Background: Currently, arthrodesis is the most commonly performed
surgical procedure for the treatment of severe arthritis of the first
metatarsophalangeal joint. The objective of this study was to compare the
long-term clinical and radiographic outcomes of a metallic hemiarthroplasty
with those of arthrodesis for the treatment of this condition.
Methods: A series of patients with osteoarthritis of the first
metatarsophalangeal joint were treated with either a metallic hemiarthroplasty
or an arthrodesis between 1999 and 2005. Postoperative satisfaction and
function were graded with use of the American Orthopaedic Foot and Ankle
Society Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) scoring system,
and pain was scored with use of a visual analogue scale.
Results: Twenty-one hemiarthroplasties and twenty-seven arthrodeses
were performed in forty-six patients. Five (24%) of the hemiarthroplasties
failed; one of them was revised, and four were converted to an arthrodesis.
Eight of the feet in which the hemiprosthesis had survived had evidence of
plantar cutout of the prosthetic stem on the final follow-up radiographs. At
the time of final follow-up (at a mean of 79.4 months), the satisfaction
ratings in the hemiarthroplasty group were good or excellent for twelve feet,
fair for two, and poor or a failure for seven. The mean pain score was 2.4 of
10. All twenty-seven of the arthrodeses achieved fusion, and no revisions were
required. At the time of final follow-up (at a mean of thirty months), the
satisfaction ratings in this group were good or excellent for twenty-two feet,
fair for four, and poor for one. The mean pain score was 0.7 of 10. Two
patients required hardware removal, which was performed as an office procedure
with the use of local anesthesia. The AOFAS-HMI and visual analogue pain
scores and satisfaction were significantly better in the arthrodesis
Conclusions: Arthrodesis is more predictable than a metallic
hemiarthroplasty for alleviating symptoms and restoring function in patients
with severe osteoarthritis of the first metatarsophalangeal joint.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.