Outcome following first metatarsophalangeal joint replacement using TOEFIT-PLUS™: A mid term alert

• We examine mid-term results of the Toefit-Plus™ Metatarsophalangal prosthesis.
• Unacceptably high revision rate; 24% at 33 months post surgery.
• We have abandoned use of this prosthesis.

BackgroundWe aim to evaluate the mid-term results of first metatarsophalangeal joint replacement for hallux rigidus using Toefit-Plus™ in a single surgeon series.MethodsWe prospectively studied the outcomes of 86 toes in 73 patients using the AOFAS-HMI score and radiological follow up. The mean follow up was 33 months (2–72). Ten patients have been lost to follow up.ResultsEight patients sustained intraoperative fractures or impending fractures requiring circlage wiring. Eighteen joints have either been revised or listed for revision giving a revision rate of 24%; this occurred at a mean of 33 months post-surgery.ConclusionsFirst MTPJ replacement is an option in hallux rigidus and patients who are not revised experience significant improvement in AOFAS scores in the medium term. We have previously published satisfactory results with this prosthesis. However the revision rate is unacceptably high and we have discontinued its use completely. Future design evolutions should address the issue of osteointegration on the phalangeal side.