Arthrodesis Associated With Greater Patient Satisfaction Versus Synthetic Implant

For patients with hallux rigidus 3 or 4 with either first metatarsophalangeal joint (MTPJ), arthrodesis more effectively decreased pain and improved function within one year compared with synthetic implant. Results of this study were presented at the AAOS 2021 Annual Meeting.

Muhammad Yazid Mutawakkil, MD, of Northwestern University, and colleagues examined patient reported outcomes among 69 patients who underwent surgery at a single institution. Thirty-three patients were treated with MTPJ arthrodesis and 36 were treated with Cartiva synthetic implant.

The researchers analyzed Patient-reported Outcome Measurement Information System (PROMIS) scores for pain interference, physical function, and Likert satisfaction scores for all patients. In their analysis, only patients in the arthrodesis group showed significant improvement in physical function PF (P<0.01). Arthrodesis also was associated with superior improvement of pain improvement at one year post surgery.

Regarding patient satisfaction, Likert surveys (available in 62 of 69 patients) showed that 78% of patients in the arthrodesis group were “very satisfied” or “somewhat satisfied” with their surgery, compared with 56% in the synthetic implant group. More patients in the synthetic implant group reported being “somewhat dissatisfied” or “very dissatisfied” compared with the arthrodesis group (33% vs. 15%).

However, patients treated with arthrodesis had more reoperations, which included three patients who underwent removal of symptomatic hardware and three revision surgeries for nonunion. One patient in the synthetic implant group had a peri-implant fracture that required open reduction–internal fixation.

“This assessment tool demonstrates that arthrodesis is the superior option from the patients’ perspective and experience,” the researchers concluded. “These findings are consistent with previous studies, thus adding to the perpetual debate on the optimal operative treatment for hallux rigidus.”