Salvage arthrodesis for failed first metatarsophalangeal joint arthroplasty: A network meta-analysis

•There is fair evidence (grade B) to support salvage arthrodesis with structural bone graft.•There is poor evidence (grade C) for salvage arthrodesis without bone graft.•There was no good evidence (grade A) to recommend either intervention.•Meta-analysis showed salvage arthrodesis resulted in improved functional outcome over time. We aim to provide an evidence-based literature review of salvage arthrodesis for failed first metatarsophalangeal joint arthroplasty with a network meta-analysis. A search of PubMed, Embase and Cochrane databases was conducted in December 2016 which identified 12 relevant articles out of 340 articles assessing the efficacy of salvage arthrodesis for failed joint arthroplasty of the first metatarsophalangeal joint. The 12 studies were assigned a level of evidence (I–V) and interventions were graded a level of recommendation (A–C, I) in support of or against the treatment modality. There is fair evidence (grade B) to support salvage arthrodesis with structural bone graft. There is poor evidence (grade C) for salvage arthrodesis without bone graft. There was no good evidence (grade A) to recommend either intervention. Meta-analysis showed that salvage arthrodesis resulted in improved functional outcome over time. Salvage arthrodesis showed good bone union rates and patient satisfaction. Level of Clinical Evidence: III – Systematic Review of Level III studies.