Interpositional Arthroplasty for the First Metatarsophalangeal Joint
Treatment of advanced first metatarsophalangeal joint (MTPJ) arthritis has many options. Choosing the appropriate treatment strategy for first MTPJ arthritis is dependent upon many factors. The use of an interpositional arthroplasty is an attractive option for younger and active patients with severe (Coughlin and Shurnas Grade III and IV) MTPJ arthritis as it preserves motion and avoids the activity limitations, restricted shoewear options, and stiffness associated with arthrodesis. Interposition arthroplasty procedures allow the surgeon to successfully address both the pain and discomfort resultant from arthritic first MTPJ changes without compromising joint bone stock, metatarsal length, and joint stability as are commonly encountered after joint hemi- and total arthroplasty. Furthermore, joint arthrodesis complications such as nonunion, among others, are avoided. In addition, interposition arthroplasty techniques allow for future arthroplasty or arthrodesis at a later date should further joint deterioration occur. Lastly, our technique also resurfaces the metatarsosesamoid joints, which are left untreated by nearly all other surgical treatments and have potential to produce postoperative pain. In this chapter we will review our preferred method for first MTPJ interpositional arthroplasty utilizing an allograft regenerative tissue matrix (RTM).