This study compared outcomes of 3 surgical treatments for hammertoe deformities: arthroplasty, arthrodesis, and interpositional implant arthroplasty. 114 patients underwent one of the procedures and were followed for at least 12 months. All treatments significantly improved pain and sagittal plane correction, but only implant arthroplasty provided significant transverse plane correction and had the lowest revision rate at 10.4%. The study demonstrates implant arthroplasty may have advantages over the other procedures for hammertoe correction.

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.

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