de Bot Robin T A L, Veldman Hidde D, Eurlings Roxanne, Stevens Jasper, Hermus Joris P S, Witlox Adhiambo M
Department of Orthopaedic Surgery, Maastricht University Medical Center, P. Debyelaan 25, NL-6202 AZ Maastricht, The Netherlands; Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 50, NL-6229 ER Maastricht, The Netherlands.
Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center Sittard-Geleen, Dr. H. van der Hoffplein 1, NL-6162 BG Sittard-Geleen, The Netherlands.
Foot Ankle Surg. 2022 Feb;28(2):139-152. doi: 10.1016/j.fas.2021.03.004. Epub 2021 Mar 11.
Arthrodesis and metallic hemiarthroplasty are two surgical interventions for the treatment of end-stage osteoarthritis of the first metatarsophalangeal (MTP1) joint. This systematic review and meta-analysis aims to compare the two operations with regards to patient-reported outcomes, pain reduction, complications and revision rates.
A systematic literature search identified all relevant studies. The methodological quality was assessed using two validated tools. Data of interest were derived and presented. For non-comparative studies, data was assessed for trends, while for comparative studies pooling statistics were performed.
A total of 33 studies were included for analysis. The majority of studies (>75%) reported an AOFAS-HMI score greater than 80 points after both metallic hemiarthroplasty and arthrodesis. The lowest VAS pain score was observed after arthrodesis (weighted mean difference -1.58, 95% confidence interval (CI) -2.16 to -1.00 P< 0.00001). Comparable numbers of complications (odds radio 1.48, 95% CI 0.81 to 2.73, P = 0.21, favoring: hemiarthroplasty) and revisions (odds ratio 1.16, 95% CI 0.62 to 2.15 P = 0.64, favoring: hemiarthroplasty) were observed after both interventions. The included non-comparative studies seem to confirm these findings of the comparative studies.
Metallic hemiarthroplasty and arthrodesis have excellent clinical outcomes and acceptable complication- and revision rates. Arthrodesis seems to be superior in pain reduction, while metallic hemiarthroplasty is a suitable alternative for patients performing activities that requires motion in the first metatarsophalangeal joint.
关节融合术和金属半关节成形术是治疗第一跖趾关节（MTP1）终末期骨关节炎的两种手术干预方式。本系统评价和荟萃分析旨在比较这两种手术在患者报告结局、疼痛减轻、并发症及翻修率方面的差异。
通过系统文献检索确定所有相关研究。使用两种经过验证的工具评估方法学质量。提取并呈现感兴趣的数据。对于非对比研究，评估数据趋势，对于对比研究则进行合并统计分析。
共纳入33项研究进行分析。大多数研究（>75%）报告金属半关节成形术和关节融合术后AOFAS-HMI评分均大于80分。关节融合术后观察到最低的视觉模拟评分（VAS）疼痛评分（加权平均差-1.58，95%置信区间（CI）-2.16至-1.00，P<0.00001）。两种干预后观察到的并发症数量（比值比1.48，95%CI 0.81至2.73，P = 0.21，倾向于：半关节成形术）和翻修率（比值比1.16，95%CI 0.62至2.15，P = 0.64，倾向于：半关节成形术）相当。纳入的非对比研究似乎证实了对比研究的这些结果。
金属半关节成形术和关节融合术具有良好的临床结局以及可接受的并发症和翻修率。关节融合术在减轻疼痛方面似乎更具优势，而金属半关节成形术对于需要第一跖趾关节活动的患者来说是一种合适的替代方案。
