A consecutive, prospective analysis of the Rotoglide 1st metatarsophalangeal joint replacement

A systematic review of total arthroplasty and arthrodesis for end-stage hallux rigidus: A biomechanical perspective

BACKGROUND

Both arthrodesis and total arthroplasty are acceptable surgical options for end stage hallux rigidus without significant angular deformity. Total arthroplasty preserves first metatarsophalangeal joint (MTPJ) motion, which may help restore a more physiological gait pattern.

RESEARCH QUESTION

Is there a difference in the findings of gait studies after 1st MTPJ total arthroplasty or arthrodesis for end-stage hallux rigidus?

METHODS

PRISMA guidelines were followed to conduct a systematic review of literature for studies reporting gait analysis after the above procedures. Predetermined criteria were used to select papers and evaluated the findings of kinematic (spatial-temporal and dynamic motion), kinetic and foot pressure (pedobarographic) studies.

RESULTS

12 titles were short-listed for synthesis. There was 1 randomized controlled trial comparing the two procedures. Among the remaining cohort studies, 5 reported on total arthroplasty and 6 on arthrodesis of the 1st MTPJ. Due to significant heterogeneity, a narrative synthesis was undertaken. No studies in the arthroplasty group reported spatial-temporal or kinetic parameters. Only 2 papers, 1 in each group, recorded motion within the foot. One of them showed preserved dynamic motion at the 1st MTPJ after total arthroplasty. Pedobarographic studies had discordant findings in studies within both groups regarding restoration of weight bearing through the medial forefoot and the pulp of the great toe during gait.

CONCLUSION

Currently available studies are heterogenous and report inconsistent findings, which do not convincingly answer our research question. Prospective comparative studies with a large sample size, using standardized methodology in accredited laboratories with detailed reporting of kinetic, kinematic and pedobarographic components of gait analysis are required in order to draw concrete conclusions.

A prospective clinical and biomechanical analysis of feet following first metatarsophalangeal joint replacement

BACKGROUND

There is a lack of research providing a biomechanical outcome following 1^st MTPJ replacement for hallux rigidus. Despite this, 1^st MTPJ replacement continues to be an alternative surgical option to fusion for this painful debilitating condition. Several studies do consider the patient reported outcomes which are subjective.

RESEARCH QUESTION

The objective of this study is to provide an in depth biomechanical analysis to examine the effects of 1^st MTPJ replacement for hallux rigidus on gait mechanics.

METHODS

Kinematic data was collected at our CMAS (Clinical Movement Analysis Society) UK accredited gait laboratory during the gait cycle together with pressure plate pressure readings and a validated patient outcome measure before surgery and at 6 and 12 months after surgery. A complete literature review is performed.

RESULTS

Kinematic data revealed a significant increase in stride length, cadence and velocity following 1^st MTPJ replacement for hallux rigidus. Foot kinematic data revealed significantly reduced tibia-hindfoot abduction and pronation and reduced hindfoot-forefoot supination and adduction. There was no effect on 1^st MTPJ weight bearing range of motion. Pressure plate data revealed an increase in peak pressure and pressure time integral towards the 1^st metatarsal following surgery. There was a significant improvement in the patient reported outcome measure.

SIGNIFICANCE

This study has demonstrated objectively that following 1^st MTPJ replacement, biomechanically, a restoration of the foot posture to allow medialisation of foot pressures towards the medial column and normalisation of gait including an increase in the stride length, cadence and velocity and that clinically, there was an improvement in the MOXFQ.