03/08/2021    Don Peacock, DPM, MS

RE: FDA Approves Accufix Surgical's Accu-Joint Hemi Implant

In my 20+ years of practice and surgical correction
of first MPJ arthritis, I have learned a lot the
hard way. Implants seem to work well at first, but
given time, some fail. Fusions work when performed
perfectly, although shoe fit and the inability to
move the toe bothers many patients. I have done
many fusions and many implants, however, I have not
done a fusion or implant in about 7 to 8 years
since learning MIS techniques.

There is a description of a procedure in minimally
invasive foot surgery described by the DePrado
which I have used very successfully. I have used
the procedure up to stage IV hallux rigidus with
success and long-term satisfaction with most
patients. One of the things to be cautious of when
performing a minimally invasive hallux ridges
correction is a potential for neuritis created by
resection of the arthritic joint by the 3-1 burr.
If you do the DePardo procedure you will have some
incidences of neuritis created by the procedure.

So far I have not found a perfect correction for
DJD of the first metatarsal joint. The closest
procedure for my practice has been the MIS DePrado
procedure. It is not perfect but is better than
implants in my experience. We do not have this
issue solved yet. There is so much to understand in
the 1st MPJ pathology created by abnormal
biomechanics and to a lesser degree previous
injury.

Younger researchers need to consider many causes
and potential complications. One size will probably
never fit this deformity. It remains a challenge so
far and will require better techniques and better
biomechanical knowledge. I still have hopes for a
better procedure whether implant or not. It is my
hope that we eventually solve the issue with good
scientific and patient satisfaction proof.

Don Peacock, DPM, MS, Whiteville, NC

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