1st MTP Arthrodesis 28750

hallux valgus dislocation xray

 hallux MTP fusion
CPT Coding Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms:1st MTP fusion, metatarsal-phalangeal fusion, big toe fusion, hallux rigidus correction, arthrodesis of the first metatarsophalangeal joint, great toe fusion

 1st MTP Arthrodesis CPT

1st MTP Arthrodesis Indications

  • Grade 4 hallux rigidus
  • Recurrent hallux valgus
  • Failed 1st MTP arthroplasty
  • Nueromuscular disorder with instability

 1st MTP Arthrodesis Contraindications

  • Infection
  • Severe osteoporosis

1st MTP Arthrodesis Alternatives

  • Evidence-based reviews demonstrate:  Grade B support of arthrodesis for treatment of hallux rigidus. Grade C support of cheilectomy, osteotomy, implant arthroplasty, resection arthroplasty, and interpositional arthroplasty. Insufficient evidence (grade I) for cheilectomy with osteotomy.  (McNeil DS, Foot & Ankle International 2013:34(1) 15–32)Cheilectomy
  • Non-operative care
  • Soft tissue interpositional arthoplasty
  • 1st MTP arthroplasty

1st MTP Arthrodesis Pre-op Planning / Technique Guides

  • Ensure appropriate 1st MTP plate or screws are available as well as small joint reamers
  • Arthrosurface Checkmate MTP Arthrodesis system
  • Acumed 1st MTP Fusion plate
  • Wright Medical CHARLOTTE® MTP Fusion surgical technique
  • Arthrex Low Profile MTP Plate™
  • Synthes MTP fusion plate
  • Tornier NexFix MTP fusion plate

1st MTP Arthrodesis Technique

  • regional anesthesia, tourniquet.  
  • 4-5cm dorsal longitudinal incision centered over MTP joint.  
  • Incise capsule medial to EHL.  
  • Joint Debridement.  
  • Prox phalanx plantar flexed, 0.62mm K-wire driven proximally into center of MT head.  
  • Cannulated cylindrical reamer creates cylindrical MT.  Canulated reamer(Howmedica) creates convex cancellous MT head.  
  • 0.62mm k-wire center in base of PP.  Convex phalangeal reamers create matching surface.  
  • Hallux placed in neutral rotation, 15 valgus, 20 dorsiflexion.  
  • 6-hole vitalium mini-compression plate and lag screw.  
  • Irrigate.  Capsule repair.  Closure

1st MTP Arthrodesis Complications

1st MTP Arthrodesis Follow-up care

  • Post-op: WBAT in stiff-soled shoe on lateral aspect and heel until radiographic fusion. 3 months for maximal improvement.

1st MTP Arthrodesis Outcomes

  • Arthrodesis=  87% Excellent, 13% Good, O%fair/poor subjective patient result.

1st MTP Arthrodesis Review References

  • Goucher NR, Foot Ankle Int 2006;27:869