## 4 Discussion  
In this systematic review, the clinical and kinematic outcomes of salvage MTP arthrode-sis for restoration of length were investigated to improve patient care and surgeon decision making. Due to the limited number of high-evidence studies, most analyses in this study were centered around describing the clinical outcomes of three different graft groups (foot and ankle autograft, non-foot and ankle autograft, and allograft) qualitatively. While previous systematic reviews have summarized the current literature on salvage MTP arthrodesis, their study was limited to salvage procedures for failed arthroplasties and did not separate outcomes based on graft type [16]. As arthroplasty is not the only conservative treatment to treat MTP arthritis, our study included cases with failed bunion \begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Author (Year)** & **Procedures (\(n\))** & **Graft Group** & **Nonunion Rate** & **Complications** \\ \hline [PERSON] (2021) [21] & 38 & Allograft & 5\% & Pain (\(n=1,2,6\%\)), \\  & & & & nonunion (\(n=2,5.3\%\)), \\ \hline [PERSON] (1997) [22] & 16 & Unclassified & - & Neuroma (\(n=1,6.3\%\)) \\ \hline [PERSON] (2017) [23] & 12 & Foot and ankle autograft & 25\% & Nonunion (\(n=3,25\%\)), \\ \hline [PERSON] (2015) [24] & 11 & Allograft & 9.09\% & Superficial wound (\(n=1,9,09\%\)), \\  & & & & painful nonuniform (\(n=1,9.09\%\)) \\ \hline [PERSON] (2015) [25] & 15 & Unclassified & 6.67\% & Nonunion (\(n=1,6.6\%\)), \\  & & & & painless arthritis, (\(n=1,6.6\%\)), \\  & & & & stress fracture (\(n=1,6.6\%\)) \\ \hline [PERSON] (2015) [26] & 25 & Non-foot and ankle autograft & - & Nonunion (\(n=3,12.0\%\)), \\  & & & & painful neuroma (\(n=2,8\%\)), \\  & & & & pain at graft site (\(n=1,4\%\)), \\  & & & & hardware removal (\(n=3,12\%\)), \\  & & & & discomfort (\(n=6,33\%\)) \\ \hline [PERSON] (2000) [27] & 24 & Unclassified & 21\% & Nonunion (\(n=5,21\%\)), \\  & & & & deep infection (\(n=1,4.2\%\)), \\  & & & & superficial wound infection (\(n=2,8.3\%\)), \\  & & & & pain syndrome (\(n=1,4.2\%\)) \\ \hline [PERSON] (2018) [28] & 8 & Non-foot and ankle autograft & - & Removal due to discomfort (\(n=1,13\%\)), pain (\(n=1,13\%\)), \\  & & & & numbness (\(n=1,13\%\)) \\ \hline [PERSON] (2013) [3] & 12 & Unclassified & - & Painful nonuniform (\(n=2,16.7\%\)), \\  & & & & prominent plate (\(n=16.7\%\)), \\  & & & & graft site irritation (\(n=1,8.35\%\)) \\ \hline [PERSON] (2000) [29] & 12 & Non-foot and ankle autograft & 8.33\% & Discomfort (\(n=1,8.25\%\)), \\  & & & & sesemoid discomfort (\(n=4,33\%\)), \\  & & & & painless nonunion (\(n=1,8.25\%\)) \\ \hline \hline \end{tabular}
\end{table} 
Table 5: Complications for the individual included articles in this systematic review. Data recorded included first author, year of publication, number of procedures, graft group, non-union rate, and complications with number of cases and percentage of total procedures. osteotomy, hemiarthoplasty, total joint arthroplasty, infected MTP joint, and even diseases such as gout. Additionally, while our review focused on clinical outcomes, it also had a strong focus on the kinematics of the MTP joint. Length restoration, IMA, HV angle, and DFA are all important metrics for not only the success of the arthropods, but the likelihood of preventing foot and ankle biomechanical issues post-operation [6]. As described by [PERSON] et al., the three-dimensional location of the plantar aspect of the MTP head is an important measurement within foot and ankle offset--a surrogate measurement for hindfoot alignment [9]. As length, IMA, DFA, and HV angle all directly alter the location of the MTP head, it is crucial that proper salvage arthrodeis is performed with caution to ensure proper kinematic alignment. Additionally, a shortening of the first ray can have negative effects on forefoot loading that can lead to decreased first ray plantar pressure, potentially increasing the risk of developing lesser toe metatarasalgia [8; 13].