The Debate Is Over, Right?

Fusion of the great toe reigns supreme over joint replacement for first metatarsophalangeal joint arthritis. Case closed, right?

Perspective

Silicone implants that migrated from the hand to the foot failed miserably, except in a very select patient population. Reactive synovitis, bone loss, and resultant loosening and instability were the common culprits.

Two- and three-component systems were also fraught with problems, and many were abandoned, eventually.

A different design

Roto-Glide Great Toe System is a non-cemented, TiCaP-coated, three-component system featuring a long metatarsal stem, metatarsal flange, and a phalangeal component with a hollow stem that seats with the corresponding peg of the polyethylene component.

Debate not yet settled

A few months ago, Richter et al. published “Comparison of Total Joint Replacement With Arthrodesis of the First Metatarsophalangeal Joint” in Foot & Ankle International.

Most readers likely glimpsed the title and turned the page. But the research merits a read.

Over an eight-year period, a comparison between first MTPJ arthroplasty with Roto-Glide (n=70) versus fusion (n=72) showed marginally lower revision rates for replacement, higher patient reported outcomes, more motion, and more normal force distribution in favor of the replacement group versus fusion.