Journal of Foot and Ankle Surgery - 2026-08-07 - Journal Article
Comparison of Radiographic Fusion Outcomes in First Metatarsophalangeal Joint Arthrodesis Using Staple, Plate-and-Staple, and Plate Fixation.
Frey CP, Osorio AS, Melia KM, Saeidi S, Ballew IM, Dietlein CB, Higinbotham SE, Gorski MA, Jerabek MR, Hoffman KM
Topics
Key Takeaway
Staple, plate-and-staple, and plate fixation produced equivalent radiographic fusion rates in first MTPJ arthrodesis, with smoking and postoperative noncompliance—not construct choice—as the dominant predictors of fusion failure.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective study compared radiographic fusion outcomes (complete, partial, nonunion) across three fixation constructs—standalone staple, plate-and-staple hybrid, and standalone plate—in 45 patients undergoing first MTPJ arthrodesis from 2020–2024. No significant differences in fusion grade, hardware failure, or revision rate were identified among constructs. Multivariable analysis identified current smoking and postoperative noncompliance as the only significant independent predictors of inferior fusion outcomes.
Key Limitation
The sample size of 45 patients distributed across three fixation groups provides insufficient statistical power to rule out clinically meaningful differences in fusion rates, making equivalence conclusions premature.
Original Abstract
BACKGROUND
Hallux rigidus is a painful degenerative condition characterized by limited dorsiflexion of the first metatarsophalangeal joint (MTPJ). When nonoperative treatment fails, arthrodesis is widely considered the gold standard surgical intervention. Although arthrodesis reliably restores a stable, functional joint, the optimal fixation construct remains debated.
PURPOSE
To compare radiographic fusion outcomes among different fixation constructs used for first MTPJ arthrodesis and identify factors associated with successful fusion.
STUDY DESIGN
Retrospective cohort study.
METHODS
A retrospective review of first MTPJ arthrodesis procedures from 2020-2024 included 45 patients meeting inclusion criteria and a minimum 90-day follow-up. Patients underwent fixation with standalone staples, hybrid plate and staple fixation, or standalone plates. Fusion was classified as complete, partial, or nonunion. Secondary outcomes included hardware failure, revision surgery, and factors associated with fusion.
RESULTS
No significant differences were observed among fixation constructs with respect to fusion outcomes, hardware failure, revision surgery, or baseline patient characteristics. Multivariable analysis demonstrated that current smoking and postoperative noncompliance were strongly associated with worse fusion outcomes. Patients who smoked had substantially lower odds of achieving higher fusion grades, and patients who were noncompliant with postoperative protocols also had significantly reduced odds of successful fusion, independent of fixation type.
CONCLUSION
Staple, plate, and hybrid fixation constructs produced comparable radiographic fusion outcomes following first MTPJ arthrodesis. Patient factors, particularly smoking status and postoperative compliance, appear to play a more important role in determining successful fusion than fixation construct selection.