Spherical ceramic interpositional arthroplasty for basal fourth and fifth metatarsal arthritis

Background: Arthrosis of the fourth and fifth tarsometatarsal joints is difficult to treat. Arthrodesis is both difficult to achieve as well as disabling. Tendon interpositional arthroplasty has been performed with some success. A new technique using ceramic ball interpositional arthroplasty was evaluated. Methods: Between 2001 and 2003, 13 patients in whom nonoperative treatment had failed had resection arthroplasty of the base of the fourth or fifth metatarsals with ceramic ball interposition (Orthosphere, Wright Medical Technology, Arlington, Tennessee). Patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, a visual analogue scale, a satisfaction index, physical examination, and radiographs. Results: At an average 34-months followup, 11 of the 13 patients were available for evaluation. The five men and six women had an average age of 48 years. Seven patients reported a traumatic etiology. Average postoperative AOFAS score was 53 points, an 87% improvement over preoperative values. Visual analogue scale pain improved 42%. All 11 patients were satisfied and would undergo the operation again. One of the patients demonstrated subsidence of the implant into the cuboid but continued to have improvement in symptoms. To date there have been no implant dislocations. Three of the 11 patients had differential injections before surgery. Conclusions: Lateral column tarsometatarsal interpositional arthroplasty is an effective salvage operation for lateral column midfoot arthrosis and should be considered in this patient population. The use of the ceramic ball allows a technically simple procedure and rapid recovery.