PIP joint resection vs. fusion comparable for pain & function after hammertoe surgery

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: 2
55 patients undergoing hammertoe surgery were randomized to undergo one of the following procedures: proximal interphalangeal joint (PIPJ) resection or PIPJ fusion. The purpose of this study was to compare the effectiveness of the two techniques using the American Orthopaedic Foot & Ankle Society scale, the Foot Function Index, and the visual analogue scale pain scores up to one year postoperatively. Radiographic outcomes such Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-funded
Conflicts: None disclosed
Why was this study needed now?
Lesser toe deformities are common conditions that can often require operative management with either resection or fusion techniques. However, comparisons of efficacy between these two types of surgical procedures have yet to be conducted in high-quality research trials, thus warranting the present study.
What was the principal research question?
In the treatment of proximal interphalangeal joint (PIPJ) flexion deformity and metatarsophalangeal joint hyperextension deformity, what is the comparative efficacy of PIPJ resection and PIPJ fusion with regards to pain and function outcomes when assessed up to 1 year postoperatively?
Population: 55 patients, between the ages of 18 to 85 years, with rigid PIP flexion deformity in one or more toes and undergoing hammertoe surgery for one or more flexion deformity in the PIP and hyperextension deformity in the MTP joint were included. Eligible patients were unresponsive to at least 6 months of non-operative treatment prior to study inclusion. Both treatment groups received a dorsal capsulotomy of the MTP joint and extensor tendon lengthening in cases of contracture, and a plantar release procedure was performed in cases of persistent subluxation. A flexor tenotomy was also performed if necessary.
Intervention: PIPJ fusion group: patients received PIPJ fusion technique which was similar to the resectioning technique in approach but cartilage from proximal and intermedial phalanx was removed. The length of resection depended on the severity of the deformity, where more bone was removed with increasing severity. (n=29; Mean age: 63+/-9; 6M/23F)
Comparison: PIPJ resection group: patients underwent a dorsal longitudinal incision at the extensor tendon and joint capsule and remained divided using Hohmann retractors. In this procedure only the proximal part of the pip joint was resected. (n=26; Mean age: 61+/-9; 6M/20F)
Outcomes: Outcomes consisted of the American Orthopaedic Foot & Ankle Society scale (AOFAS), the Foot Function Index (FFI) pain and activity subscales, and a visual analogue scale (VAS 0-10 from no pain to worst pain). Radiographic outcomes included sagittal and anteroposterior toe alignment. Physical assessments of forefoot deformity, alignment plantar fat pad, and mobility of the hallux and lesser MTP joints were also conducted.
Methods: RCT; multi-center, prospective
Time: Clinical outcomes were followed up at 2 and 6 weeks, 3 months, and 1 year postoperatively. Radiographic outcomes were assessed at 6 weeks and 1 year postoperatively.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.