Bone-Block Arthrodesis Procedure in Failures of First Metatarsophalangeal Joint Replacement

Category: Midfoot/Forefoot Introduction/Purpose: The treatment of the failure of the first metatarsophalangeal joint (MTP1) prosthesis can be complex. There is no consensus regarding treatments options. The main issue is the available bone stock.The aim of the study was to report on clinical and radiographic results for MTP1 arthrodesis with autologous bone graft (bone-block fusion) as a revision procedure of a previous MTP1 implant failure. Methods: We enrolled 12 patients who underwent MTP1 prosthesis failures and retrospectively collected data. All the patient underwent removal of the prosthetic implant and simultaneous MTp1 arthrodesis with autologous bone graft, harvested from the ipsilateral calcaneus (minimum follow-up of 24 months). The minimum time period elapsed between the surgical procedure of prosthetic implant and the revision surgery has been 18 months. Patients were evaluated preoperatively with a weight-bearing radiograph of the foot and CT-scan and at 24 months after surgery with Foot Ankle Disability Index (FADI). Results: The reasons for implant-failures were: 8 mobilization and 4 malalignment. The average defect filled with bone-block was 12.2 mm. The fusion was performed with a plate and locking-screws. We had 3 cases of asymptomatic nonunion at the falangeal side of the fusion, none on the other side. Mean average rate of consolidation in other patients was 10 weeks. All patients returned to common activities’ of daily living. Average FADI was foun1d to be 84.6 at final follow-up. Conclusion: The management of this pathology is still controversial. Bone-block MTP1 arthrodesis The main limitation of the study is the small sample. seems to be a viable option