Abstract
Introduction
There are a number of options available for surgical management of hallux rigidus. Ceramic implants of the first metatarsophalangeal joint (MTPJ) have been available for years; however there are no published long-term results existing.
Methods
We performed a retrospective review of all consecutive first MTPJ replacements carried out for later stage hallux rigidus using second generation MOJE ceramic implant with press-fit design. Two specialised foot and ankle surgeons performed these operations at a tertiary referral centre. Patient underwent regular follow ups including clinical review, functional scoring (AOFAS and FFI) and assessment of radiographs. Kaplan Meyer Survival analysis was performed.
Results
Our study included 31 prostheses in 24 female patients. Average age at operation was 55.3 years and average follow up time was 80 months. No patients were lost until follow up. Complications included one case of superficial infection and five cases of revision, reasons being fracture of the prostheses (1), unexplained pain (1), subluxation (1) and loosening/sinkage of the implant (2). Prosthesis survival rate was 85.2% at seven years. Assessment of the radiographs showed considerable sinkage of the prosthesis in 43%, tilting in 33% and loosening of the implant in 40.9%. Average postoperative AOFAS score was 71.6 and the average FFI was 27.7. 84% of the patients were satisfied with the results of their operation.
Conclusion
Surgery has failed to preserve the function and increase the range of movement in most cases in the long duration. From the patients perspective however the satisfaction with the procedure suggests a success of the implant. Due to poor radiological results and high revision rate we do not recommend the routine use of this prosthesis and all patients that have this type of prosthesis need regular follow up consultations at least yearly with radiographs to assess the position of the implant.
