Comparison of Radiographic Fusion Outcomes in First Metatarsophalangeal Joint Arthrodesis Using Staple, Plate-and-Staple, and Plate Fixation.

BACKGROUND: Hallux rigidus is a painful degenerative condition characterized by limited dorsiflexion of the first metatarsophalangeal joint (MTPJ). When nonoperative treatment fails, arthrodesis is widely considered the gold standard surgical intervention. Although arthrodesis reliably restores a stable, functional joint, the optimal fixation construct remains debated. PURPOSE: To compare radiographic fusion outcomes among different fixation constructs used for first MTPJ arthrodesis and identify factors associated with successful fusion. STUDY DESIGN: Retrospective cohort study. METHODS: A retrospective review of first MTPJ arthrodesis procedures from 2020-2024 included 45 patients meeting inclusion criteria and a minimum 90-day follow-up. Patients underwent fixation with standalone staples, hybrid plate and staple fixation, or standalone plates. Fusion was classified as complete, partial, or nonunion. Secondary outcomes included hardware failure, revision surgery, and factors associated with fusion. RESULTS: No significant differences were observed among fixation constructs with respect to fusion outcomes, hardware failure, revision surgery, or baseline patient characteristics. Multivariable analysis demonstrated that current smoking and postoperative noncompliance were strongly associated with worse fusion outcomes. Patients who smoked had substantially lower odds of achieving higher fusion grades, and patients who were noncompliant with postoperative protocols also had significantly reduced odds of successful fusion, independent of fixation type. CONCLUSION: Staple, plate, and hybrid fixation constructs produced comparable radiographic fusion outcomes following first MTPJ arthrodesis. Patient factors, particularly smoking status and postoperative compliance, appear to play a more important role in determining successful fusion than fixation construct selection.