Surgery for 1st MTP joint arthritis - outcomes from the BOFAS registry

S Jha, L Mason, N Makwana, E Wood, BOFAS Registry Collaborative

Introduction: Symptomatic 1st MTP joint arthritis is common (7.8% prevalence reported in adults over 50 years in the UK [1]). Established surgical treatments include 1st MTPJ fusion, 1st MTPJ arthroplasty and 1st MTPJ cheilectomy Utilising BOFAS registry to evaluate outcomes from these treatments has the advantage of providing high volume cohort observational data from the UK population.

Methods: A BOFAS registry database analysis was performed to identify all patients who had undergone surgery for 1st MTPJ arthritis. Demographic data and functional scores (MOXFQ/VAS) at baseline and 12 months post-operative were evaluated.

Results: 1508 1st MTPJ fusions, 28 1st MTPJ arthroplasties and 218 1st MTPJ cheilectomies were identified. The 1st MTPJ cheilectomy group demonstrated a significantly lower baseline (p<0.001) for MOXFQ/VAS scores compared to the other cohorts, although this was lower than the MCID [2, 3]. 35.71% in the 1st MTPJ Arthroplasty cohort, 26.15% in the 1st MTPJ Cheilectomy cohort and 16.46% in the 1st MTPJ fusion cohort had complete data collection allowing comparison of PROM score difference at 12 months. 1st MTP fusion and 1st MTPJ cheilectomy groups demonstrated both a statistical and clinically significant improvement in all MOXFQ/VAS components at 12 months. There was significantly greater improvement in MOXFQ/VAS scores in the 1st MTPJ fusion group and 1st MTPJ Cheilectomy group compared to the 1st MTPJ Arthroplasty cohort.

Conclusion: Acknowledging the limitations of our analysis due to low follow-up rate, our data suggests 1st MTPJ fusion and 1st MTPJ arthrodesis lead to greater improvements in functional outcome than 1st MTPJ arthroplasty. We note the relatively low numbers of MTPJ arthroplasty patients in our data-set which may lead to bias; we therefore recommend and encourage surgeons performing this procedure to submit registry data to allow ongoing evaluation.