Nonunion and complication rate after percutaneous versus open first metatarsophalangeal joint arthrodesis: a proportional meta-analysis.

OBJECTIVE Severe osteoarthritis of the first metatarsophalangeal joint (MTPJ-1) is commonly treated through arthrodesis. Our aim was to evaluate whether percutaneous approaches to perform MTPJ-1 arthrodesis reduce the nonunion and complication (including reoperation) rate as compared to the standard open technique.

METHODS This systematic review was designed as per PRISMA checklist; Pubmed, Cochrane, Scopus and Web of Science databases were analyzed; all studies focused on patients diagnosed with MTPJ-1 osteoarthritis and treated through arthrodesis using exclusively crossed screws. Data related to the cohort (size, age, sex, type of osteoarthritis), the study design (level of evidence and type of study), the technique adopted (the number of screws, open/percutaneous approach, technique of preparation of the joint) and the final outcome (nonunion and complication and reoperation rate) were recorded. The quality of studies included was evaluated through the MINORS score (methodological index for nonrandomized studies). The nonunion, complication and reoperation rates of the percutaneous (PERC) vs the open (OPEN) technique were compared through a proportional meta-analysis.

RESULTS Overall, nine studies (including 225 arthrodeses in 211 patients) were analyzed (130 cases in the PERC group vs 95 cases in the OPEN group). In the two groups, the mean (± standard deviation) sample size (PERC: 26.6 ± 5.1 cases; OPEN: 23.7 ± 10.2 cases; p = 0.33), sex distribution (PERC: 81% ± 0.6; OPEN: 57% ± 0.2 females; p = 0.17) and length of follow-up (PERC: 20.8 ± 11.6 months; OPEN: 29.5 ± 16.8 months; p = 0.19), mean age (PERC: 62 ± 5.4 years; OPEN: 59.5 ± 5.4 years; p = 0.26), were not significantly different. The pooled nonunion rate (9% vs 5% in PERC vs OPEN; p = 0.57), complication rate (15% vs 23%; p = 0.46) and reoperation rate (3% vs 5%; p = 0.74) were not significantly different. The quality of studies was moderate and comparable in the two groups (mean MINORS at 8.4 ± 1.5 points vs 11.7 ± 4.3 in PERC vs OPEN; p = 0.08).

CONCLUSIONS The nonunion and complication (including reoperation) rate after percutaneous vs open first metatarsophalangeal joint arthrodesis (fixed using screws) are comparable at 2 years of follow-up. Only moderate-quality evidence is available so far in this area. Further comparative and prospective studies with a robust design are needed to clarify which strategy allows to obtain the best outcome after MTPJ-1 arthrodesis.

LEVEL OF EVIDENCE IV.