ARTHRODESIS OF THE FIRST METATARSOPHALANGEAL JOINT TO SALVAGE FAILED SILICONE IMPLANT ARTHROPLASTY

Between 1987 and 1992, all patients presenting to the senior author wi th a symptomatic failed silicone implant arthroplasty refractory to co nservative treatment were converted to a metatarsophalangeal joint art hrodesis, Internal fixation was achieved with either dual intramedulla ry threaded Steinmann pins or an obliquely placed AO compression screw and a three- or four-hole one-third tubular dorsal neutralization pla te. Bone grafting was used to maintain hallux length, Successful arthr odesis was achieved in all five feet in patients with rheumatoid arthr itis. Subjectively, patients improved from an average of 0.69 before a rthrodesis to 4.89 after arthrodesis. The average walking tolerance im proved from 1.11 to 4.80, and the overall level of satisfaction improv ed from 0.0 to 4.79, The patient's ability to wear shoes improved from 0.87 to 3.1. Successful arthrodesis produces a foot that is more func tional and durable than excisional arthroplasty. Subjectively, these p atients stated that their level of pain, walking tolerance, and overal l satisfaction improved significantly after the arthrodesis. Clinicall y, there was no evidence of transfer lesions, tenderness, or hallux su bluxation, Hallux length was well maintained after surgery with bone g rafting, but it was more difficult to obtain the alignment goals, The average postoperative metatarsophalangeal dorsiflexion angle was 15.6 degrees and the first metatarsophalangeal angle was 3.1 degrees. Despi te this, patient satisfaction was high. Arthrodesis of the first metat arsophalangeal joint using a bone graft to salvage failed silicone imp lant arthroplasty produces acceptable subjective and radiographic resu lts, Although technically demanding, it provides long-term stability t o the hallux, restores weightbearing, and allows for maintenance of a propulsive gait, We recommend this procedure instead of an excisional arthroplasty to maintain high level of function and overall patient sa tisfaction.