Thou Shalt not Fuse: Implant Survival Outcomes and Complications Following Arthroplasty in Hallux Rigidus

This study is a narrative review of the current evidence base assessing the first MTPJ-sparing procedures using interposition implants.A comprehensive literature search in PubMed was performed using the following search terms-"HR," "first MTPJ osteoarthritis," "treatment," "surgery," "arthroplasty," "hemiarthroplasty," "silastic," "metallic," "Swanson" "polyvinyl alcohol," "Cartiva," and "implant" with "AND" and "OR" as Boolean terms.Relevant publications were retrieved as full-text articles, and reference lists of the related articles were hand-searched for any additional eligible studies.Only articles published in peer-reviewed journals and only articles written in English were included in the review.Two investigators extracted the relevant data from the eligible studies.Finally, data were categorized based on implant options to present the introduction Hallux rigidus (HR) is a common condition characterized by pain and loss of range of motion of the metatarsophalangeal joint (MTPJ) of the great toe caused by degenerative arthritis.HR affects 2.5% of people over the age of 50, and it is twice more common in female patients.1 Several predisposing factors have been described, including acute trauma and repetitive microtrauma, anatomical variations, such as metatarsus adductus, familial history, shoe wear, and female gender.However, the exact etiology remains unknown. 2 Mild and moderate cases of HR have been traditionally treated with conservative measures, such as nonsteroidal antiinflammatory drugs, intraarticular steroid injections, and orthotics or with dorsal cheilectomy.3,4 Arthrodesis of the first MTPJ has been widely accepted as the gold standard for the treatment of end-stage HR. 5 More recently, joint-sparing techniques have been introduced as an alternative treatment option to severe HR.The main advantage of these techniques over arthrodesis is the preservation of the range of movement without the risk of nonunion or malunion.The first implant for the first MTPJ arthroplasty was designed in 1952 by Swanson and was followed by several modifications.Lack of appreciation of 1st MTPJ biomechanics and appropriate patient selection led to poor medium to long-term outcomes.6 Since then, there has been a constant improvement in materials and designs.Currently, there are numerous implants available, including silastic, metallic, as well as the recently introduced polyvinyl alcohol (PVA) implants.The purpose of this article is to present the clinical outcomes, survivorship, and complication profile of the available implants for the salvage of the first MTPJ.