Abstract
Abstract
Background
The role of first metatarsophalangeal (MTP) joint arthroplasty in hallux rigidus remains controversial. Although used as a motion-preserving alternative to arthrodesis, outcomes vary between studies and implant designs. This systematic review and meta-analysis evaluated clinical outcomes, range of motion (ROM), and implant survivorship following total first MTP arthroplasty.
Methods
A systematic review identified studies reporting pre- and postoperative outcomes following total first MTP arthroplasty for hallux rigidus. Pooled outcomes were the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI) score, visual analogue scale (VAS) pain score, and ROM. One postoperative timepoint per study was selected using a prespecified rule, prioritising the timepoint closest to 24 months, or follow-up between 12 and 36 months where discrete timepoints were not reported. Random-effects pre-post meta-analysis used an assumed pre-post correlation of 0.5. Heterogeneity, prediction intervals, leave-one-out analysis, and sensitivity analyses were performed.
Results
Twelve studies were included in the AOFAS-HMI meta-analysis, seven in the VAS meta-analysis, and thirteen in the ROM meta-analysis. Arthroplasty was associated with a pooled improvement in AOFAS-HMI of 42.76 points (95% CI 38.44–47.09;
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Conclusions
Total first MTP arthroplasty is associated with improvement in pain and function, but these benefits should be interpreted alongside appreciable revision and radiographic failure rates. ROM improves on average, although restoration of motion remains inconsistent and non-physiological. Current evidence therefore supports total arthroplasty as an option in select patients rather than a uniformly reliable alternative to arthrodesis and highlights the need for further implant development and longer-term evaluation of newer designs.