A prospective investigation of the BioPro hemi-arthroplasty for the first metatarsophalangeal joint

Metallic hemiarthroplasty for the treatment of end-stage hallux rigidus

Aims

To examine the mid-term outcome and cost utility of the BioPro metallic hemiarthroplasty for the treatment of hallux rigidius.

Patients and Methods

We reviewed 97 consecutive BioPro metallic hemiarthroplasties performed in 80 patients for end-stage hallux rigidus, with a minimum follow-up of five years. There were 19 men and 61 women; their mean age was 55 years (22 to 74). No patient was lost to follow-up.

Results

A total of 12 patients (15 first metatarso-phalangeal joints (MTPJs)) required a revision; one for infection, two for osteolysis and 12 for pain. The all cause rate of survival at five years was 85.6% (95% confidence interval (CI) 83.5 to 87.9). Younger age was a significant predictor of revision (odds ratio 1.09, 95% CI 1.02 to 1.17, p = 0.014) on excluding infection and adjusting for confounding variables (Cox regression). Significant improvements were demonstrated at five years in the Manchester Oxford Foot Questionnaire (13.9, 95% CI 10.5 to 17.2) and in the physical component of the Short Form-12 score (6.5, 95% CI 4.1 to 8.9). The overall rate of satisfaction was 75%. The cost per quality adjusted life year at five years, accounting for a 14% rate of revision was between £4431 and £6361 depending on the complexity and morbidity of the patient.

Conclusion

The BioPro hemiarthroplasty offers good short to mid-term functional outcome and is a cost effective intervention. The relatively high revision rate is associated with younger age and perhaps the use of this implant should be limited to older patients. Cite this article: Bone Joint J 2016;98-B:945–51.

Techniques in Hemiarthroplasty of the First Metatarsophalangeal Joint

Surgical intervention for hallux rigidus could be necessitated when conservative attempts fail to alleviate pain and dysfunction. Controversy exists as to which procedure is ideal and will provide lasting relief of hallux rigidus pain. Many arguments have been made for and against hemi-implant arthroplasty. We advocate the use of a low-profile hemimetallic endoprosthesis (Metasurg(®)) and present our technique of using a reamer to sculpt the articular surface of the metatarsal head when necessary. We further advocate for minimal resection of the phalangeal base when using a low-profile device to maintain the soft tissue periarticular intrinsics. We present a 2- to 3-position reamer decompression of the metatarsal and discuss the benefits of maintaining range of motion at the first metatarsophalangeal joint.

Short-Term Clinical Outcome of Hemiarthroplasty Versus Arthrodesis for End-Stage Hallux Rigidus

Few data are available to compare the outcomes of first metatarsophalangeal joint (MTPJ) hemiarthroplasty and arthrodesis. We included 46 patients who had undergone BioPro(®) first MTPJ hemiarthroplasty and 132 who had undergone arthrodesis, with a minimum follow-up duration of 12 months. The primary outcome was patient satisfaction, which was determined using binominal questions. The Foot and Ankle Outcome Score, Foot Function Index, and Numerical Rating Scale for pain and limitations questionnaires were also used. The secondary outcome was treatment failure. No differences were found in the satisfaction rate (p = .54) after a median period of 38.4 (range 12 to 96) months and 39.8 (range 12 to 96) months in the hemiarthroplasty and arthrodesis patients, respectively. Furthermore, no differences were found in the failure rates (p = .93) or the interval to failure (p = .32).The results of the present study showed no significant differences in the short-term clinical outcomes and failure rates for BioPro(®) first MTPJ hemiarthroplasty and arthrodesis. Prospective comparative studies are required to determine whether BioPro(®) first MTPJ hemiarthroplasty is a good alternative for first MTPJ arthrodesis in the long term.

Management of a failed metatarso-phalangeal joint fusion utilizing a hemicup prosthesis

We report a case of a 65-year-old man with a painful nonunion of the first metatarsophalangeal joint (MTPJ). It is one of the main severe complications of this surgery. Its prevalence is described between 5% and 10% across different operative techniques. The implantation of hemicup-prosthesis has been successfully used for the hallux rigidus treatment with very promising results. In our case report, we introduce a treatment method of converting a pseudoarthrosis of the first MTPJ, made of two crossing screws into a hemicup-prosthesis as a salvage procedure. This is to our best knowledge the first report using this device for treatment of pseudoarthrosis of the first MTPJ.

Comparison of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in the treatment of advanced hallux rigidus

The purpose of the present study was to compare the functional results of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in hallux rigidus. The data from patients treated from 2006 to 2010 for advanced stage hallux rigidus were retrospectively reviewed. A total of 38 patients who had at least 2 years (range 24 to 66 months, mean 31.1) of follow-up were included in the present study. Of the 38 patients, 12 were included in the total joint replacement group (group A), 14 in the resurfacing hemiarthroplasty group (group B), and 12 in the arthrodesis group (group C). At the last follow-up visit, the functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) scale, visual analog scale (VAS), and metatarsophalangeal range of motion. Significant improvements were seen in the AOFAS-HMI score, with a decrease in the VAS score in all 3 groups. According to the AOFAS-HMI score, no significant difference was found between groups A and B. However, in group C, the AOFAS-HMI scores were significantly lower than in the other groups owing to the lack of motion. According to the final VAS scores, no significant difference was found between groups A and B; however, the VAS score had decreased significantly more in group C than in the other groups. No major complications occurred in any of the 3 groups. After 2 years of follow-up, all the groups had good functional outcomes. Although arthrodesis is still the most reliable procedure, implant arthroplasty is also a good alternative for advanced stage hallux rigidus.

Design of an implant for first metatarsophalangeal hemi-arthroplasty

This study was designed to examine the three-dimensional geometry of the head of the first metatarsal bone of the foot. Ninety-seven adult first metatarsal head (MTH1) bones were scanned using a laser scanner at 400 dpi. A best-fit ellipsoid was obtained from the articular surfaces of MTH1 for each size group using nonlinear unconstrained optimisation. Average root mean square errors between the articulating surfaces and the optimal fit surfaces of the bone specimens were between 0.29 and 0.42 mm. After classification based on sex and size groups, the profile provided a good fit to individual bones. Consideration of the thickness of cartilage overlying the metatarsal head (MTH) may further improve the fit. The proposed approach provides the basis for a design of an MTH hemi-arthroplasty that has good anatomical congruence with the native joint.

Hemiarthroplasty augmented with bone graft for the failed hallux metatarsophalangeal Silastic® implant

Symptomatic failure of Silastic® implants at the hallux metatarsophalangeal joint can result in the challenging problem of instability which may be painful. There is often marked bone loss making reconstruction difficult. Arthrodesis sacrifices joint movement while excision arthroplasty shortens the ray and is less acceptable to active patients. We describe a case in which reconstruction was achieved by using a porous coated metatarsophalangeal hemiarthroplasty augmented with bone graft with good early results. This previously unreported technique may offer an additional surgical option for reconstruction, maintaining joint movement without compromising future arthrodesis or excision arthroplasty as salvage measures. Long term follow up is required to confirm the success of this technique.

First metatarsophalangeal joint interpositional arthroplasty using a meniscus allograft for the treatment of advanced hallux rigidus: surgical technique and short-term results

Hallux rigidus is a progressive disorder of the first metatarsophalangeal (MTP) joint. The disorder is characterized by a loss of range of motion, degenerative changes, and pain within the joint. In later stages of the disease, the surgical procedure of choice is arthrodesis of the joint. Recently, salvage procedures of the first MTP joint using soft tissue interposition has gained popularity. In this retrospective review of 12 patients (13 total procedures) who had late-stage hallux rigidus, we evaluated the effectiveness of a newly proposed salvage procedure using a cadaver meniscus allograft for interposition. First MTP joint dorsiflexion improved from 15.77° (range, 5° -30°) preoperatively to 47.77° (range, 40° -57°; P < .0001). AOFAS (American Orthopaedic Foot and Ankle Society) scores improved from 52.54 points (range, 35-69 points) preoperatively to 90.01 points (range, 82-95 points; P < .0001), with all patients showing improvement. The mean length of follow-up for this study was 16.46 months (range, 5-26 months) with no complications being recorded. The results show that cadaver meniscus allograft interposition is a viable procedure for end-stage hallux rigidus.

LEVEL OF EVIDENCE

therapeutic, level III: retrospective review.