Is arthrodesis still the best treatment option for first metatarsophalangeal joint arthritis?—a systematic review of arthrodesis and arthroplasty outcomes

Background: To analyse if there is scientific support to consider arthrodesis as the gold standard treatment for advanced hallux rigidus, as compared to hemi or total arthroplasty. The hypothesis was that arthroplasty would provide at least comparable results to arthrodesis in patients with advanced hallux rigidus. Methods: PubMed and EMBASE databases were searched for clinical studies up to July 2019. We included cohort studies and case series that report the clinical outcomes of arthrodesis or arthroplasty (either hemi or total) in adult patients with primary or secondary osteoarthritis of the first metatarsophalangeal joint that used a still commercialized implant type and with a minimum of 12 months follow-up. Meta-analysis was not feasible and we present the results as a narrative synthesis for each surgical approach and implant type. The methodological index for non-randomized studies (MINORS) was used to assess study quality. Results: Forty-six studies comprising of 1,868 patients (arthrodesis, n=570; total arthroplasty, n=690; hemiarthroplasty, n=608). Arthrodesis showed high satisfaction rates (>90%) and American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal score (around 80 points). ToeFit-Plus® was the most common implant (n=300) for total arthroplasty. Postoperative American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal score was generally high (range, 80–100). Survivorship was high (100%) at 2 years, but decreased at 3 years (76%). Considering hemiarthroplasties, HemiCap® had high postoperative AOFAS-HMI (83–94.1 points) and satisfaction rates (95–100%). Conclusions: Metatarsal head hemiarthroplasties, may be considered as an optimal choice for first-line of treatment of advanced hallux rigidus showing comparable outcomes to arthrodesis while preserving motion.