Emerging Implant May Be An Effective Option For First MPJ Arthroplasty

An innovative product offers surgeons a user-friendly option for restoring motion and reducing pain in individuals suffering from first metatarsophalangeal joint (MPJ) pathologies.

The In2Bones Reference Toe System (RTS) for first MPJ arthroplasty features a medical grade silicone elastomer implant along with titanium grommets. A sterile disposable instrument set is designed to accompany each implant based on size, according to In2Bones, the manufacturer of the product.

The company adds that the Reference Toe System implant consists of an angled metatarsal stem that matches the natural declination angle along with a grommet and stem design that eliminates the need for broaching.

According to Gary Lepow, DPM, MS, FACFAS, the creative design of the Reference Toe System instrumentation allows for greater precision during surgery as well as reduced operating time.

“The design of the instruments, implant sizers, implants and grommets are improvements over all previous and existing total first MPJ implants,” says Dr. Lepow, a Senior Partner at Lepow Foot and Ankle Specialists and an Associate Clinical Professor at both the Baylor College of Medicine and the University of Texas Medical School in Houston.

Orlando Rivera, DPM, who recently performed revision surgery on a patient with a failed hemi-implant, touts the system’s ease of use.

“It eliminates any kind of guesswork from the surgeon by providing cannulated power reamers and color-coded sizers. Other older systems have manual reamers and broaches that sometimes make for a less than perfect fit,” says Dr. Rivera, a Fellow of the American College of Foot and Ankle Surgeons, and a member of the Texas Podiatric Medical Association.

For Kurt Massey, DPM, the Reference Toe System implant has some unique qualities that make it appealing.

“The Reference Toe System has an anatomically designed hinge specifically for the great toe joint. The grommets are much easier to insert than previous products and the hinge contours are smooth and rounded off,” notes Dr. Massey, who is board-certified in foot and ankle surgery and rearfoot reconstructive surgery by the American Board of Podiatric Surgery.

Dr. Massey describes a recent procedure in which he used the Reference Toe System implant to correct a great toe joint fusion.

“The patient was having a great deal of pain due to pressure on the bottom of the first metatarsal head. I gave him the choice to have an osteotomy and fuse the joint in the correct position, or insert the Reference Toe System implant after an osteotomy through the fusion. He elected the (implant) to get motion back in the great toe again (and) has been pleased with his choice,” explains Dr. Massey.

According to surgeons who have used the Reference Toe System implant, the implant is well suited to address some common problems associated with arthrodesis of the first metatarsophalangeal joint.

“I find the Reference Toe System very useful in cases when there is a lack of toe purchase after a failed first MPJ arthrodesis,” notes Dr. Rivera.

“If there is a failure such as a non-union of a first MPJ fusion,” says Dr. Lepow, “the Reference Toe System is uniquely designed to use for reconstruction.”

Dr. Lepow points to successful surgical outcomes when using the Reference Toe System. In describing a recent case in which he used the Reference Toe System, Dr. Lepow says, in addition to a reduction in operating time, “the patient had an immediate relief of pain and increased range of motion.”

Ms. Garthwait is a freelance writer who lives in Downingtown, Pa.