Influence of selective versus nonselective joint preparation in first metatarsophalangeal arthrodesis: A systematic review and meta-analysis

First metatarsophalangeal (MPJ) arthrodesis is a common and effective procedure for hallux rigidus and select patients with hallux valgus. Non selective joint preparation with conical reamers is the most common method for joint preparation in the literature. This meta-analysis compares patients who underwent 1st MPJ arthrodesis with reamer versus patients who underwent selective joint preparation with rongeurs and/or burrs. A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, Cochrane, and Scopus databases were used to identify recent studies based on inclusion and exclusion criteria, and only patients with locking plate fixation were included. Twenty three studies with reamers and 5 studies with selective joint preparation met criteria. Many of the included studies in both treatment groups had low quality data with inadequate radiographic follow-up. A random effects model was utilized to compare union rates between the treatment groups. The estimated union rate was significantly higher (p = 0.03) for selective joint preparation, 99 % (95 % CI 98–100), compared with reamers, 93 % (95 % CI 91–96). Current data suggests selective debridement with rongeurs and/or burrs has superior union rates when 1st MPJ arthrodesis is performed with locking plate fixation.

Level of Clinical Evidence: 3