Implants for proximal interphalangeal joint arthrodesis of the lesser toes: Where are we? A systematic review

Q2 Health Professions

Foot Pub Date : 2025-03-01 DOI:10.1016/j.foot.2025.102157

Vinodh Arumugam , Shreyas Sanjeev Chitnis , Esha Singh , Alba Morillo Paterson , Matthew Welck

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引用次数: 0

Abstract

Introduction

Proximal interphalangeal joint (PIPJ) arthrodesis is indicated for the treatment of lesser toe deformities. K-wires have traditionally been the standard of care for PIPJ arthrodesis, however intramedullary implants may be superior. This systematic review evaluates the union rate and outcomes of implants for PIPJ arthrodesis.

Methods

MEDLINE, CENTRAL, EMBASE and Google Scholar databases were reviewed for studies reporting on outcomes of intramedullary implants for PIPJ arthrodesis in hammer or claw toe. The primary outcome measure was union rate. Secondary outcome measures included pain scores, functional improvement, patient satisfaction, quality of life and complications.

Results

12 studies comparing 12 different implants in 797 patients with 1118 treated toes were reviewed. Fusion rates ranged from 22.2 % to 96 % with the highest fusion rates demonstrated with Ossiofiber (96 %, n = 24), Smart toe (43.6–93.8 %, n = 217) and Nextra (84.44 %, n = 47) respectively. 4 studies compared 3 implants to K-wire (Smart toe, Tenfuse and Nextra) with improved union rates demonstrated compared to K-wire (p < 0.05). Function, pain relief, patient satisfaction and quality of life all improved following PIPJ arthrodesis with implants, however these outcomes were equivocal to K-wire. All studies were rated as high or critical risk of bias.

Conclusion

A definitive judgement on the best implant for PIPJ arthrodesis is currently unobtainable due to the high risk of bias in the reviewed studies. Given the high cost of intramedullary implants and equivocal functional outcomes to K-wire, further comparative study with randomised control trials is advised to establish the standard of care for PIPJ arthrodesis.

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小趾近端指间关节关节置换术的植入物：进展如何？系统回顾

导言近端指间关节（PIPJ）关节置换术适用于治疗小趾畸形。传统上，K线是PIPJ关节置换术的标准护理方法，但髓内植入物可能更胜一筹。本系统性综述评估了髓内植入物用于 PIPJ 关节置换术的结合率和疗效。方法回顾了MEDLINE、CENTRAL、EMBASE 和 Google Scholar 数据库中有关髓内植入物用于锤状趾或爪状趾 PIPJ 关节置换术疗效的研究报告。主要结果指标为关节结合率。结果回顾了 12 项研究，比较了 12 种不同植入物对 797 名患者 1118 个脚趾的治疗效果。融合率从 22.2% 到 96% 不等，融合率最高的分别是 Ossiofiber（96%，n = 24）、Smart toe（43.6-93.8%，n = 217）和 Nextra（84.44%，n = 47）。4 项研究将 3 种植入物与 K 线（Smart toe、Tenfuse 和 Nextra）进行了比较，结果表明，与 K 线相比，植入物的结合率有所提高（p < 0.05）。使用植入物进行 PIPJ 关节固定术后，患者的功能、疼痛缓解、满意度和生活质量都有所提高，但这些结果与 K 型钢丝的效果不相上下。所有研究均被评为高偏倚风险或严重偏倚风险。结论由于所审查的研究存在较高的偏倚风险，因此目前还无法对PIPJ关节置换术的最佳植入物做出明确判断。考虑到髓内植入物的高昂成本以及与K线相比模棱两可的功能结果，建议进一步开展随机对照试验比较研究，以确定PIPJ关节置换术的护理标准。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Foot Health Professions-Podiatry

CiteScore

2.00

自引率

0.00%

发文量

期刊介绍： The Foot is an international peer-reviewed journal covering all aspects of scientific approaches and medical and surgical treatment of the foot. The Foot aims to provide a multidisciplinary platform for all specialties involved in treating disorders of the foot. At present it is the only journal which provides this inter-disciplinary opportunity. Primary research papers cover a wide range of disorders of the foot and their treatment, including diabetes, vascular disease, neurological, dermatological and infectious conditions, sports injuries, biomechanics, bioengineering, orthoses and prostheses.