dyack is a third-year podiatric medical student at the College of Podiatric Medicine and Surgery at Des Moines University in Des Moines, Iowa.
Dr. Lee is in private practice at Capital Orthopaedics and Sports Medicine, PC. He is an Associate Clinical Professor at the College of Podiatric Medicine and Surgery at Des Moines University in Des Moines, Iowa. Dr. Lee is a Fellow and Past President of the American College of Foot and Ankle Surgeons.