1
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Lee W, Wang C, Prat D, Wapner KL, Chao W, Farber DC. Patient Satisfaction Following Hallux Rigidus Treatment With a Synthetic Cartilage Implant. Foot Ankle Spec 2023; 16:527-536. [PMID: 33769110 DOI: 10.1177/19386400211001993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There remains no clear consensus on patient satisfaction and functional outcomes following synthetic cartilage implant (SCI) implantation for hallux rigidus. The purpose of this study was to review our experience at a single academic institution using an SCI for treatment of hallux rigidus. METHODS A retrospective review was performed of patients who underwent the SCI procedure for treatment of hallux rigidus between January 2017 and May 2019. Functional outcomes were evaluated using Patient-Reported Outcome Measures Informational System (PROMIS)-10 scores as well as a survey investigating patient satisfaction, self-reported clinical improvement, and changes in sporting ability. Patients were divided into satisfied versus unsatisfied subgroups, and between-group differences in preoperative variables and complications were reviewed. A total of 90 patients (96 implants) were included in this study. The mean follow-up time was 26.4 months. RESULTS In all, 81.2% of patients reported that their foot was "much improved" (55.2%) or "improved" (26.0%) since undergoing the SCI procedure, whereas a slightly lower percentage, 74.0%, stated that they were "extremely satisfied" (41.7%) or "satisfied" (32.3%) at final follow-up. Patients were able to tolerate higher impact sporting activities after the procedure, and 75.0% of patients stated they would have the same surgery again. PROMIS-10 T-scores averaged 54.2 points for physical health and 57.4 points for mental health. Only 2.1% of patients required conversion to arthrodesis. Significant differences between the satisfied versus unsatisfied subgroups were found in preoperative corticosteroid injection use (21.1% vs 41.1%, respectively; P = .029) and preoperative VAS pain score (8.2 vs 7.1, respectively; P = .036). CONCLUSION The SCI procedure can be a viable option for treating hallux rigidus with high satisfaction overall, increased sport activity levels, and a very low revision rate. However, maximizing patient satisfaction may require more careful consideration of preoperative prognosticators and extensive patient counseling to ensure realistic expectations for recovery time and individual outcome. LEVEL OF EVIDENCE Level IV: Retrospective case series.
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Affiliation(s)
- Wonyong Lee
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Carol Wang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dan Prat
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Keith L Wapner
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Wen Chao
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Daniel C Farber
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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2
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Sethi M, Limaye N, Alderton E, Limaye R, Kulkarni A. Silastic Joint Arthroplasty as a Joint-Preserving Alternative for End-Stage Hallux Rigidus: Outcomes From 112 First Metatarsophalangeal Joint Arthroplasties. Cureus 2023; 15:e46561. [PMID: 37933343 PMCID: PMC10625660 DOI: 10.7759/cureus.46561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/08/2023] Open
Abstract
Aim Osteoarthritis of the first metatarsophalangeal joint (MTPJ) is a common forefoot problem affecting patients in later years. It leads to pain, gait problems, and difficulty with activities of daily living. Treatment is controversial and varies according to patient symptoms and surgeon preference. Arthrodesis remains the gold standard but it has its own complications. It is associated with adjacent joint arthritis and transfer metatarsalgia. The aim of this study was to analyze the outcome of double-stemmed silastic joint arthroplasty (Wright-Medical, Memphis, TN) for end-stage hallux rigidus. Methods This retrospective analysis included 117 consecutive first MTPJ silastic arthroplasties done between January 2016 and February 2023 for end-stage hallux rigidus. There were 77 females and 40 males with a mean age of 65 years (46-82 years). Radiological and clinical assessments were performed, and patient-reported outcome measure data (PROMS) and visual analogue scale (VAS) scores were collected pre- and post-operatively. Results Findings showed 99.1% survivorship following a silastic joint arthroplasty with a mean follow-up of four years (six months to seven years). The MOXFQ (Manchester Oxford Foot Questionnaire) score improved from a mean of 81 (59.8-100) to 13 (0-57). The mean VAS scores improved from 7.2 (5-10) to 1.5 (0-7) postoperatively. Five patients were lost to follow-up. Two patients developed deep infection and one required revision. The other patient with infection was lost to follow-up. In total 10 patients (8.9%) developed complications, out of which eight patients responded to simple treatments. Conclusion Results have shown good to excellent outcomes following a silastic arthroplasty of the first MTPJ for the treatment of end-stage hallux rigidus. The survivorship at a mean follow-up of four years was 99.1% and the patient satisfaction rate was 90.1%. As historically reported, we did not see any soft tissue reaction or progressive osteolysis in any of our patients. It provides comparable and predictable outcomes to joint fusion for end-stage arthritis.
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Affiliation(s)
- Mohit Sethi
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
| | - Natalie Limaye
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
| | - Elizabeth Alderton
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
| | - Rajiv Limaye
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
| | - Ameet Kulkarni
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
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3
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Anderson MR, Ho BS, Baumhauer JF. Republication of "Current Concepts Review: Hallux Rigidus". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231188123. [PMID: 37506124 PMCID: PMC10369095 DOI: 10.1177/24730114231188123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Arthritis of the first metatarsophalangeal (MTP) joint, hallux rigid, is a common and disabling source of foot pain in the adult population. Hallux rigidus is characterized by diseased cartilage and large, periarticular osteophytes that result in a stiff, painful joint. Activity modification, sensible shoes, orthotics, anti-inflammatory medications and occasional intra-articular steroid injections can be attempted to alleviate the discomfort associated with hallux rigidus. A number of surgical options exist for the treatment of recalcitrant hallux rigidus. Cheilectomy is a useful treatment for dorsal impingement pain seen in mild hallux rigidus. A new polyvinyl alcohol hemi-arthroplasty implant has shown promising early and midterm results in the treatment of advanced hallux rigidus; however, arthrodesis of the first MTP joint remains the gold standard treatment for advanced hallux rigidus because of unpredictable outcomes after early-generation joint replacement implants.
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4
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Grimm MPD, Irwin TA. Complications of Hallux Rigidus Surgery. Foot Ankle Clin 2022; 27:253-269. [PMID: 35680287 DOI: 10.1016/j.fcl.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hallux rigidus can be treated with a variety of surgical procedures, including joint preserving techniques, arthrodesis, and arthroplasty. The most commonly reported complications for joint preserving techniques consist of progression of arthritis, continued pain, and transfer metatarsalgia. Although good outcomes have been reported for arthrodesis overall, careful attention must be paid to technique and positioning of the toe to avoid nonunion or malunion. Arthroplasty preserves motion but in the case of failure can present the additional challenge of bone loss. In these scenarios, the authors recommend distraction bone block arthrodesis with structural autograft.
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Affiliation(s)
- Maj Patrick D Grimm
- Dwight D. Eisenhower Army Medical Center, 300 West Hospital Road, Fort Gordon, GA 30905, USA
| | - Todd A Irwin
- OrthoCarolina Foot and Ankle Institute, Atrium Health Musculoskeletal Institute, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207, USA.
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5
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Barták V, Heřt J, Štědrý J, Popelka S, Popelka S, Hromádka R. Long-term results of total joint arthroplasty and phalangeal hemiarthroplasty of the first metatarsophalangeal joint using the ToeFit Plus™ system. Foot Ankle Surg 2022; 28:56-61. [PMID: 33558143 DOI: 10.1016/j.fas.2021.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/29/2020] [Accepted: 01/25/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This paper compares long term success rate of MTP joint replacement for hallux rigidus. We provide long term results of MTP joint replacement with the use of the ToeFit Plus™ System. MATERIALS AND METHODS Our group consisted of 19 total joint replacements and 12 hemiarthroplasties in 18 and 11 patients respectively, performed between 2005-2009. The average follow-up period was 12.2 years (range 9.8-13.7, SD 1.1) for total arthroplasty group and 11.1 years (range 9.5-13.9, SD 1.7) for hemiarthroplasty group. In all followed patients AOFAS score was calculated along with the range of motion assessment. RESULTS Average AOFAS score improved from 37 preoperatively to 79 at the time of last follow-up in total arthroplasty group and from 45 to 86 in the hemiarthroplasty group, with consideration to the statistically considerable difference of both groups. The total range of motion improved on average from 14° to the current 32° in patients with total arthroplasty and from 15° to 32° with hemiarthroplasty. The total number of cases that required surgical revision was 7 (37%) in total arthroplasty group and 2 (17%) in hemiarthroplasty group. CONCLUSION Due to the high percentage of failure that was shown in our long term results, we no longer utilise the ToeFit Plus™ System.
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Affiliation(s)
- V Barták
- Department of Orthopaedic Surgery, 1st Faculty of Medicine Charles University, Motol University Hospital, Prague, Czech Republic.
| | - J Heřt
- Department of Orthopaedic Surgery, 1st Faculty of Medicine Charles University, Motol University Hospital, Prague, Czech Republic
| | - J Štědrý
- Department of Orthopaedic Surgery, 1st Faculty of Medicine Charles University, Motol University Hospital, Prague, Czech Republic
| | - S Popelka
- Department of Orthopaedic Surgery, 1st Faculty of Medicine Charles University, Motol University Hospital, Prague, Czech Republic
| | - S Popelka
- Department of Orthopaedic Surgery, 1st Faculty of Medicine Charles University, Motol University Hospital, Prague, Czech Republic
| | - R Hromádka
- Department of Orthopaedic Surgery, 1st Faculty of Medicine Charles University, Motol University Hospital, Prague, Czech Republic
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Lerch M, Plaass C, Claassen L, Ettinger S. [Mini implants in foot and ankle surgery: an alternative to total joint replacement or joint fusion]. DER ORTHOPADE 2021; 50:96-103. [PMID: 33337505 DOI: 10.1007/s00132-020-04052-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mini implants are increasingly used in foot and ankle surgery. They preserve the joints' functions, are easy to insert and easy to convert to an alternative treatment. Early surgical attempts using silastic implants did not bring the expected success. First achievements where reached with modern metallic mini implants in the first metatarsophalangeal (MTP) joint and the ankle joint. For a few years now, a polyvinyl alcohol implant has been used to treat the arthritic first MTP joint. Even severe arthritic joints can be treated with an implant made of polylactide. This implant can also be used in the treatment of Lisfranc joint pathologies. To address severe osteochondral defects of the talus, an innovative hemiarthroplasty implant has been suggested. This article gives a summary of currently used mini implants. Their application as possible alternatives to total joint replacement or joint fusion are critically reviewed in the light of the current literature.
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Affiliation(s)
- Matthias Lerch
- Orthopädische Klinik der Medizinischen Hochschule Hannover im DIAKOVERE Annastift, Anna-von-Borries Str. 1-7, 30625, Hannover, Deutschland.
| | - Christian Plaass
- Orthopädische Klinik der Medizinischen Hochschule Hannover im DIAKOVERE Annastift, Anna-von-Borries Str. 1-7, 30625, Hannover, Deutschland
| | - Leif Claassen
- Orthopädische Klinik der Medizinischen Hochschule Hannover im DIAKOVERE Annastift, Anna-von-Borries Str. 1-7, 30625, Hannover, Deutschland
| | - Sarah Ettinger
- Orthopädische Klinik der Medizinischen Hochschule Hannover im DIAKOVERE Annastift, Anna-von-Borries Str. 1-7, 30625, Hannover, Deutschland
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Adamson P, Janney C, Chen J, Panchbhavi V. First Metatarsal Phalangeal Joint Arthrodesis without the Use of Hardware after Failed Arthroplasty: A Case Report. J Orthop Case Rep 2021; 11:63-66. [PMID: 34141673 PMCID: PMC8180337 DOI: 10.13107/jocr.2021.v11.i02.2028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction First metatarsal phalangeal joint (MTPJ) arthroplasty has a high failure rate due to aseptic loosening, which leads to bone loss. The salvage procedure is conversion to an arthrodesis, but bone loss can make obtaining screw fixation difficult. Herein, we report a unique case of revision first-metatarsal arthrodesis without the use of hardware after a failed arthroplasty. Case Report A 60-year-old women presented to us with first MTPJ pain in the setting of failed arthroplasty. We performed an arthrodesis; however, intraoperatively, hardware fixation could not be obtained due to bone loss. We utilized allograft bone struts to maintain first ray length and to hold the correct hallux position during arthrodesis maturation. Conclusion Bone loss is a frequently encountered problem in revision surgery to a first MTPJ arthrodesis. An arthrodesis can be obtained without the use of hardware in scenarios where bone loss precludes screw fixation.
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Affiliation(s)
- Peter Adamson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd Route 0165, Galveston, TX 77555-0165
| | - Cory Janney
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134
| | - Jie Chen
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd Route 0165, Galveston, TX 77555-0165
| | - Vinod Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd Route 0165, Galveston, TX 77555-0165
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8
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Sansone V, Maiorano E, Melato M, Martinelli N, Pascale V. Novel treatment for hallux rigidus using a temporary metal interpositional device. Foot Ankle Surg 2020; 26:630-636. [PMID: 31439504 DOI: 10.1016/j.fas.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this prospective study is to evaluate the results of a consecutive series of patients suffering from grade II-III hallux rigidus who underwent a mobility preserving surgical technique consisting of resection arthroplasty with implantation of a temporary metal spacer. METHODS Thirty consecutive patients, 18 female and 12 male with a diagnosis of a grade II-III hallux rigidus, not responding to conservative treatment, underwent a minimal resection arthroplasty followed by the implantation of a temporary metal interpositional device by the same surgeon. All spacers were removed after 6 months through a minimal incision under regional anaesthesia. Patients were clinically and radiographically evaluated at 3, 6, 12 months, and 5 years after spacer removal. RESULTS The clinical AOFAS scores improved already at first follow-up and continued to improve over time with a statistically significant change until the first year. At 3, 6, and 12 months follow-ups, the number of patients with severely limited ROM (i.e. under 30°, that means grade II-III according to Coughlin and Shaurnas classification) significantly decreased. There were only two minor complications, so defined as both of which resolved spontaneously and did not affect the procedure's effectiveness. CONCLUSIONS We observed good to excellent results with the use of this mobility preserving surgical technique for the treatment of symptomatic grades II and III hallux rigidus. The never before published procedure is easy to perform and inexpensive. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Valerio Sansone
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Emanuele Maiorano
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Marco Melato
- Department of Orthopaedic, Hospital SS. Antonio and Biagio and Cesare Arrigo Alessandria, Italy
| | - Nicoló Martinelli
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy.
| | - Valerio Pascale
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
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Brandao B, Aljawadi A, Poh ZE, Fox A, Pillai A. Comparative study assessing sporting ability after Arthrodesis and Cartiva hemiarthroplasty for treatment of hallux rigidus. J Orthop 2020; 18:50-52. [PMID: 32189883 PMCID: PMC7067982 DOI: 10.1016/j.jor.2019.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - Ahmed Aljawadi
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | | | - Anna Fox
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Anand Pillai
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
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10
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Abstract
AIMS Arthroplasty for end-stage hallux rigidus (HR) is controversial. Arthrodesis remains the gold standard for surgical treatment, although is not without its complications, with rates of up to 10% for nonunion, 14% for reoperation and 10% for metatarsalgia. The aim of this study was to analyze the outcome of a double-stemmed silastic implant (Wright-Medical, Memphis, Tennessee, USA) for patients with end-stage HR. METHODS We conducted a retrospective review of 108 consecutive implants in 76 patients, between January 2005 and December 2016, with a minimum follow-up of two years. The mean age of the patients at the time of surgery was 61.6 years (42 to 84). There were 104 females and four males. Clinical, radiological, patient reported outcome measures (PROMS) data, a visual analogue score (VAS) for pain, and satisfaction scores were collected. RESULTS The survivorship at a mean follow-up of 5.3 years (2.1 to 14.1) was 97.2%. The mean Manchester Oxford Foot and Ankle Questionnaire (MOXFQ) scores improved from 78.1 to 11.0, and VAS scores for pain from 7/10 to 1.3/10. The rate of satisfaction was 90.6%. Three implants (2.8%) required revision; one for infection, one-month postoperatively, and two for stem breakage at 10.4 and 13.3 years postoperatively. There was a 1.9% reoperation rate other than revision, 23.1% of patients developed a minor complication, and 21.1% of patients had non-progressive and asymptomatic cysts on radiological review. CONCLUSION We report a 97.2% survivorship at a mean follow-up of 5.3 years with this implant. We did not find progressive osteolysis, as has been previously reported. These results suggest that this double-stemmed silastic implant provides a predictable and reliable alternative with comparable outcomes to arthrodesis for the treatment of end-stage HR. Cite this article: Bone Joint J 2020;102-B(2):220-226.
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Affiliation(s)
- Timothy M Clough
- Wrightington and Leigh NHS Foundation Trust, Wrightington Hospital, Wigan, UK
| | - Joseph Ring
- Wrightington and Leigh NHS Foundation Trust, Wrightington Hospital, Wigan, UK
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11
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Stibolt RD, Patel HA, Lehtonen EJ, DeBell HA, Moon AS, Naranje S, Shah A. Hemiarthroplasty Versus Total Joint Arthroplasty for Hallux Rigidus: A Systematic Review and Meta-analysis. Foot Ankle Spec 2019; 12:181-193. [PMID: 30132693 DOI: 10.1177/1938640018791017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND When surgery is indicated for hallux rigidus, toe arthroplasty is an alternative procedure to arthrodesis for patients who wish to preserve toe range of motion. Our study investigated midterm outcomes of first metatarsophalangeal joint (MTPJ) arthroplasty in an effort to discern whether or not partial or total joint replacement confers benefit in these patients. METHODS A systematic review of MTPJ arthroplasty was performed for the years 2000 to 2017. A Forest plot was created comparing preoperative and postoperative American Orthopedic Foot and Ankle Score (AOFAS), Visual Analogue Scale (VAS), and range of motion (ROM) results for both hemitoe and total-toe arthroplasty. Statistical analysis was performed. RESULTS Mean postoperative AOFAS scores in patients undergoing hemiarthroplasty improved by 50.7 points (95% CI = 48.5, 52.8), whereas the mean AOFAS score improvement in total joint arthroplasty patients was 40.6 points (95% CI = 38.5, 42.8). VAS outcomes were comparable. Mean postoperative MTPJ ROM improved by 43.0° (95% CI = 39.3°, 46.6°) in hemitoe patients, which exceeded the mean ROM improvement of 32.5° (95% CI = 29.9°, 35.1°) found in total joint arthroplasty cases. A meta-analysis revealed no significant difference. CONCLUSION Hemisurface implants in MTPJ arthroplasty may improve postoperative AOFAS and ROM results to a greater extent than total-toe devices. LEVEL OF EVIDENCE Level IV: Systematic review.
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Affiliation(s)
- Robert D Stibolt
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
| | - Harshadkumar A Patel
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
| | - Eva J Lehtonen
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
| | - Henry A DeBell
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
| | - Andrew S Moon
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
| | - Sameer Naranje
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
| | - Ashish Shah
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
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12
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Abstract
Arthritis of the first metatarsophalangeal (MTP) joint, hallux rigid, is a common and disabling source of foot pain in the adult population. Hallux rigidus is characterized by diseased cartilage and large, periarticular osteophytes that result in a stiff, painful joint. Activity modification, sensible shoes, orthotics, anti-inflammatory medications and occasional intra-articular steroid injections can be attempted to alleviate the discomfort associated with hallux rigidus. A number of surgical options exist for the treatment of recalcitrant hallux rigidus. Cheilectomy is a useful treatment for dorsal impingement pain seen in mild hallux rigidus. A new polyvinyl alcohol hemi-arthroplasty implant has shown promising early and midterm results in the treatment of advanced hallux rigidus; however, arthrodesis of the first MTP joint remains the gold standard treatment for advanced hallux rigidus because of unpredictable outcomes after early-generation joint replacement implants.
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13
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Wanivenhaus F, Fust J, Erschbamer M, Schirm A. Clinical and Radiologic Outcomes of Metatarsophalangeal Hemiarthroplasty: A Review of 12 Consecutive Cases. Orthopedics 2018; 41:e64-e69. [PMID: 29156072 DOI: 10.3928/01477447-20171114-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/28/2017] [Indexed: 02/03/2023]
Abstract
This study examined function, pain, satisfaction, and radiologic outcomes among patients treated with first metatarsophalangeal hemiarthroplasty. Patients were invited to participate in an outcome study conducted with questionnaires on subjective and objective outcomes and clinical and radiographic follow-up. A total of 12 patients (12 feet; mean patient age, 58.8±12.3 years) agreed to participate. Mean follow-up was 22.3±19.8 months. Of these patients, 7 were satisfied with the postoperative result. The mean visual analog scale pain score decreased significantly from 7.0±2.3 preoperatively to 3.5±3.3 postoperatively (P=.024). Mean passive range of motion of the first metatarsophalangeal joint was 32°±10° preoperatively, 93°±18° intraoperatively after implantation of the prosthesis and closure of the joint capsule, and 38°±19° at final follow-up (P=.26). Mean American Orthopaedic Foot and Ankle Society forefoot score increased significantly from 47.3±14.7 preoperatively to 71.8±15.2 at last follow-up (P=.033). During the follow-up period, 6 patients underwent additional procedures: 5 therapeutic joint infiltrations and 1 arthrodesis. No patients had radiologic loosening of the implant at final follow-up. Osseous dysplastic changes at the base of the proximal phalanx were noted among 6 of 11 patients (12 total cases) at final follow-up. Although first metatarsophalangeal hemiarthroplasty provided significant pain reduction at mean follow-up of 22.3 months, range of motion of the first metatarsophalangeal joint was not restored to anticipated levels and there were high rates of patient dissatisfaction and secondary interventions. [Orthopedics. 2018; 41(1):e64-e69.].
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14
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Stevens J, de Bot RT, Hermus JP, van Rhijn LW, Witlox AM. Clinical Outcome Following Total Joint Replacement and Arthrodesis for Hallux Rigidus. JBJS Rev 2017; 5:e2. [DOI: 10.2106/jbjs.rvw.17.00032] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Tunstall C, Laing P, Limaye R, Walker C, Kendall S, Lavalette D, Mackenney P, Adedapo A, Al-Maiyah M. 1st metatarso-phalangeal joint arthroplasty with ROTO-glide implant. Foot Ankle Surg 2017; 23:153-156. [PMID: 28865582 DOI: 10.1016/j.fas.2017.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Total joint replacement of the 1st metatarso-phalangeal Joint (MTPJ) has been controversial as arthrodesis remains a good option for patients with end stage 1st MTPJ arthritis. We present a multi centre service evaluation of the ROTO-glide device METHODS: 33 ROTO-glide procedures were carried out in 30 patients across 7 sites within the UK. Exclusion criteria - hallux valgus and arthritis, age below 45 years and over 80 years, inflammatory joint disease. Patient assessed pre and post operatively with AOFAS and Oxford forefoot (MOXFQ) scores and plain radiographs. All patients carried out the same post operative protocol RESULTS: Average age at patients was 58.6 years (45-77). Follow up average was 16.9 months (12-29). Pre-op AOFAS scores average 41.4 (17-67) and post op average 76 (29-100) and the MOXFQ summary index decreased from an average of 43 (20-64) pre op to an average of 17 (0-51) post op. Average total range of motion pre operatively was 32° and post operatively was 61°. There were 2 post operative complications but no revisions were necessary. CONCLUSIONS The early results of this multi centre service evaluation of the ROTO-glide 1st MTPJ replacement support its continued use and evaluation of the prosthesis further.
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Affiliation(s)
- C Tunstall
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, Shropshire SY10 7AG, United Kingdom.
| | - P Laing
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, Shropshire SY10 7AG, United Kingdom; Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, United Kingdom
| | - R Limaye
- North Tees and Hartlepool NHS Foundation Hospital Trust, Hardwick Road, Stockton-on-Tees, Cleveland TS19 8PE, United Kingdom
| | - C Walker
- Royal Liverpool University Hospital, Prescot Street, Liverpool, Merseyside L7 8XP, United Kingdom
| | - S Kendall
- New Victoria Hospital, 184-188 Coombe Lane West, Kingston-upon-Thames, Surrey KT2 7EG, United Kingdom
| | - D Lavalette
- Harrogate District Hospital, Lancaster Park Road, Harrogate, North Yorkshire HG2 7SX, United Kingdom
| | - P Mackenney
- South Tees University Hospital, Marton Road, Middlesborough TS4 3BW, United Kingdom
| | - A Adedapo
- South Tees University Hospital, Marton Road, Middlesborough TS4 3BW, United Kingdom
| | - M Al-Maiyah
- South Tees University Hospital, Marton Road, Middlesborough TS4 3BW, United Kingdom
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Abstract
An estimated 40% of the US population have foot problems.Of all patients aged over 50 years, 2.5% report degenerative arthritis of the first metatarsophalangeal (MTP) joint, termed 'hallux rigidus'. First MTP osteoarthritis is the most common arthritic condition in the foot.Progression of great toe arthritis is associated with pain and loss of motion. Non-surgical intervention begins with shoe modifications and orthotics designed to limit MTP motion.In patients with mild arthritis, operative procedures focus on removing excess osteophytes (cheilectomy) to prevent dorsal impingement with or without a concomitant osteotomy (Moberg) to improve or shift range of motion into a less painful arc.In patients with more advanced arthritis, operative management has centred on arthrodesis of the first MTP joint.A recent Level 1 study shows excellent function and pain relief with a small hydrogel hemi-implant into the metatarsal headMultiple joint-sparing procedures such as joint arthroplasty or resurfacing have been described with inconsistent results. Cite this article: EFORT Open Rev 2017;2:13-20. DOI: 10.1302/2058-5241.2.160031.
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Affiliation(s)
- Bryant Ho
- Hinsdale Orthopaedics, Hinsdale, Illinois, USA
| | - Judith Baumhauer
- University of Rochester, Department of Orthopaedics, Rochester, New York, USA
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17
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Abstract
Hallux valgus deformity is a very common pathological condition which commonly produces painful disability. It is characterised as a combined deformity with a malpositioning of the first metatarsophalangeal joint caused by a lateral deviation of the great toe and a medial deviation of the first metatarsal bone. Taking the patient’s history and a thorough physical examination are important steps. Anteroposterior and lateral weight-bearing radiographs of the entire foot are crucial for adequate assessment in the treatment of hallux valgus. Non-operative treatment of the hallux valgus cannot correct the deformity. However, insoles and physiotherapy in combination with good footwear can help to control the symptoms. There are many operative techniques for hallux valgus correction. The decision on which surgical technique is used depends on the degree of deformity, the extent of degenerative changes of the first metatarsophalangeal joint and the shape and size of the metatarsal bone and phalangeal deviation. The role of stability of the first tarsometatarsal joint is controversial. Surgical techniques include the modified McBride procedure, distal metatarsal osteotomies, metatarsal shaft osteotomies, the Akin osteotomy, proximal metatarsal osteotomies, the modified Lapidus fusion and the hallux joint fusion. Recently, minimally invasive percutaneous techniques have gained importance and are currently being evaluated more scientifically. Hallux valgus correction is followed by corrective dressings of the great toe post-operatively. Depending on the procedure, partial or full weight-bearing in a post-operative shoe or cast immobilisation is advised. Post-operative radiographs are taken in regular intervals until osseous healing is achieved.
Cite this article: Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. EFORT Open Rev 2016;1:295-302. DOI: 10.1302/2058-5241.1.000005.
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Clement ND, MacDonald D, Dall GF, Ahmed I, Duckworth AD, Shalaby HS, McKinley J. Metallic hemiarthroplasty for the treatment of end-stage hallux rigidus. Bone Joint J 2016; 98-B:945-51. [DOI: 10.1302/0301-620x.98b7.36860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 02/05/2016] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- N. D. Clement
- Royal Infirmary of Edinburgh, Little
France Crescent, Old Dalkeith Road, Edinburgh, EH16
4SA, UK
| | - D. MacDonald
- Royal Infirmary of Edinburgh, Little
France Crescent, Old Dalkeith Road, Edinburgh, EH16
4SA, UK
| | - G. F. Dall
- Borders General Hospital, Melrose, Roxburghshire, TD6
9BS, UK
| | - I. Ahmed
- Royal Infirmary of Edinburgh, Little
France Crescent, Old Dalkeith Road, Edinburgh, EH16
4SA, UK
| | - A. D. Duckworth
- Royal Infirmary of Edinburgh, Little
France Crescent, Old Dalkeith Road, Edinburgh, EH16
4SA, UK
| | - H. S. Shalaby
- Royal Infirmary of Edinburgh, Little
France Crescent, Old Dalkeith Road, Edinburgh, EH16
4SA, UK
| | - J. McKinley
- Royal Infirmary of Edinburgh, Little
France Crescent, Old Dalkeith Road, Edinburgh, EH16
4SA, UK
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Horisberger M, Haeni D, Henninger HB, Valderrabano V, Barg A. Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux. Foot Ankle Int 2016; 37:755-65. [PMID: 26979844 DOI: 10.1177/1071100716637901] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The current gold standard in the treatment of severe hallux rigidus is arthrodesis of the first metatarsophalangeal (MTP-I) joint. We present the results of a new 3-component MTP-I prosthesis. We determined (1) the intraoperative and perioperative complications; (2) survivorship of prosthesis components and rate of secondary surgeries for any reason; (3) prosthetic component stability and radiographic alignment; (4) the degree of pain relief; and (5) the midterm functional outcomes including radiographic range of motion (ROM). METHODS From 2008 to 2010, we prospectively included 29 MTP-I prostheses in 25 patients. The average age of the patients was 63.1 years (range, 48-87 years). The average follow-up was 49.5 months (range, 36-62 months). We observed complications and reoperations. A visual analog scale for pain and the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score were obtained pre- and postoperation. Component stability and alignment were assessed using weight-bearing radiographs. Fluoroscopy was used to determine radiographic MTP-I ROM. RESULTS Seven (24.1%) patients underwent 1 or more secondary surgeries. Four cases (13.7%) eventually had a conversion to MTP-I arthrodesis. Two patients (3 cases) died from causes not related to the procedure. This left 22 feet in 19 patients for final follow-up. All but 3 remaining prostheses showed stable osteointegration and no migration, but MTP-I alignment showed high variability. The average pain score decreased from 5.9 (range, 3-9) to 1.2 (range, 0-5). The average AOFAS forefoot score increased from 55 (range, 0-80) to 83.5 (range, 58-95). Range of motion initially increased from 37.8 degrees (range, 0-60 degrees) to 88.6 degrees (range, 45-125 degrees) intraoperatively and decreased to 29.0 degrees (range, 11-52 degrees) at latest follow-up. CONCLUSION Our data suggest that total arthroplasty of MTP-I leads to a high amount of revision surgeries, but the remaining patients had significant pain relief at midterm follow-up. However, we observed high variability regarding the prosthesis component alignment and poor range of motion. LEVEL OF EVIDENCE Level IV, prospective cohort study.
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Affiliation(s)
- Monika Horisberger
- Department of Orthopaedic Surgery, University Hospital of Basel, Basel, Switzerland
| | - David Haeni
- Department of Orthopaedic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Heath B Henninger
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Victor Valderrabano
- Department of Orthopaedics and Traumatology, Schmerzklinik Basel, Basel, Switzerland
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Manipulative and Multimodal Therapies in the Treatment of Osteoarthritis of the Great Toe: A Case Series. J Chiropr Med 2015; 14:270-8. [PMID: 26793039 DOI: 10.1016/j.jcm.2015.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The objective of this case series is to describe manual manipulative therapy with exercise for 3 patients with mild to moderate osteoarthritis of the great toe. CLINICAL FEATURES Three patients, a 32-year-old man, a 55-year-old woman, and a 49-year-old woman, had great toe pain of 8, 1, and 2 years, respectively. Each had a palpable exostosis, a benign outgrowth of bone projecting outward from the bone surface, and decreased dorsiflexion with a hard end-feel. INTERVENTION AND OUTCOME Manual manipulative therapy with exercise, the Brantingham protocol, was used with patients receiving 6, 9, and 12 treatments over 6 weeks. Specific outcome measures for hallux rigidus and the foot were chosen to document the effects of this intervention including digital inclinometry, the lower extremity functional scale, the foot functional index, overall therapy effectiveness and Visual Analogue Scale (VAS). Each patient had an increase in range of motion that surpassed the minimal clinically important change, an increase in the overall therapy effectiveness and a decrease in the foot functional index that surpassed the minimally clinically important difference. Most importantly for the patients, each reported a decrease in both usual and worst pain on the VAS that exceeded the minimally clinically important difference of 20 to 30 mm. CONCLUSION The 3 patients reported decreased pain measured by the VAS, increased range of motion and minimally clinically important difference in 3 other outcome measures.
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21
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Abstract
Hallux rigidus is the most commonly occurring arthritic condition of the foot and is marked by pain, limited motion in the sagittal plane of the first metatarsophalangeal joint and varying degrees of functional impairment. In conjunction with clinical findings, radiographic grading helps guide therapeutic choices. Nonsurgical management with anti-inflammatory medications, corticosteroid injections, or shoewear and activity modifications can be successful in appropriately selected patients. Patients with more severe disease or refractory to conservative management may benefit from surgical intervention. Operative options range from joint-preserving procedures (eg, cheilectomy with or without associated osteotomies) to joint-altering procedures (eg, arthroplasty or arthrodesis).
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Affiliation(s)
- Kamran S Hamid
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Selene G Parekh
- Department of Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Duke University School of Medicine, 3609 Southwest Durham Drive, Durham, NC 27707, USA.
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Unger A, Stoica L, Olms KH, Renken F, Kasch R, Schulz A. Mittel- und langfristige Ergebnisse nach endoprothetischer Versorgung des Hallux rigidus. DER ORTHOPADE 2013; 42:561-8. [DOI: 10.1007/s00132-013-2112-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Gutteck N, Lebek S, Wohlrab D, Zeh A, Delank KS. Treatment of aseptic loosened MTPI prosthesis by one-stage revision with ToeFit Plus prosthesis. Arch Orthop Trauma Surg 2013; 133:11-4. [PMID: 23080420 DOI: 10.1007/s00402-012-1630-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Due to the missing bony integration of the ceramic Moje prosthesis for replacing the first metatarsophalangeal joint (MTPI) in hallux rigidus, the mid-term results were bad so far. In case of revision, the distraction arthrodesis with autologous bone taken from the iliac crest as a salvage procedure is the method of choice. METHOD In our prospective case series, the short-term results after revision of the Moje prosthesis with the ToeFit Plus prosthesis were investigated. The clinical and radiological investigations were done in six MTPI over a 24-month period using AOFAS score and visual analogue scale. RESULTS There were no radiological signs of loosening or implant migration of the ToeFit Plus 24 months, postoperatively. There was one fissure at the first proximal phalanx necessitating a wire stabilisation. No other complications could be observed. A significant improvement of the AOFAS score and the range of motion were observed 6 weeks postoperatively. CONCLUSION We could show good and very good short-term results after the replacement of a loosened MTPI prosthesis with a ToeFit Plus. Due to the conic screw anchorage, ToeFit Plus is excellently suited for prosthesis replacement at the MTPI. With sufficient bony anchorage prerequisites, it is possible to preserve and improve the range of motion by changing the loosened MTPI prosthesis in the ToeFit Plus, thereby avoiding the morbidity of gaining autologous bone from the iliac crest.
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Affiliation(s)
- Natalia Gutteck
- Department of Orthopaedic Surgery, Martin Luther University Halle Wittenberg, Magdeburger Straße 22, 06112 Halle (Saale), Germany.
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