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2. Purpose To compare the long-term outcomes of second hammertoe deformities that underwent proximal interphalangeal (PIP) joint correction using arthroplasty, arthrodesis or interpositional implant arthroplasty. Retrospective Comparative Study EBM Level of evidence: III (Therapeutic)

3. Purpose Background Indications for surgical correction of hammertoe8 Pain Pressure over the dorsal aspect of the PIP joint Deformity There are many reports regarding the outcomes of PIP joint implant arthroplasty1-3, PIP arthrodesis4-6, and PIP arthroplasty7. However there are no studies that compare the outcomes of all three with significant follow-up.

4. Methods We retrospectively reviewed medical records of patients who underwent second PIP joint deformity correction between January 1998 to December 2008. A total of 114 patients (136 cases) were included in the study with at least 12 months of follow-up. Assessment Visual analog pain scale (VAS) Anterior-posterior (AP) and lateral (LAT) radiographic views were evaluated Second PIP joint angles was measured onsagittal and transverse planes

5. Methods Separated into three treatment groups Arthroplasty Arthrodesis Implant

6. Methods Transverse Pre-operative Post-operative Sagittal Pre-operative Post-operative

7. Statistical Analysis All statistical analysis were performed with SPSS version 14.0 (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.

8. Results Demographics & Revisions Arthroplasty Average follow-up of 45.3 months 39 patients/ 45 cases with an average age of 62.7 Seventeen (37.8%) cases elected revision surgery. Implant Average follow-up of 67.4 months 41 patients/ 48 cases with an average age of 67.4 Four (10.4%) cases elected revision surgery. Arthrodesis Average follow-up of 47.8 months 34 patients/ 43 cases with an average age of 55.5 Six (14.6%) cases elected revision surgery.

10. Discussion Our study demonstrates that all three techniques Significantly improves pain Significantly corrects in the sagittal plane (LAT). However, only the implant group significantly corrected the deformity in the transverse plane (AP). Moreover, surgical revisions were lowest in this group. There are many studies that demonstrate good 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.

11. Discussion Strength Comparative study Statistical analysis Follow-up Weakness Observer bias Variability in patient selection. Underpowered to determine variance

12. 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 transverse plane with less chance for revision surgery.

13. 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.