Silastic arthroplasty versus 1st metatarsophalangeal joint arthrodesis: a prospective comparative series
S.E. Eastwood, A. Kingman, S. Asaad, J. Coorsh, R. Kakwani, A.N. Murty, D. Townshend
Introduction: Both 1st MTPJ arthrodesis and silastic arthroplasty have been shown to provide good long-term outcomes for end-stage hallux rigidus. Novel implants are compared against arthrodesis as a historical gold standard. Although there is good evidence to demonstrate long term survival from the established Swanson silastic arthroplasty there are no published studies comparing this to arthrodesis. We present a comparison of outcomes in patients who had these procedures performed after a shared decision-making process.
Methods: Consecutive patients who received 1st MTPJ arthrodesis or silastic arthroplasty for hallux rigidus between June 2014 and November 2015 were included. Demographics, complications and prospectively collected pre-operative and 6-months post-operative PROMS (MOXFQ and VAS) were reviewed.
Results: 61 patients received silastic arthroplasty (52 female, mean age 63 years) and 61 patients received arthrodesis (25 female, mean age 60 years). Complete PROMS data was available for 53% of patients. There was a significant improvement in MOXFQ and VAS following both silastic arthroplasty (MOXFQ mean change 18, p=0.005; VAS mean change 24, p=0.0004) and arthrodesis (MOXFQ mean change 38, p< 0.0001; VAS mean change 44, p< 0.0001). There was a significant difference in mean improvement of both MOXFQ and VAS in favour of arthrodesis (MOXFQ p=0.0004, VAS p=0.002). There was 1 post-operative infection and 1 reoperation (conversion to fusion) in the silastic arthroplasty group, and 1 post-operative infection and 6 reoperations (4 removal of prominent metalwork, 2 revision fusions) in the arthrodesis group.
Conclusion: Both silastic arthroplasty and arthrodesis have shown a significant improvement in pain and function with low complication rates. Patients may choose arthroplasty over arthrodesis to maintain motion. In these cohorts, arthrodesis showed a greater improvement over silastic arthroplasty in patient reported outcomes but a higher reoperation rate and this should be considered in the shared decision-making process.
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