First Metatarsophalangeal Joint Arthrodesis Technique With Interposition Allograft Bone Block

Background: We present a technique of first metatarsophalangeal joint arthrodesis utilizing an interposition allograft bone block with a bipolar reaming technique that creates congruent fusion surfaces on both ends of the graft-host bone interface. In addition, we examined the union rates, fusion position, patient satisfaction, and functional outcome of this technique. Methods: Fifteen patients underwent first metatarsophalangeal joint arthrodesis with an interposition allograft bone block between September 2004 and October 2013. Charts and radiographs were reviewed. Six measures were compared on preoperative and postoperative radiographs. Clinical outcomes were measured using a telephone questionnaire, pre- and postoperative visual analog scale pain scale, and Foot and Ankle Ability Measure. Average follow-up was 46 weeks (range, 19 to 97). Results: Thirteen of 15 (87%) patients achieved bony union at an average of 21 weeks. One patient underwent revision arthrodesis for their nonunion. Symptomatic hardware was removed in 3 cases. Improvement was noted in visual analog scale pain scores (6 to 2) and functional scores as measured by the Foot and Ankle Ability Measure. There were no postoperative wound complications or infections. Average length of the first ray on anteroposterior radiograph increased from 10.7 to 11.3 cm and from 10.0 to 10.7 cm on the lateral radiograph. Thirteen of 14 patients were very satisfied or satisfied. One patient expressed dissatisfaction with the procedure. One patient was not available for clinical follow-up. Conclusion: First metatarsophalangeal joint allograft bone block arthrodesis using the bipolar reaming technique achieved high bony union rates and satisfactory radiographic and clinical outcomes. This procedure was an effective salvage option for managing bone loss on 1 or both sides of the joint. Level of Evidence: Level IV, retrospective case series.