What is a first MTP joint fusion?
Arthritis of the first metatarsophalangeal or MTP joint (the big joint of the big toe) can cause pain and swelling. This can lead to difficulty with shoewear and mild activity such as walking. Arthritis develops when the cartilage in the joint wears away and the two bones that make up the big toe joint rub against one another. The goal of this procedure is to join (fuse) bones together permanently. By doing this, the joint is gone and the arthritis pain lessens.
What happens before the operation?
Prior to admission you will need to have a pre‐ operative assessment. This is an assessment of your health to make sure you are fully prepared for your admission, treatment and discharge. The pre‐operative assessment nurses are there to help you with any worries or concerns that you have, and can give you advice on any preparation needed for your surgery.
Before the date of your admission, please read very closely the instructions given to you.
If you are undergoing a general anaesthetic you will be given specific instructions about when to stop eating and drinking, please follow these carefully as otherwise this may pose an anaesthetic risk and we may have to cancel your surgery.
What does the operation involve?
The entire surgery is performed in about two hours and you may go home on the same day.
An incision is made on top of the big toe. Remaining cartilage is cleared away to allow the two bones to heal together. Your orthopaedic surgeon may use a combination of tools to shape each bone for a perfect fit.
Once prepared, the two bones are positioned and a metal plate is placed to hold both bones together. An additional screw is driven across the joint for extra stability and compression, which stimulates healing. Also, two screws can be placed across the joint without using a plate. After the hardware is placed, the incision is closed with sutures and the foot is placed in a dressing or splint.
What happens after surgery?
You will likely be examined at two weeks, six weeks, three months and six months. X‐rays may be taken at each visit to evaluate the bone healing and the position of the big toe. Weight bearing status will be determined by your surgeon. After a first MTP fusion, you should not wear shoes that put extra stress on the joint.
What are the complications for this procedure?
Common complications specific to MTP fusion include poor or delayed bone healing, infection, and stiffness in neighboring joints. The metal plate used during surgery can sometimes cause irritation. In this case it can be removed after the bone has healed. Finally, scarring within the joint can limit neighboring tendons.
There is a small risk of a clot forming in the leg veins (Deep Venous Thrombosis or DVT) associated with any form of orthopaedic surgery. This is the same type of clot that passengers on long aeroplane flights may develop. A DVT may cause the leg to swell and occasionally the clot may break loose and lodge in the lung (Pulmonary embolism or PE). Overall the risk of a DVT or PE is small and we will take active measures to minimise this risk to you.
A DVT is more likely if you are overweight or smoke. You can reduce the risk of developing a DVT by getting up and walking about as soon as possible after your operation.
A DVT may only be obvious after you have gone home. If you notice any swelling of the calf or more rarely the thigh, or you experience pain or tenderness in the calf, or notice that your leg is shiny or discoloured you should seek medical advice quickly. You should also contact a doctor immediately if you develop shortness of breath or pain on breathing following surgery.