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Background . Hallux rigidus is the most prevalent arthritic condition of the foot. Treatment of end-stage disease traditionally consists of a first metatarsophalangeal joint (MTPJ) arthrodesis; however, the use of a synthetic cartilage implant is becoming more common. With the high prevalence of disease and implementation of new treatment modalities, health care consumers should be aware of the costs associated with management. The purpose of this study was to determine access to the cost and variability in price of first MTPJ arthrodesis and synthetic cartilage implantation. Methods . Forty academic centers were contacted using a standardized patient script. The patient was a 59-year-old female who had failed conservative treatment of hallux rigidus. Each institution was contacted up to 3 times in an attempt to obtain a full bundled operative quote for a first MTPJ arthrodesis and synthetic cartilage implantation. Results . Twenty centers (50%) provided a quote for first MTPJ arthrodesis and 15 centers (38%) provided a quote for synthetic cartilage implantation. Only 14 centers (35%) were able to provide a quote for both procedures. The mean bundled price for MTPJ arthrodesis was $21 767 (range $8417 to $39 265). The mean bundled price for synthetic cartilage implantation was $21 546 (range $4903 to $74 145). There was no statistically significant difference between the bundled price for first MTPJ arthrodesis and synthetic cartilage implantation. Conclusions . There was limited availability of consumer prices for first MTPJ arthrodesis and synthetic implantation, thus impeding health care consumers' decision making. There was a wide range of quotes for both procedures, indicating potential cost savings. Levels of Evidence: IV, basic science.

Background: First metatarsophalangeal (MP) arthrodesis in the setting of bone loss is a difficult problem. Bone loss may compromise stability of implant fixation. Union rates may be adversely affected by these circumstances. The primary goals of this cadaveric, biomechanical study were to (1) investigate stiffness of a dual mini-plate construct versus a standard MP arthrodesis plate in the setting of severe bone loss and (2) evaluate arthrodesis interface motion when an interpositional graft is used., Methods: Twelve matched cadaveric samples were used in this study. In a given pair, both dual mini-plate fixation and standard MP arthrodesis plate were used. Interpositional graft was used in 6 of the specimen pairs. After implantation, soft tissues were dissected away and specimens were placed into a cantilever bending setup. A cantilever load was applied at a rate of 6 mm/min until catastrophic failure of the test construct or 5-mm plantar gapping of either bone block interface., Results: Based on load to failure data, there were no differences between the various constructs in terms of stiffness. There was a high degree of calculated plantar gapping with the placement of a bone block, irrespective of the fixation type., Conclusions: Although no construct differences were observed in terms of stiffness, the dual mini-plate is an alternative option for fixation when asymmetric bone loss is either seen on the phalangeal or metatarsal head side. The high degree of plantar gapping of the proximal interface with the placement of the bone block may have implications for healing potential across the arthrodesis site., Clinical Relevance: This is the first biomechanical study investigating the stiffness of multiple constructs for MP arthrodesis in the setting of severe bone loss. Furthermore, this is the first study to introduce a biomechanical rationale for difficulties in healing for this particular clinical scenario., Levels of Evidence: Level V: Bench testing., (© 2015 The Author(s).)

Background: Although plain radiographs have been historically used to evaluate the status of arthrodesis in the foot and ankle, computed tomography (CT) has gained popularity for evaluation of fusion status. The degree of fusion identified on CT scan has been correlated with functional outcome, with an arthrodesis area of 25-50% necessary for clinical success. In the clinical setting, orthopaedic surgeons often evaluate CT scans independently. The purpose of this study was to evaluate the interrater reliability of CT scans to assess the status of hindfoot or ankle fusions among orthopaedic foot and ankle surgeons., Methods: Forty-one CT scans were identified retrospectively from the tertiary referral practices of 4 fellowship-trained orthopaedic foot and ankle surgeons. Inclusion criteria were patients with ankle, subtalar, or tibiotalocalcaneal fusions. Fusions with bulk allograft were excluded. All CT scans were completed at the investigating institution. The primary author (RAC) reviewed all CT scans to ensure the adequacy and completeness of the films. Images were blinded of any patient identifiers. All 4 surgeons individually reviewed the blinded scans and determined whether the arthrodesis site was greater than or less than 50% fused. Interrater reliability was completed via kappa analysis., Results: Based on kappa analysis, there was high interrater reliability in the assessment of subtalar arthrodesis. This was not statistically significant for the evaluation of ankle arthrodesis., Conclusion: The CT scan has become instrumental in determining the adequacy of arthrodesis in the foot and ankle. The present study demonstrates the reliability of orthopaedic surgeons to ascertain the status of subtalar arthrodesis via CT scan., Level of Evidence: Level IV, case series., (© The Author(s) 2014.)