Management of late-stage degenerative joint disease of the first metatarsophalangeal
joint (MPJ) is a complex topic that is frequently the source of debate among foot
and ankle surgeons. Several surgical interventions have been described to treat this
condition. One of the most contested of these treatments is implant arthroplasty of
the first MPJ.
The primary aim of this meta-analysis was to evaluate the clinical benefit of first
MPJ implant arthroplasty in regard to patient satisfaction. Reviewers formally trained
in meta-analysis abstraction techniques searched databases and indices using medical
subject heading terms and other methods to identify all relevant studies published
since 1990. Initially, 3874 citations were identified and evaluated for relevance.
Abstract screening produced 112 articles to be read in entirety, of which 47 articles
studying 3049 procedures with a mean 61.48 (SD 45.03) month follow-up met all prospective
inclusion criteria necessary for analysis.
Overall crude patient satisfaction following first MPJ implant arthroplasty was 85.7%
(95% confidence interval: 82.5%–88.3%). When adjusting for lower quality studies (retrospective,
less than 5 years of follow-up, higher percent of patients lost to follow-up), the
overall patient satisfaction increased to 94.5% (89.6%–97.2%) in the highest-quality
studies. This adjustment also significantly decreased heterogeneity across studies
(crude Q = 184.6, high-quality studies Q = 2.053). Additional a priori sources of
heterogeneity were evaluated by subgroup analysis and meta-regression.
In regards to patient satisfaction, this comprehensive analysis provides supportive
evidence to the clinical benefit of first MPJ implant arthroplasties. Level of Clinical
Evidence: 1
Key Words
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References (In addition to studies included in the meta-analysis as listed in Appendix 1)
- Surgical options for salvage of end-stage hallux rigidus.Foot Ankle Clin. 2002; 7: 49-73
- Clinical Practice Guideline First Metatarasophalangeal Joint Disorders Panel of the American College of Foot and Ankle Surgeons.Section 2: Hallux rigidus. 2003; 42: 124-136
- Clinical experience with two-component first metatarsal phalangeal joint implants.Clin Podiatr Med Surg. 1995; 12: 403-413
- Grand rounds: first metatarsophalangeal joint replacement.J Foot Ankle Surg. 1996; 35: 78-85
- First metatarsophalangeal joint replacement: the method of choice for end-stage hallux rigidus?.Foot Ankle Clin. 2003; 8: 711-721
- Implant arthroplasty of the first metatarsalphalangeal joint.Clin Podiatr Med Surg. 2006; 23: 725-731
- An overview of first metatarsophalangeal joint implant arthroplasty.J Long Term Eff Med Implants. 1995; 5: 93-104
- Metatarsus primus elevatus in hallux rigidus: fact or fiction?.J Am Podiatr Med Assoc. 2005; 95: 221-228
- Hypermobility of the first ray: a critical review of the literature.J Foot Ankle Surg. 2003; 42: 377-390
- A prospective comparison of clinical, radiographic, and intraoperative features of hallux rigidus: short-term follow-up and analysis.J Foot Ankle Surg. 2002; 41: 158-165
- Calculation of theoretical lubrication regimes in two-piece first metatarsophalangeal prostheses.Biomed Mater Eng. 2008; 18: 45-51
- Use of grommets for flexible hinge implant arthroplasty of the great toe.Clin Orthop Relat Res. 1997; 340: 87-94
- Kinematics and contact characteristics of the first metatarsophalangeal joint.Foot Ankle Int. 1997; 18: 170-174
- Kinematics of the first metatarsophalangeal joint.J Bone Joint Surg Am. 1986; 68: 392-398
- The case against first metatarsal phalangeal joint arthroplasty.Clin Podiatr Med Surg. 2006; 23: 709-723
- Meta-analysis of observational studies in epidemiology: a proposal for reporting.JAMA. 2000; 283: 2008-2012
- Patient satisfaction after total knee arthroplasty: a comparison between subjective and objective outcome assessments.J Arthroplasty. 2001; 16: 740-747
National Institutes of Health. NIH consensus statement on total knee replacement. Available at: http://consensus.nih.gov/2003/2003TotalKneeReplacement117PDF.pdf. Accessed December 18, 2008.
Appendix 1
Studies included in this meta-analysis
- A retrospective analysis of Swanson Silastic double-stemmed great toe implants with titanium grommets following podiatric surgery for arthritic joint disease.Foot. 2000; 10: 69-74
- Swanson double-stem arthroplasty of the hallux: a survivorship analysis.Foot Ankle Surg. 1999; 5: 235-243
- The MOJE total joint arthroplasty for 1st metatarso-phalangeal osteoarthritis: a short-term retrospective outcome study.Foot. 2008; 18: 150-155
- Long-term follow-up of silastic joint replacement of the first metatarsophalangeal joint.Foot. 2003; 13: 151-155
- Retrospective analysis of Silastic implant arthroplasty of the first metatarsophalangeal joint.J Foot Ankle Surg. 1998; 37: 128-134
- Arthroplasty of rheumatoid metatarsophalangeal joints.Clin Orthop Relat Res. 1997; 340: 48-57
- Arthroplasty of the first metatarsophalangeal joint with a double-stem silicone implant.J Bone Joint Surg Am. 1992; 74: 552-563
- Non-constrained titanium-polyethylene total endoprosthesis in the treatment of hallux rigidus: a prospective clinical 2-year follow-up study.Scand J Surg. 2002; 91: 202-207
- Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial.Foot Ankle Int. 2005; 26: 680-690
- Use of a hinged silicone prosthesis for replacement arthroplasty of the first metatarsophalangeal joint.J Bone Joint Surg Am. 1991; 73: 1453-1459
- TOEFIT-PLUS replacement of the first metatarsophalangeal joint of the first toe: a short-term follow-up study.Foot. 2008; 18: 20-24
- Flexible hinge toe implant arthroplasty for rheumatoid arthritis of the first metatarsophalangeal joint: long-term results.J Orthop Sci. 2001; 6: 141-147
- Silastic metatarsophalangeal arthroplasty: very long-term results of single-stem implants in degenerative joint disease.Foot. 2003; 13: 146-150
- Short-term follow-up of ceramic press fit first metatarso-phalangeal joint arthroplasty.Foot. 2006; 16: 142-144
- Resurfacing of the first metatarsal head in the treatment of hallux rigidus.Techniques in Foot and Ankle Surgery. 2008; 7: 31-40
- Possibilities of therapy of hallux valgus et rigidus in a private hospital (Swanson great toe implant) [in German].Langenbecks Arch Chir Suppl Kongressbd. 1991; : 396-400
- A long-term review of replacements of the great toe metatarsophalangeal joint using a bistemmed silicone elastomer ball-shaped spacer.Foot. 1997; 7: 61-67
- Silicone implant arthroplasty: a retrospective analysis.J Foot Ankle Surg. 1993; 32: 430-433
- The new press-fit ceramic Moje metatarsophalangeal joint replacement: short-term outcomes.Foot. 2004; 14: 124-128
- Koenig total great toe implant.J Am Podiatr Med Assoc. 1990; 80: 462-468
- Mid-term results of titanium hemi-great toe implants.Foot Ankle Int. 2006; 27: 922-929
- Mid-term results of futura hemi-great toe implants.Foot Ankle Int. 2008; 29: 831-837
- Intermediate results with Swanson's hallux implant [in German].Z Orthop Ihre Grenzgeb. 1990; 128: 519-524
- Silastic joint arthroplasty of the great toe.Clin Orthop Relat Res. 1990; 255: 268-272
- Long-term results of single stem silastic implants in the metatarsophalangeal joint [in German].Z Orthop Ihre Grenzgeb. 1998; 136: 83-86
- Long-term efficacy of total SILASTIC implants: a subjective analysis.J Foot Ankle Surg. 1997; 36: 341-346
- Replacement of the first metatarsophalangeal joint with a silicone elastomer ball-shaped spacer.Foot Ankle. 1990; 10: 257-262
- The double-stemmed silicone-rubber implant for rheumatoid arthritis of the first metatarsophalangeal joint.J Bone Joint Surg Am. 1992; 74: 564-750
- Silastic arthroplasty of the great toe metatarsal joint [in German].Orthopade. 1996; 25: 332-337
- Early results of implantation of an unconstrained metatarsophalangeal joint prosthesis of the first toe [in German].Z Orthop Ihre Grenzgeb. 2001; 139: 326-331
- Replacement arthroplasty for hallux rigidus: 21 patients with a 2-year follow-up.Int Orthop. 1999; 23: 240-243
- Early results of ceramic/ceramic first metatarsophalangeal joint replacement.Foot. 2004; 14: 204-206
- Survivorship analysis of implant arthroplasty for the first metatarsophalangeal joint.Clin Orthop Relat Res. 1994; 302: 164-172
- Double-stem silicone implant arthroplasty of all metatarsophalangeal joints in patients with rheumatoid arthritis.Semin Arthroplasty. 1992; 3: 16-24
- First metatarsophalangeal joint replacement using the bio-action great toe implant: intermediate results.Foot Ankle Int. 2005; 26: 1033-1037
- Silicone granulomatous reactions after first metatarsophalangeal hemiarthroplasty.J Bone Joint Surg Br. 1993; 75: 637-639
- Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint.J Bone Joint Surg Am. 2007; 89: 1979-1985
- Use of titanium grommets in silicone implant arthroplasty of the hallux metatarsophalangeal joint.Foot Ankle Int. 1996; 17: 145-151
- Treatment of hallux rigidus with the TOEFITPLUS joint replacement system.Interactive Surgery. 2007; 2: 77-85
- Treatment of hallux rigidus with the TOEFITPLUS joint replacement system.Interactive Surgery. 2007; 2: 77-85
- Treatment of hallux rigidus with the TOEFITPLUS joint replacement system.Interactive Surgery. 2007; 2: 77-85
- Hinged silastic implants of the great toe.Clin Orthop Relat Res. 1991; 272: 227-234
- Silastic single-stem implants in the treatment of hallux rigidus.Foot Ankle Int. 1995; 16: 487-491
- Hemiarthroplasty in the treatment of hallux rigidus.Foot Ankle Int. 2008; 29: 273-281
- Contemporary approaches to stage II and III hallux rigidus: the role of metallic hemiarthroplasty of the proximal phalanx.Foot Ankle Clin. 2005; 10: 713-728
- A metallic hemiarthroplasty resurfacing prosthesis for the hallux metatarsophalangeal joint.Foot Ankle Int. 1994; 15: 575-580
- A ceramic prosthesis for hallux rigidus.Foot. 2001; 11: 24-27
Article info
Publication history
Published online: January 12, 2009
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2009 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
