A multicentre retrospective cohort study of First metatarsophalangeal joint arthrodesis

Abstract In this multicenter study, we evaluated commonly used methods of fixation and two methods of joint preparation for first metatarsophalangeal joint (MTPJ) fusion, in terms of radiological union and revision rates. Included were 409 consecutive fusions in 385 patients. The overall union rate was 91.4% (34/409). 29.4% (10/34) of our non-unions were symptomatic. Preoperative hallux valgus showed a statistically significant relation to non-union (OR = 9.33, p = 0.017). Other potential contributing factors like gender (OR1.9, p = 0.44), diabetes (OR = 0, p = 0.99), steroid use (OR = 2.07, p = 0.44), inflammatory arthritis (OR = 0, p = 0.99) and smoking (OR = 2.69, p = 0.34) did not attain statistical significance. Further, the methods of fixation like solid screws (OR = 0, p = 0.99), plate (OR = 3.6, p = 0.187) or cannulated screws (OR = 0.09, p = 0.06) showed no correlation with incidence of non-union. We compared two techniques of joint preparation and found no significant difference in union rates (Chi-square = 1.0426, p = 0.30). Our crude comparison of costs showed the average saving to the trust per year could be 33,442.50£ by choosing screws over plates. To conclude, only hallux valgus had a statistically significant relation to non-union. All other variables had no significant impact on the union. Solid screw seems to be economically the most viable option and a valid alternative.