The Outcome of the Use of Continuous Action Compression Device for the First Metatarsophalangeal Joint Fusion

Abstract

Introduction: First metatarsophalangeal (MTP) joint fusion is a widely accepted surgical intervention for treating severe arthritis, deformities, and instability of the first MTP joint. This paper provides a review of a single surgeon's experience with continuous compression implants (CCI), which offer a notable advantage by providing uniform compression across a larger surface area of the fusion site compared to plate and screw constructs. This design potentially reduces soft tissue irritation and, consequently, the need for subsequent implant removal. It also saves on cost and has the potential to reduce the length of surgery.

Methods: A retrospective review was conducted on 27 patients (n=36 feet) who underwent primary first metatarsophalangeal joint (MTPJ) fusion using continuous compression implants (CCI) between March 2020 and April 2024 at Bradford Royal Infirmary. Patient data were collected from the surgeon's logbook and medical records. The outcomes analyzed included the fusion rate and complications. Statistical analysis was performed using SPSS version 22.0, with p<0.05 considered significant.

Results: The mean age of the cohort was 60.24 years (range 41-90), with 88.88% female. The ratio of left to right was 70%. The mean follow-up duration was 27 months (range 6-48 months). Complete fusion of the first MTPJ was achieved in 34 out of 36 feet (94.4%). Nonunion occurred in one patient, while delayed union was observed in another. Clinically, 35 out of 36 patients (97.3%) reported satisfaction with the procedure, with one patient requiring metalwork removal and revision due to loosening.

Conclusion: Early results show that the rate of fusion achieved by using the CCI for the first MTPJ arthrodesis in our series was comparable to that of other devices quoted in the literature.

Keywords: ankle and foot; foo and ankle; great toe; mtp fusion; small joint arthritis.

Figure 1. An intraoperative mini C-arm fluoroscope confirming the position of staples

A: AP radiograph. B: Oblique radiograph AP: Anteroposterior

Figure 2. AP X-ray of left foot taken at six weeks showing signs of healing

WB: Weight-bearing; AP: Anteroposterior

Figure 3. Illustration of biomechanical compression of stables in comparison to plates with screws and crossing screws.

BME: Biomedical enterprises. Reprinted from the Comprehensive Overview of Orthopedic Solutions - CONTINUOUS COMPRESSION IMPLANTS (DePuy Synthes, 2021), with permission. Permission was obtained from DePuy Synthes.

Figure 4. X-ray of left foot taken at three months showing healed fusion site.

Figure 5. Graphical representation of patient factors and surgical outcomes in fusion procedures

A: Age distribution of patients: Showing the age range and frequency of patients who underwent the procedure, indicating a concentration of cases among individuals aged 41-90. B: Fusion rate: Displaying the proportion of successful versus failed fusions, with a high success rate of 94.4%. C: Patient satisfaction: Illustrating satisfaction levels post-surgery, with a 96.3% satisfaction rate, indicating favorable patient-reported outcomes. D: Follow-up duration: Depicting the distribution of follow-up periods, showing that most patients were monitored between 6 and 48 months post-procedure.

Figure 6. Serial X-rays of the left foot of a patient who underwent the first MTPJ fusion

A: Preoperative X-ray; B: Intraoperative X-ray; C: Postoperative X-ray; MTPJ: Metatarsophalangeal joint