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The Lisfranc joint connects the forefoot to the midfoot. Tarsometatarsal (TMT) arthrodesis is commonly employed for Lisfranc joint injuries; however, there is active discussion regarding the optimal method of fixation for TMT arthrodesis. The purpose of this systematic review is twofold: to assess the stability of various constructs used in TMT arthrodesis and to evaluate joint motion and force distribution in the foot following arthrodesis. The PubMed, CINAHL, MEDLINE, and Web of Science databases were searched for articles evaluating biomechanical and kinetic properties of TMT arthrodesis constructs in accordance with PRISMA guidelines. The preliminary search yielded 367 articles and the final review included 14 articles with 195 cadaveric and 70 synthetic bone constructs. Plantar plates and intramedullary screw fixation at the first TMT joint were consistently found to bear significantly greater loads and resist diastasis more effectively than crossed screws. Furthermore, whole foot and lateral column arthrodesis significantly elevate calcaneocuboid and lateral column pressures. This increase was not observed with isolated fourth or fifth TMT arthrodesis. TMT arthrodesis should aim to avoid the lateral column and fuse as few joints as possible. Overall, plantar plates are an effective construct for first TMT arthrodesis due to their ability to withstand both compressive and tensile forces while maintaining stable alignment of the foot via reinforcement of the transverse arch. Intramedullary fixation devices are an alternative option that provide a high degree of active compression across the joint space while avoiding irritation of surrounding soft tissue structures.

As outcomes and survivorship improve, total knee arthroplasty (TKA) has expanded into broader age groups. The purpose of this study is to analyze the impact of age on TKA outcomes using the National Surgical Quality Improvement Program (NSQIP) database from 2015 to 2020. Patients were categorized into young (40–49 years), middle (50–79 years), and elderly (80–89 years) groups. Findings reveal notable differences across age groups. The young cohort had the highest BMI, smoking incidence, and steroid use, while the elderly group exhibited a higher prevalence of comorbidities. Young patients experienced shorter hospital stays (p < 0.001) but longer operative times (p < 0.001), and outpatient surgery was most common in the middle age group. Multivariable regression demonstrated that the elderly group faced increased risks of pneumonia (p < 0.001), acute renal failure (p < 0.001), stroke (p < 0.001), cardiac arrest (p < 0.001), and transfusions (p < 0.001), while both young and elderly patients had higher 30-day reoperation risks (youngest cohort, 1.4% and elderly cohort 1.3% (p < 0.001)). In summary, elderly patients undergoing TKA are at the highest risk for medical complications, while young patients are more likely to undergo inpatient surgery, experience reoperations, and have longer operative times. This study underscores the importance of age-specific counseling for TKA patients and contributes valuable insights into the evolving landscape of knee replacement surgery.

The first metatarsophalangeal (MTP) joint is a frequently loaded joint, handling loads up to 90% of bodyweight. First MTP arthrodesis is a frequently performed procedure designed to improve pain in patients with degenerative MTP joint disease. There are a wide variety of fixation constructs for this procedure without consensus on the most effective method. The purpose of this study was to compare the biomechanical integrity of various constructs utilized for first MTP arthrodesis. A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, MEDLINE, and Web of Science databases were searched from inception to 18 June 2023. Articles discussing the biomechanics of first MTP arthrodesis constructs were included. A total of 168 articles were retrieved. A total of 20 articles involving 446 cadaveric and synthetic bone constructs were included in the final review. Of the six articles comparing dorsal plating with compression screws to crossed interfragmentary screws, five found that dorsal plating had significantly higher stiffness. All three studies assessing shape-memory staples found them to be significantly less stable than crossed screws or dorsal plates alone. Both studies evaluating fully threaded screws found them to be stronger than crossed cancellous screws. Wedge resections have been shown to be 10 times stronger than standard planar or conical excision. Dorsal plating with compression screws is the gold standard for MTP arthrodesis. However, more research into newer methods such as fully threaded screws and wedge resections with an increased focus on translation to clinical outcomes is needed.

Motion-preserving options for the treatment of first metatarsophalangeal (MTP) osteoarthritis are appealing, but the conversion to arthrodesis in failed cases comes with additional challenges. Loss of first ray length may not only lower arthrodesis success rates but can also cause aberrancies in the biomechanics of the foot and ankle. Selection of the proper graft for the restoration of length is crucial in order to minimize the chance of post-operative complications. The primary objective of this systematic review was to determine the optimal graft type for MTP salvage arthrodesis in terms of clinical outcomes, kinematic outcomes, and bony integration to improve patient care. A systematic review was performed using PubMed, SPORTDiscus, Cumulated Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, and Web of Science from database inception until 20 June 2023. Inclusion criteria were articles that examined clinical outcomes, examined different types of bone grafts, discussed impact of bone graft on lengthening, and articles related to first MTP arthrodesis salvage procedures. Data extraction relating to clinical metrics and kinematic metrics was performed and analyzed. Subgroup analysis was performed to compare graft types, such as (1) foot and ankle autograft, (2) non-foot and ankle autograft, and (3) allograft. A total of ten articles met eligibility criteria from 180 articles initially retrieved. Included patients (n = 164) had a frequency-weighted mean age of 55.2 ± 4.6 years with a frequency-weighted mean time from primary to salvage procedure of 36.6 ± 21.9 months and a frequency-weighted mean follow-up time of 42.7 ± 17.4 months. The non-foot and ankle autograft group had a mean length restoration of 4.4 ± 0.1 mm (n = 33, 73.3% reported) whereas the allograft group had a mean length restoration of 7.6 ± 3.5 mm (n = 49, 100% reported). The foot and ankle autograft group (n = 12 procedures) had an overall complication rate of 25.0%, the non-foot and ankle autograft group (n = 45 procedures) had an overall complication rate of 53.3%, and the allograft group (n = 49 procedures) had an overall complication rate of 10.2%. Preoperative AOFAS scores were lower but improved postoperatively, with the allograft group showing the highest postoperative scores, shorter time to union, and varying graft lengths among different autograft subgroups. The allograft group for salvage MTP arthrodesis has promise, as this group had the greatest mean length restoration and the lowest complication rate. This is the first systematic review examining different bone graft utilization for salvage MTP arthrodesis. More high-quality research is needed before solid recommendations can be made on this topic.