Nonunion incidence following differing weightbearing protocols after first metatarsal phalangeal joint arthrodesis: A systematic review.

BACKGROUND

When performing arthrodesis of the first metatarsophalangeal joint (MTPJ), reported fixation options have been vast with high success rates and a low complication profile. Immediate postoperative weightbearing status typically varies by surgeon irrespective of fixation construct.

PURPOSE: There has been a paucity of literature regarding the effect postoperative weight bearing status has on the nonunion rate following first MTPJ arthrodesis.

STUDY DESIGN/

METHODS

We performed a systematic review and identified a total of 40 studies and 3,222 feet that underwent first MTPJ arthrodesis with a cohort of patients that were made heel weightbearing as tolerated (HWB), non weightbearing (NWB), and full weightbearing (FWB).

RESULTS

Nonunion rate was found to be lowest in the FWB cohort at 4.34% compared to 8.20% for that of the HWB group, and 9.27% for NWB (p < 0.001). Time to union was found to be fastest in the NWB group at 8.8 weeks, compared to 10.42 weeks for immediate full weight bearing and 12.18 weeks for immediate heel weight bearing (p < 0.001).

CONCLUSION

While time to union varied, immediate full weightbearing was associated with the lowest nonunion rate, with no adverse effect on fusion success compared to delayed protocols.