Revision First MTP Arthrodesis & Arthroplasty Using Titanium Truss Implants: Early Outcomes and Cost Comparison of Custom Versus Prefabricated Options

Abstract Bone loss following failed first metatarsophalangeal (MTP) arthrodesis or arthroplasty presents a challenging reconstructive problem requiring restoration of length and structural stability. Titanium truss implants are an alternative option to traditional bone grafting, with both custom and prefabricated options available. However, differences in costs and intraoperative adaptability between these implant types remain underreported. This report presents seven patients (eight feet) who underwent revision procedures for first MTP arthrodesis or arthroplasty using either custom or prefabricated titanium truss implants. Osseous union was confirmed radiographically or via computed tomography in all cases. Patients remained non-weight-bearing for at least seven weeks and achieved pain-free ambulation in regular shoe-gear at approximately three months postoperatively. A substantial difference in implant cost was observed, with custom titanium trusses averaging $12,700 and prefabricated titanium truss implants averaging $1,880. Titanium truss implants appear to be a viable option for revision for first MTP reconstruction. Prefabricated titanium truss implants may offer potential advantages in cost and intraoperative flexibility, particularly in cases where defect size is difficult to fully assess preoperatively.