Treatment of aseptic loosened MTPI prosthesis by one-stage revision with ToeFit Plus prosthesis.

INTRODUCTION

Due to the missing bony integration of the ceramic Moje prosthesis for replacing the first metatarsophalangeal joint (MTPI) in hallux rigidus, the mid-term results were bad so far. In case of revision, the distraction arthrodesis with autologous bone taken from the iliac crest as a salvage procedure is the method of choice.

METHOD: In our prospective case series, the short-term results after revision of the Moje prosthesis with the ToeFit Plus prosthesis were investigated. The clinical and radiological investigations were done in six MTPI over a 24-month period using AOFAS score and visual analogue scale.

RESULTS

There were no radiological signs of loosening or implant migration of the ToeFit Plus 24 months, postoperatively. There was one fissure at the first proximal phalanx necessitating a wire stabilisation. No other complications could be observed. A significant improvement of the AOFAS score and the range of motion were observed 6 weeks postoperatively.

CONCLUSION

We could show good and very good short-term results after the replacement of a loosened MTPI prosthesis with a ToeFit Plus. Due to the conic screw anchorage, ToeFit Plus is excellently suited for prosthesis replacement at the MTPI. With sufficient bony anchorage prerequisites, it is possible to preserve and improve the range of motion by changing the loosened MTPI prosthesis in the ToeFit Plus, thereby avoiding the morbidity of gaining autologous bone from the iliac crest.