An evidenced based review of the efficacy of fixation type and post operative weight-bearing status on metatarsophalangeal joint fusion for treatment of hallux rigidus

BACKGROUND: First metatarsophalangeal joint (MTP) arthrodesis is a common operative management for end-stage hallux rigidus. The purpose of this study is to present an evidence-based literature review and evaluation of the literature regarding the efficacy of different fixation methods and postoperative weight-bearing status for first MTP Arthrodesis. METHODS: A comprehensive literature review was conducted across three databases: Medline, Embase, and Cochrane, in September 2024. Exclusion criteria included biomechanical, cadaveric, and non-human studies, review articles, letters, and technical tips. The included articles were analysed and categorised according to their level of evidence (level I-V). A grade of recommendation (A, B, C, or I) in favour of or against each modern fixation method and weight-bearing status for first MTP arthrodesis for hallux rigid was determined by collective review of the categorised articles. RESULTS: 86 of the 1390 identified articles were included. There is fair evidence (grade B) for fixation with screws, plates, and plate with a compression screw, as well as both immediate postoperative weight-bearing and non-weight-bearing, according to the current literature. Insufficient evidence (grade I) for staple and novel fixation methods exists. CONCLUSIONS: The results of this comprehensive review provide the most up-to-date recommendations for fixation and postoperative protocol for surgical management of first MTP arthritis. The best available published peer-reviewed literature demonstrates that both immediate weight-bearing or non-weight bearing are viable postoperative protocols for first MTP arthrodesis, giving similar clinical outcomes. Additionally, the literature supports the use of screws, plates and plates with a compression screw as fixation methods. It is evident that additional high-quality level I and II studies are required to compare and validate these fixation methods and weight-bearing statuses to allow for stronger recommendations. LEVEL OF EVIDENCE: Level III, Systematic review.