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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Determinants of Sagittal Alignment Following First Metatarsophalangeal Arthrodesis: The Influence of Native Anatomy, Fixation Construct, and Surgeon Experience

  • Thomas Stumpner1
  • Paul Pöchgraber1
  • Dietmar Mattausch1
  • Reinhold Ortmaier1
  • Martin Bischofreiter1
  • Harald Kindermann2
  • Alexander Auffarth3
  • Simon Recheis1
  1. 1Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern Vinzenzgruppe Center of Orthopedic Excellence, Teaching Department of the Paracelsus Medical University Salzburg, Seilerstätte 4, 4020 Linz, Austria
  2. 2Department of Marketing and Electronic Business, University of Applied Sciences Upper Austria, Wehrgrabengasse 1, 4400 Steyr, Austria
  3. 3Department of Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020 Salzburg, Austria
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Abstract

Background/Objectives: Optimal sagittal alignment after first metatarsophalangeal (MTP) joint arthrodesis is important for postoperative function, but its determinants remain poorly understood. This study evaluated the associations of fixation method, native sagittal anatomy, and surgeon case volume with postoperative alignment. Methods: A retrospective cohort study included 272 primary first MTP arthrodeses for end-stage hallux rigidus performed between 2012 and 2022. Fixation consisted of compression screws (n = 149) or a dorsal plate with a compression screw (n = 123). Sagittal alignment was assessed on weight-bearing radiographs using the dorsiflexion angle (DFA) and hallux ground angle (HGA); secondary parameters were the metatarsal declination angle (MDA) and hallux valgus angle (HVA). Surgeons were stratified by case volume as high (>30), medium (10–30), or low (<10 arthrodeses). Radiographic nonunion was assessed at 6 months. Group comparisons and correlation analyses evaluated associations between fixation construct, native anatomy, surgeon case volume, and postoperative alignment. Results: Plate fixation was associated with greater postoperative hallux dorsiflexion relative to both the first metatarsal (DFA: 25.4 degrees vs. 21.9 degrees, p < 0.001) and the ground plane (HGA: 6.4 degrees vs. 4.15 degrees, p < 0.001), whereas HVA was similar between groups (p = 0.545). The plate group demonstrated a greater MDA (21.3 degrees vs. 20.5 degrees, p = 0.028), and MDA correlated positively with DFA in both fixation groups (screw: r = 0.19, p = 0.042; plate: r = 0.29, p = 0.006). Surgeon case volume was associated with postoperative sagittal alignment, with lower-volume surgeons demonstrating greater HGA values (p = 0.002). The overall radiographic nonunion rate was 9.6%. Conclusions: Postoperative sagittal alignment was associated with native anatomy, fixation construct, and surgeon case volume. Hallux position should be individualized according to native anatomy and confirmed by functional intraoperative assessment rather than relying on implant geometry or predefined radiographic target angles alone. Level of Evidence: Level III, retrospective comparative study.

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Cite

BibTeXRIS
BibTeX
@article{stumpner2026determinants,
  title = {{Determinants of Sagittal Alignment Following First Metatarsophalangeal Arthrodesis: The Influence of Native Anatomy, Fixation Construct, and Surgeon Experience}},
  author = {Thomas Stumpner and Paul Pöchgraber and Dietmar Mattausch and Reinhold Ortmaier and Martin Bischofreiter and Harald Kindermann and Alexander Auffarth and Simon Recheis},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = nov,
  doi = {10.3390/jcm15218698},
  url = {https://www.mdpi.com/2077-0383/15/21/8698},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Determinants of Sagittal Alignment Following First Metatarsophalangeal Arthrodesis: The Influence of Native Anatomy, Fixation Construct, and Surgeon Experience
AU  - Thomas Stumpner
AU  - Paul Pöchgraber
AU  - Dietmar Mattausch
AU  - Reinhold Ortmaier
AU  - Martin Bischofreiter
AU  - Harald Kindermann
AU  - Alexander Auffarth
AU  - Simon Recheis
PY  - 2026
DA  - 2026/11/07
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218698
UR  - https://www.mdpi.com/2077-0383/15/21/8698
AB  - Background/Objectives: Optimal sagittal alignment after first metatarsophalangeal (MTP) joint arthrodesis is important for postoperative function, but its determinants remain poorly understood. This study evaluated the associations of fixation method, native sagittal anatomy, and surgeon case volume with postoperative alignment. Methods: A retrospective cohort study included 272 primary first MTP arthrodeses for end-stage hallux rigidus performed between 2012 and 2022. Fixation consisted of compression screws (n = 149) or a dorsal plate with a compression screw (n = 123). Sagittal alignment was assessed on weight-bearing radiographs using the dorsiflexion angle (DFA) and hallux ground angle (HGA); secondary parameters were the metatarsal declination angle (MDA) and hallux valgus angle (HVA). Surgeons were stratified by case volume as high (>30), medium (10–30), or low (<10 arthrodeses). Radiographic nonunion was assessed at 6 months. Group comparisons and correlation analyses evaluated associations between fixation construct, native anatomy, surgeon case volume, and postoperative alignment. Results: Plate fixation was associated with greater postoperative hallux dorsiflexion relative to both the first metatarsal (DFA: 25.4 degrees vs. 21.9 degrees, p < 0.001) and the ground plane (HGA: 6.4 degrees vs. 4.15 degrees, p < 0.001), whereas HVA was similar between groups (p = 0.545). The plate group demonstrated a greater MDA (21.3 degrees vs. 20.5 degrees, p = 0.028), and MDA correlated positively with DFA in both fixation groups (screw: r = 0.19, p = 0.042; plate: r = 0.29, p = 0.006). Surgeon case volume was associated with postoperative sagittal alignment, with lower-volume surgeons demonstrating greater HGA values (p = 0.002). The overall radiographic nonunion rate was 9.6%. Conclusions: Postoperative sagittal alignment was associated with native anatomy, fixation construct, and surgeon case volume. Hallux position should be individualized according to native anatomy and confirmed by functional intraoperative assessment rather than relying on implant geometry or predefined radiographic target angles alone. Level of Evidence: Level III, retrospective comparative study.
SN  - 2077-0383
ER  -