Our Summary
This research paper looks into the risk of needing additional surgery on a specific joint in the big toe (the interphalangeal or IP joint) after having a fusion procedure done on the joint at the base of the big toe (the metatarsophalangeal or MTP joint). This is an important issue to investigate because patients often ask about this possibility before they decide to have the original MTP fusion surgery.
The researchers used a large national database of insurance claims to identify patients who had the MTP fusion surgery and then checked to see if they later had fusion surgery on the IP joint. They only included patients who had insurance coverage for at least 10 years after the original surgery to make sure they didn’t miss any cases.
Out of nearly 16,000 patients who had the MTP fusion surgery, only 166 later had the IP fusion surgery. This means that the risk of needing the second surgery within 10 years of the first one is about 1%. On average, the second surgery happened about 4 years after the first one.
The researchers caution that there may be a few cases where the second surgery was done on the opposite foot, which would make the actual risk even lower than 1%.
Overall, this study should reassure both patients and doctors that the MTP fusion surgery is a durable procedure with a low risk of needing additional surgery on the IP joint of the big toe.
FAQs
- What is the risk of needing additional surgery on the IP joint of the big toe after having MTP fusion surgery?
- How was the research conducted to determine the risk of needing additional surgery on the IP joint after having MTP fusion surgery?
- How long after the original MTP fusion surgery does the second surgery usually happen?
Doctor’s Tip
A doctor might tell a patient considering joint fusion surgery that the risk of needing additional surgery on a different joint, such as the IP joint in the big toe, is very low, around 1%. This information can help alleviate concerns about the long-term success of the procedure and provide reassurance about the durability of the MTP fusion surgery.
Suitable For
Patients who are typically recommended joint fusion are those who have severe arthritis or deformities in a joint that are causing significant pain and limiting function. In the case of the research paper mentioned above, patients with arthritis in the MTP joint of the big toe would be candidates for MTP fusion surgery.
It is important for patients considering joint fusion to have exhausted conservative treatment options such as medication, physical therapy, and injections before considering surgery. Additionally, patients should be in good overall health and have realistic expectations about the outcomes of joint fusion surgery.
In the case of the specific research paper mentioned above, patients who have undergone MTP fusion surgery and are at risk of needing additional surgery on the IP joint of the big toe would be those who continue to experience pain and dysfunction in the IP joint despite the initial surgery. These patients may have progressive arthritis or other issues that necessitate further intervention.
Overall, joint fusion surgery is typically recommended for patients with severe joint problems that have not responded to conservative treatments, and the decision to undergo surgery should be made in consultation with a healthcare provider based on individual circumstances and risk factors.
Timeline
Before MTP fusion surgery, patients may experience pain and stiffness in the MTP joint of the big toe, which can significantly impact their ability to walk and perform daily activities. They may also have tried conservative treatments such as pain medication, physical therapy, or orthotic devices before opting for surgery.
After MTP fusion surgery, patients typically experience a period of recovery and rehabilitation to regain strength and mobility in the foot. This may involve wearing a protective boot or cast, physical therapy, and gradually increasing weight-bearing activities. Over time, most patients report a significant reduction in pain and improvement in their ability to walk and engage in activities.
If a patient does require IP fusion surgery after MTP fusion, they may experience a similar recovery process as they did with the initial surgery. However, the overall risk of needing additional surgery on the IP joint is low, and patients can expect long-term relief from pain and improved function in the affected toe.
What to Ask Your Doctor
Some questions a patient should ask their doctor about joint fusion include:
- What are the potential risks and complications associated with joint fusion surgery?
- What is the success rate of joint fusion surgery for my specific condition?
- How long is the recovery process after joint fusion surgery?
- Will I need physical therapy or rehabilitation after the surgery?
- What are the long-term outcomes of joint fusion surgery?
- Are there any alternative treatments to joint fusion that I should consider?
- What is the likelihood of needing additional surgery on other joints after joint fusion surgery?
- How can I best prepare for joint fusion surgery, both physically and mentally?
- What can I expect in terms of pain management after the surgery?
- How soon can I expect to return to normal activities after joint fusion surgery?
Reference
Authors: Alkaramany E, Rodriguez-Materon S, Dai AZ, Mansur NSB, Guyton GP. Journal: Foot Ankle Int. 2025 Jun;46(6):629-632. doi: 10.1177/10711007251328656. Epub 2025 Jun 11. PMID: 40495764