title: Review of 107 hallux MTP joint arthrodesis using dome-shaped reamers and a stainless-steel dorsal plate.
abstract: BACKGROUND
  The purpose of this study was to retrospectively review the results of patients treated with hallux MTP joint arthrodesis using dome-shaped reamers for joint preparation and a precontoured dorsal stainless steel plate for internal fixation.
  
  
  METHODS
  A series of 145 patients (155 feet) were identified. Postoperative evaluation included weightbearing radiographs, physical examination, and chart review. Outcomes were assessed with a pain visual analog scale, AOFAS hallux score, as well as a detailed questionnaire and a subjective satisfaction survey.
  
  
  RESULTS
  Ninety-eight patients (107 feet) met the criteria for the study. The mean followup was 61 weeks. Revision cases accounted for 18.7% (20/107). Rheumatoid arthritis (RA) was present in 32.7% (35/107). The average postoperative AOFAS hallux score was 79.7 and pain VAS was 19. The average pre- and postoperative hallux valgus angle was 26.5 and 12.3 degrees, respectively (p < 0.05). Eighty-nine of 107 patients (83.1%) reported good to excellent results at final followup. Discomfort related to prominence of the plate occurred in 14.9% (16/107). The nonunion rate was 12.1% (13/107). The nonunion rate for patients with/without RA was 22.9% (8/35) and 6.9% (5/72), respectively (p < 0.05). Patients with a nonunion noted more hardware related pain than those with a union (p < 0.05).
  
  
  CONCLUSIONS
  First MTP joint arthrodesis using this technique achieves a high union rate. RA patients have a lower union and higher complication rate.
authors.affiliation: OrthoCarolina, Foot and Ankle Institute, Charlotte, NC 28203, USA. kentellington@yahoo.com
authors.forename: J Kent
authors.initials: JK
authors.lastname: Ellington
authors.forename: Carroll P
authors.initials: CP
authors.lastname: Jones
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Cohen
authors.forename: W Hodges
authors.initials: WH
authors.lastname: Davis
authors.forename: Florian
authors.initials: F
authors.lastname: Nickisch
authors.forename: Robert B
authors.initials: RB
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000295:instrumentation*; D015331:Cohort Studies; D005260:Female; D020859:Hallux Rigidus / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006215:Hallux Valgus / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D016474:Weight-Bearing; D055815:Young Adult