This is my case-control study on second hammertoe deformity correction techniques: arthroplasty, arthrodesis, and interpositional implant arthroplasty.

3. Overview Purpose Methods Statistical Analysis Results Discussion Conclusions

4. Purpose The purpose of this study was to compare the long-term outcomes of second hammertoe deformities that underwent proximal interphalangeal (PIP) joint correction using arthroplasty, arthrodesis or interpositional implant arthroplasty.

5. Purpose Retrospective Case-Control Study EBM Level of evidence: III (Therapeutic)

6. Purpose background Indications for surgical correction of hammertoe8 Pain Pressure over the dorsal aspect of the PIP joint Hypertrophic callus on the dorsum of the digit. There are many reports regarding the outcomes PIP joint interpositional implant arthroplasty1-3, PIP joint arthrodesis4-6, and PIP joint arthroplasty7 for hammer toe deformity.

7. Purpose However there are no studies that compare the outcomes of all three with significant follow-up.

8. Methods Medical records from patients who underwent second PIP joint correction between January 1998 to December 2008 were retrospectively reviewed. A total of 114 patients (136 cases) were included in the study that had complete medical records and anterior-posterior (AP) and lateral (LAT) radiographic views pre-operatively and post-operatively.

9. Methods Separated into three groups Arthroplasty Arthrodesis Interposition Implant Arthroplasty (Implant)

10. Methods Visual analog pain scale (VAS) Revision surgeries Second PIP joint angle was measured on AP and LAT views.

11. Methods Anterior-posterior Lateral Pre-operative Post-operative Pre-operative Post-operative

12. Statistical Analysis All statistical analyses were performed with SPSS version 14.0 for a personal computer (SPSS Science Inc, Chicago, Ill). We used a two-way repeated measures analysis of variance (ANOVA). Inferential statistics included paired two-tailed t tests for continuous variables. The a priori α level was .05 for all statistical tests.

13. Results Demographics 39 patients/ 45 cases with an average age of 62.7 34 patients/ 43 cases with an average age of 55.5 41 patients/ 48 cases with an average age of 67.4 Arthroplasty Group Arthrodesis Group Implant Group

14. Results Demographics Average follow-up of 45.3 months Average follow-up of 47.8 months Average follow-up of 67.4 months Arthroplasty Group Arthrodesis Group Implant Group

16. Average pre-operative AP was 8.20vs 11.40 post-operative (P < 0.05).

17. Average pre-operative LAT was 46.90vs 31.50 post-operative (P<0.01).

19. Average pre-operative AP was 7.20vs 5.40 post-operative (P = 0.59).

20. Average pre-operative LAT was 46.40vs 24.70 post-operative (P<0.01).

22. Average pre-operative AP was 7.80vs 2.90 post-operative (P < 0.01).

23. Average pre-operative LAT was 49.10vs 24.20 post-operative (P<0.01).

25. Results

26. Results

27. Discussion Our study demonstrates that all three techniques Significantly improve pain Significantly corrects in the sagittal plane (LAT).

28. Discussion However, only the implant group significantly corrected the deformity in the axial plane (AP). Moreover, surgical revisions were lower in this group.

29. Discussion There are many studies that demonstrate great results of different techniques1-7, however, this study is the first to compare the results of three popular hammertoe treatments with long-term follow-up.

30. Discussion Strength Weakness Case-Control Statistical analysis Follow-up Observer bias Variability in patient selection. Underpowered to determine variance

31. Conclusions In conclusion, our study confirms that all three techniques provide adequate pain relief and sagittal plane correction. However, interpositional implant arthroplasty provides significant correction in the axial plane with less chance for revision surgery.

32. References Sollitto RJ et al. A preliminary report on the status of implants for the lesser toes. J Foot Surg. 1985 Nov-Dec: 24 (6): 435-6 Sgarlato TE. Digital implant arthroplasty. ClinPodiatr Med Surg 1996 Apr;13(2):255-62. Mednick DL et al. Comparison of total hinged and total nonhinged implants for the lesser digits. J Foot Surg. 1985 May-Jun;24(3):215-8. Edwards WH et al. Interphalangeal joint arthrodesis of the lesser toes. Foot Ankle Clin. 2002 Mar;7(1):43-8. Ohm OW et al. Digital arthrodesis: an alternate method for correction of hammer toe deformity. J Foot Surg 1990 May-Jun;29(3):207-11. Co AY et al. Radiographic analysis of transverse plane digital alignment after surgical repair of the second metatarsophalangeal joint. J Foot Ankle Surg. 2006 Nov-Dec;45(6):380-99. Rice JR. Digital arthroplasty by power surgery with minimal incision. J Am Podiatry Assoc. 1977 Nov;67(11):811-4. Coughlin MJ. Lesser toe abnormalities. Instr Course Lect. 2003;52:421-44.

33. Thank You