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Lim B, Jassim S, Kilkenny C, Lyons F, Shaalan M. Crossed screws versus plating supplemented with an interfragmentary screw in first metatarsophalangeal joint fusion: A systematic review and meta-analysis. J Foot Ankle Surg 2025; 64:309-317. [PMID: 39864491 DOI: 10.1053/j.jfas.2025.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 11/26/2024] [Accepted: 01/18/2025] [Indexed: 01/28/2025]
Abstract
First metatarsophalangeal joint (MTPJ) fusion is an effective surgical intervention for conditions such as hallux valgus and hallux rigidus. This systematic review and meta-analysis aims to compare the safety and efficacy of crossed screws versus plating supplemented with an interfragmentary screw. A literature search of the Scopus, Embase, Web of Science, and MEDLINE databases was performed to identify all studies directly comparing the two techniques. Meta-analysis was carried out using RevMan Web. Nine studies with 976 patients (1,035 toes in total, 512 toes in the crossed screws group, and 523 toes in the plate supplemented with screws group) were included. There was no significant difference in union rates (OR=0.75, CI 0.45 - 1.27, p = 0.29), overall complication rates (OR = 1.13, CI = 0.71 - 1.77, p = 0.61), superficial complications, (OR = 0.41, CI = 0.10 - 1.68, p = 0.22), revision surgery (OR = 1.92, CI 0.81 - 4.57, p = 0.14), hardware removal (OR = 1.07, CI = 0.55 - 2.08, p = 0.85), and malunion (OR = 1.63, CI 0.27 - 10.00, p = 0.60). Plate and screws had a significantly shorter time to fusion than crossed screws (MD = 0.51, CI = 0.10 - 0.92, p = 0.02). No significant difference was noted in patient-reported outcome measures or in postoperative hallux valgus, intermetatarsal, and lateral metatarsophalangeal angles. Other potential factors that should influence the decision to use one technique over the other include the indication for MTPJ fusion, the patient's bone quality, and the differing costs of surgery.
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Affiliation(s)
- Brandon Lim
- Department of General Medicine, Changi General Hospital, Singapore, Singapore.
| | - Samher Jassim
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Conor Kilkenny
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Frank Lyons
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Mohamed Shaalan
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
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Duff JR, Alecxih AG, White CC, Doty JF. Minimally Invasive First Metatarsophalangeal Joint Arthrodesis With a Low-Profile Hybrid Locking Plate and a Beveled Compression Screw: A Surgical Technique. Foot Ankle Spec 2025:19386400251331648. [PMID: 40219862 DOI: 10.1177/19386400251331648] [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: 04/14/2025]
Abstract
Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a valuable intervention for a variety of hallux pathologies and is still considered the gold standard treatment for advanced hallux rigidus, one of the most commonly encountered pathologies of the forefoot. With the advent and expansion of minimally invasive surgery (MIS) techniques, MIS First MTPJ arthrodesis offers a new approach to treat hallux conditions with the potential to limit complications and further enhance patient satisfaction. We describe a technique that affords the benefits of MIS surgery without compromising the biomechanical superiority of a dorsal hybrid low-profile plate with a beveled, partially threaded compression screw.Level of Evidence: Therapeutic, Level V: Technique article.
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Affiliation(s)
- Joseph R Duff
- Department of Orthopaedic Surgery, College of Medicine-Chattanooga, University of Tennessee, Chattanooga, TN, USA
| | - Austin G Alecxih
- Department of Orthopaedic Surgery, College of Medicine-Chattanooga, University of Tennessee, Chattanooga, TN, USA
| | - Charles C White
- Department of Orthopaedic Surgery, College of Medicine-Chattanooga, University of Tennessee, Chattanooga, TN, USA
| | - Jesse F Doty
- Department of Orthopaedic Surgery, College of Medicine-Chattanooga, University of Tennessee, Chattanooga, TN, USA
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Tran-Minh D, Poirot-Seynaeve B, Vialla T, Ohl X, Diallo S, Siboni R. Comparison of the outcomes of first metatarsophalangeal joint arthrodesis by locking plate and compression screw in patients with severe hallux valgus or hallux valgus revision. Orthop Traumatol Surg Res 2024; 110:103932. [PMID: 38987032 DOI: 10.1016/j.otsr.2024.103932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Arthrodesis of the first metatarsophalangeal joint (MTP1) is indicated for hallux rigidus, septic arthritis, severe hallux valgus (HV) or HV revision. Few studies have compared the functional and radiographic outcomes between indications. The goal of this study was to compare the results of MTP1 arthrodesis in patients with severe HV or HV revision at 6 months postoperative. The hypothesis was that there are no differences in the fusion rate, functional scores and radiological correction between the two groups. MATERIALS AND METHODS This was a retrospective, observational, single-center study conducted between January 1, 2018 and July 31, 2021. The inclusion criteria were patients treated for severe HV or HV revision by MTP1 arthrodesis with a compression screw and locking plate who were at least 18 years of age. The exclusion criteria were a history of septic arthritis of MTP1 without prior HV surgery, primary hallux rigidus, rheumatoid arthritis, incomplete medical record. The functional outcomes consisted of the Foot Function Index (FFi-f) and the European Foot and Ankle Society (EFAS) score. Radiographs were made to evaluate preoperative and postoperative deformity, the correction and the fusion rate. These outcomes were compared between two groups: severe HV and HV revision. RESULTS An analysis was done of 58 cases of MTP1 arthrodesis: 45 severe HV and 13 HV revisions. The mean patient age was 66 years, and the mean follow-up was 15.7 months. There were no significant differences between the two groups in the postoperative functional scores: EFAS (p = 0.85) and FFI-f (p = 0.14). At the final review, there were no significant differences between the two groups in the foot angle measurements (hallux valgus angle, p = 0.08 and intermetatarsal angle, p = 0.15) and fusion rate (p = 0.89) with a 93% fusion rate in patients with severe HV and 92% in patients with HV revision. CONCLUSION Given the good radiographic and functional outcomes, MTP1 arthrodesis by locking plate and compression screw is indicated as a first line surgical treatment for patients with severe HV or for patients undergoing HV revision. There is no evidence of a significant difference in the functional scores, fusion rate and radiographic correction between these two indications. LEVEL OF PROOF IV; retrospective case series.
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Affiliation(s)
- Dong Tran-Minh
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Benoit Poirot-Seynaeve
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Tristan Vialla
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Xavier Ohl
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Saidou Diallo
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Renaud Siboni
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France.
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Ismail A, Hannant G, Ashour A, Broadhurst D. The Outcome of the Use of Continuous Action Compression Device for the First Metatarsophalangeal Joint Fusion. Cureus 2024; 16:e74168. [PMID: 39712823 PMCID: PMC11662993 DOI: 10.7759/cureus.74168] [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: 11/21/2024] [Indexed: 12/24/2024] Open
Abstract
INTRODUCTION First metatarsophalangeal (MTP) joint fusion is a widely accepted surgical intervention for treating severe arthritis, deformities, and instability of the first MTP joint. This paper provides a review of a single surgeon's experience with continuous compression implants (CCI), which offer a notable advantage by providing uniform compression across a larger surface area of the fusion site compared to plate and screw constructs. This design potentially reduces soft tissue irritation and, consequently, the need for subsequent implant removal. It also saves on cost and has the potential to reduce the length of surgery. METHODS A retrospective review was conducted on 27 patients (n=36 feet) who underwent primary first metatarsophalangeal joint (MTPJ) fusion using continuous compression implants (CCI) between March 2020 and April 2024 at Bradford Royal Infirmary. Patient data were collected from the surgeon's logbook and medical records. The outcomes analyzed included the fusion rate and complications. Statistical analysis was performed using SPSS version 22.0, with p<0.05 considered significant. RESULTS The mean age of the cohort was 60.24 years (range 41-90), with 88.88% female. The ratio of left to right was 70%. The mean follow-up duration was 27 months (range 6-48 months). Complete fusion of the first MTPJ was achieved in 34 out of 36 feet (94.4%). Nonunion occurred in one patient, while delayed union was observed in another. Clinically, 35 out of 36 patients (97.3%) reported satisfaction with the procedure, with one patient requiring metalwork removal and revision due to loosening. CONCLUSION Early results show that the rate of fusion achieved by using the CCI for the first MTPJ arthrodesis in our series was comparable to that of other devices quoted in the literature.
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Affiliation(s)
- Ahmed Ismail
- Orthopaedics, Bradford Royal Infirmary, Bradford, GBR
| | - Gary Hannant
- Orthopaedics and Trauma, Bradford Royal Infirmity, Bradford, GBR
| | - Ahmed Ashour
- Trauma and Orthopaedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
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Sehjal R, Rusli W, Kedgley AE, Sagmeister ML, Williamson M, Smith A. Biomechanical Comparison of 5 Different Fixation Constructs in a Trapeziometacarpal Joint Arthrodesis Model. J Hand Surg Am 2024; 49:1036.e1-1036.e9. [PMID: 36764846 DOI: 10.1016/j.jhsa.2022.12.010] [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] [Received: 06/22/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 02/12/2023]
Abstract
PURPOSE Trapeziometacarpal joint (TMC) arthrodesis has a high rate of nonunion. This biomechanical analysis sought to determine the stiffness of 5 fixation methods in a TMC joint arthrodesis model. METHODS Five fixation constructs were tested in a validated porcine model: crossed 1.1-mm K-wires, crossed 1.6-mm K-wires, crossed headless compression screws (HCSs), compression plating (CP), and locked compression plating (LCP). The cantilever bending stiffness was measured in abduction, adduction, flexion, and extension. Samples were loaded to failure in extension, and the mode of failure was examined. RESULTS The crossed HCSs performed consistently well in all tests. Loading to failure resulted in screw pullout. In abduction and adduction, HCS and 1.6-mm K-wires were significantly stiffer than the other constructs. The mean load to failure in extension was similar in the HCS, CP, and LCP groups (304 N/mm, 311 N/mm, and 293 N/mm, respectively). There were no differences between CP and LCP in any biomechanical tests, and the mode of failure was through plate bending. The crossed 1.1-mm K-wires performed poorly in all tests. CONCLUSIONS Crossed HCS displayed the greatest overall stability. Standard plating in compression mode and LCP had a similar biomechanical performance. CLINICAL RELEVANCE The ideal construct stiffness required for the successful union after TMC joint arthrodesis is unknown, but HCS has the best overall biomechanical performance and, therefore, might be considered the best choice for this clinical setting.
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Affiliation(s)
- Ranjit Sehjal
- Tunbridge Wells Hospital, Tonbridge Road, Tunbridge Wells, United Kingdom.
| | - Wan Rusli
- Department of Bioengineering, Imperial College, London, United Kingdom (the work was carried out here)
| | - Angela E Kedgley
- Department of Bioengineering, Imperial College, London, United Kingdom (the work was carried out here)
| | | | - Mark Williamson
- Queen Elizabeth Queen Mother Hospital, Margate, United Kingdom
| | - Andrew Smith
- Queen Elizabeth Queen Mother Hospital, Margate, United Kingdom
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Bullock MJ, Pierson K, Vonasek A, Hofbauer MH, Hamawi G, Persaud S, Giglio J. First Metatarsophalangeal Joint Arthrodesis With Complete Resection of the Subchondral Bone Plate. J Foot Ankle Surg 2024; 63:513-516. [PMID: 38777167 DOI: 10.1053/j.jfas.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
First metatarsophalangeal arthrodesis is associated with high union rates but there is a wide range of union incidence reported. Whether the subchondral plate is completely resected, is not reported by individual studies and without meticulous care, there is often residual subchondral plate. The primary aim was to report our union rate following first metatarsophalangeal arthrodesis with complete resection of the subchondral plate, locking plate fixation and immediate protected weight bearing. A retrospective case study of 2 surgeons was performed from August 2016 to June 2023. Our study was unique in that all patients had complete resection of the subchondral plate to trabecular bone. One hundred seventeen feet were identified for analysis, in 112 patients following exclusion criteria. Patients were excluded if they had less than 3 months follow-up, revisional surgery or charcot. Demographic data and indications for the procedure were reported. A single construct locking plate with an interfragmentary compression screw through the plate was used in 37 feet and a locking plate with separate interfragmentary compression screw was used in 80 feet. We reported a nonunion incidence of 0.9% (n = 1) with a delayed union incidence of 0.9% (n = 1) and a broken hardware incidence of 0.9% (n = 1). Complete resection of subchondral plate with early weight bearing and locking plate fixation had a high union rate for first metatarsophalangeal arthrodesis. Our results compare favorably with union rates in the literature, where there is often residual subchondral plate.
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Affiliation(s)
- Mark J Bullock
- Covenant Orthopedics, Saginaw, MI; Central Michigan University Medical Education Partners, Saginaw, MI.
| | - Kyleigh Pierson
- Central Michigan University Medical Education Partners, Saginaw, MI
| | | | | | - Gabriel Hamawi
- Central Michigan University Medical Education Partners, Saginaw, MI
| | - Sham Persaud
- Advanced Orthopedics & Rehabilitation, Washington, PA
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7
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Acker AS, Liles J, Easley ME. Arthrodesis for Hallux Rigidus. Foot Ankle Clin 2024; 29:507-520. [PMID: 39068025 DOI: 10.1016/j.fcl.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
First metatarsophalangeal (MTP) joint fusion, or arthrodesis, has been a cornerstone treatment for advanced joint degeneration since the 1950s, benefiting not only older patients but also younger individuals. The procedure boasts favorable long-term outcomes and a low rate of revision when fusion is successful. However, complications such as interphalangeal arthritis may occur, and nonunion or malunion can necessitate revision. While the first MTP fusion provides significant relief, its applicability varies, underscoring the need for careful patient selection.
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Affiliation(s)
- Antoine S Acker
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA; Centre of Foot and Ankle Surgery, Clinique La Colline, Geneva, Switzerland.
| | - Jeffrey Liles
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
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García-Jarabo E, Alonso-Tejero D, Ramos-Ramos LM, Hernanz-González Y, Vilá Y Rico J. [Translated article] Better results in consolidation of hallux metatarsophalangeal arthrodesis with dorsal plate and interfragmentary compression screw. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T351-T357. [PMID: 38325574 DOI: 10.1016/j.recot.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/19/2023] [Accepted: 11/30/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND AND AIMS The first metatarsophalangeal joint arthrodesis is indicated for the treatment of various pathologies as a technique to reduce pain and improve the support of the first radius. Numerous surgical techniques and fixation methods have been described, with the combination of a dorsal plate and an interfragmentary screw being the one that has shown to be the most stable construct in biomechanical studies. Our aim is to analyze the radiological results after metatarsophalangeal arthrodesis of the hallux using a dorsal plate associated or not with an interfragmentary screw. The differences in terms of consolidation rates and complications in patients diagnosed with hallux rigidus, hallux valgus, hallux varus and failure of previous surgeries were evaluated. MATERIALS AND METHODS A retrospective cohort study of 55 patients with a mean age of 65.10 years in whom a dorsal plate was used was performed. Patients were divided into two groups depending on whether or not an interfragmentary screw was used. The minimum follow-up was 6 months after surgery. The assessment of the pre and postoperative radiological results was based on the variation of the hallux angle, the intermetatarsal angle and the dorsal metatarsophalangeal angle of the hallux, as well as the cases of nonunion identified in each study group. RESULTS The radiological results, statistically significant differences (p<0.05) were only found in the dorsal metatarsophalangeal angle between both study groups. No statistically significant differences were found regarding the radiological evaluation of the pre and postoperative hallux angle and intermetatarsal angle. An equal decrease of each angles was observed in both study groups. Regarding the consolidation rate, statistically significant differences (p<0.05) were found between group A, which associated an interfragmentary screw, presenting a consolidation rate of 92%, and group B, which did not associate an interfragmentary screw, and that presented a union rate of 63%. CONCLUSION Hallux metatarsophalangeal arthrodesis of the hallux with a dorsal plate and interfragmentary screw show best results regarding consolidation rate and complications compared to those cases in which an interfragmentary screw was not used.
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Affiliation(s)
- E García-Jarabo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain.
| | - D Alonso-Tejero
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - L M Ramos-Ramos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Y Hernanz-González
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Vilá Y Rico
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Cirugía, Universidad Complutense de Madrid, Madrid, Spain
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9
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García-Jarabo E, Alonso-Tejero D, Ramos-Ramos LM, Hernanz-González Y, Vilá Y Rico J. Better results in consolidation of hallux metatarsophalangeal arthrodesis with dorsal plate and interfragmentary compression screw. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:351-357. [PMID: 38072308 DOI: 10.1016/j.recot.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/02/2024] Open
Abstract
INTRODUCTION AND AIMS The first metatarsophalangeal joint arthrodesis is indicated for the treatment of various pathologies as a technique to reduce pain and improve the support of the first radius. Numerous surgical techniques and fixation methods have been described, with the combination of a dorsal plate and an interfragmentary screw being the one that has shown to be the most stable construct in biomechanical studies. Our aim is to analyze the radiological results after metatarsophalangeal arthrodesis of the hallux using a dorsal plate associated or not with an interfragmentary screw. The differences in terms of consolidation rates and complications in patients diagnosed with hallux rigidus, hallux valgus, hallux varus and failure of previous surgeries were evaluated. MATERIAL AND METHODS A retrospective cohort study of 55 patients with a mean age of 65.10 years in whom a dorsal plate was used was performed. Patients were divided into 2 groups depending on whether or not an interfragmentary screw was used. The minimum follow-up was 6 months after surgery. The assessment of the pre and postoperative radiological results was based on the variation of the hallux angle, the intermetatarsal angle and the dorsal metatarsophalangeal angle of the hallux, as well as the cases of nonunion identified in each study group. RESULTS The radiological results, statistically significant differences (p<0.05) were only found in the dorsal metatarsophalangeal angle between both study groups. No statistically significant differences were found regarding the radiological evaluation of the pre and postoperative hallux angle and intermetatarsal angle. An equal decrease of each angles was observed in both study groups. Regarding the consolidation rate, statistically significant differences (p<0.05) were found between group A, which associated an interfragmentary screw, presenting a consolidation rate of 92%, and group B, which did not associate an interfragmentary screw, and that presented a union rate of 63%. CONCLUSIONS Hallux metatarsophalangeal arthrodesis of the hallux with a dorsal plate and interfragmentary screw show best results regarding consolidation rate and complications compared to those cases in which an interfragmentary screw was not used.
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Affiliation(s)
- E García-Jarabo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España.
| | - D Alonso-Tejero
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España
| | - L M Ramos-Ramos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España
| | - Y Hernanz-González
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Vilá Y Rico
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España; Departamento de Cirugía, Universidad Complutense de Madrid, Madrid, España
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Sabik A, Daszkiewicz K, Witkowski W, Łuczkiewicz P. Comparative analysis of mechanical conditions in bone union following first metatarsophalangeal joint arthrodesis with varied locking plate positions: A finite element analysis. PLoS One 2024; 19:e0303752. [PMID: 38753866 PMCID: PMC11098485 DOI: 10.1371/journal.pone.0303752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/30/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND First metatarsophalangeal joint arthrodesis is a typical medical treatment performed in cases of arthritis or joint deformity. The gold standard for this procedure is arthrodesis stabilisation with the dorsally positioned plate. However, according to the authors' previous studies, medially positioned plate provides greater bending stiffness. It is worth to compare the mechanical conditions for bone formation in the fracture callus for both placements of the locking plate. METHODS Two finite element models of the first metatarsophalangeal joint with the dorsally and medially positioned plate were defined in the Abaqus software to simulate differentiation of the fracture callus. A simplified load application, i.e. one single step per each day and the diffusion of the mesenchymal stem cells into the fracture region were assumed in an iterative hardening process. The changes of the mesenchymal stem cells into different phenotypes during the callus stiffening were governed by the octahedral shear strain and interstitial fluid velocity according to Prendergast mechanoregulation theory. Basing on the obtained results the progress of the cartilage and bone tissues formation and their distribution within the callus were compared between two models. FINDINGS The obtained results suggest that after 6 weeks of simulation the healing progress is in general comparable for both plates. However, earlier closing of external callus was observed for the medially positioned plate which had greater vertical bending stiffness. This process enables faster internal callus hardening and promotes symmetrical bridging.
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Affiliation(s)
- Agnieszka Sabik
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering Gdańsk University of Technology, Narutowicza Gdańsk, Poland
| | - Karol Daszkiewicz
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering Gdańsk University of Technology, Narutowicza Gdańsk, Poland
| | - Wojciech Witkowski
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering Gdańsk University of Technology, Narutowicza Gdańsk, Poland
| | - Piotr Łuczkiewicz
- II Clinic of Orthopaedics and Kinetic Organ Traumatology, Medical University of Gdansk, Smoluchowskiego, Gdańsk, Poland
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11
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Daszkiewicz K, Rucka M, Czuraj K, Andrzejewska A, Łuczkiewicz P. Effect of lag screw on stability of first metatarsophalangeal joint arthrodesis with medial plate. PeerJ 2024; 12:e16901. [PMID: 38436033 PMCID: PMC10908269 DOI: 10.7717/peerj.16901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/17/2024] [Indexed: 03/05/2024] Open
Abstract
Background First metatarsophalangeal joint (MTP-1) arthrodesis is a commonly performed procedure in the treatment of disorders of the great toe. Since the incidence of revision after MTP-1 joint arthrodesis is not insignificant, a medial approach with a medially positioned locking plate has been proposed as a new technique. The aim of the study was to investigate the effect of the application of a lag screw on the stability and strength of first metatarsophalangeal joint arthrodesis with medial plate. Methods The bending tests in a testing machine were performed for models of the first metatarsal bone and the proximal phalanx printed on a 3D printer from polylactide material. The bones were joined using the locking titanium plate and six locking screws. The specimens were divided into three groups of seven each: medial plate and no lag screw, medial plate with a lag screw, dorsal plate with a lag screw. The tests were carried out quasi-static until the samples failure. Results The addition of the lag screw to the medial plate significantly increased flexural stiffness (41.45 N/mm vs 23.84 N/mm, p = 0.002), which was lower than that of the dorsal plate with a lag screw (81.29 N/mm, p < 0.001). The similar maximum force greater than 700 N (p > 0.50) and the relative bone displacements lower than 0.5 mm for a force of 50 N were obtained for all fixation techniques. Conclusions The lag screw significantly increased the shear stiffness in particular and reduced relative transverse displacements to the level that should not delay the healing process for the full load of the MTP-1 joint arthrodesis with the medial plate. It is recommended to use the locking screws with a larger cross-sectional area of the head to minimize rotation of the medial plate relative to the metatarsal bone.
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Affiliation(s)
- Karol Daszkiewicz
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Magdalena Rucka
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | | | - Angela Andrzejewska
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Piotr Łuczkiewicz
- Pomeranian Reumatology Center, Sopot, Poland
- Second Clinic of Orthopaedics and Kinetic Organ Traumatology, Medical University of Gdansk, Gdańsk, Poland
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12
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Giménez-López R, Barrios-Pitarque C. Cross-sectional study of the prevalence of hyperextension of the first metatarsophalangeal joint and its relationship to onycholysis in women with hallux valgus. BMC Musculoskelet Disord 2024; 25:111. [PMID: 38317173 PMCID: PMC10840269 DOI: 10.1186/s12891-024-07219-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Hallux Valgus (HV) deformity is associated with misalignment in the sagittal plane that affects the first toe. However, the repercussions of the first toe hyperextension in HV have been scarcely considered. The purpose of this study was to provide evidence of the association between first-toe hyperextension and the risk of first toenail onycholysis in HV. METHODS A total of 248 HV from 129 females were included. The extension of 1st MTP joint was measured while the patient was in the neutral position of the hallux using a two-branch goniometer. The classification of the HV severity stage was determined by the Manchester visual scale, and the height of the first toe in the standing position was measured using a digital meter. An interview and clinical examination were performed to collect information on the presence of onycholysis of the first toe. RESULTS Of the 248 HV studied, 100 (40.3%) had onycholysis. A neutral extension > 30 degrees was noted in 110 (44.3%) HV. The incidence of onycholysis was higher in HV type C than in type B (p = 0.044). The probability of suffering onycholysis in the right foot was 2.3 times greater when the neutral position was higher than 30 degrees (OR = 2.3; p = 0.004). However, this was not observed in the left foot (p = 0.171). Onycholysis was more frequent in HV with more than 2 cm height of the first toe (p < 0.001). For both feet, the probability of suffering onycholysis was greater for each unit increase in hallux height (right foot OR = 9.0402, p = 0.005; left foot OR = 7.6633, p = 0.010). CONCLUSIONS The incidence of onycholysis appears to be significantly associated with HV showing more than 30º extension, and more than 2 cm height of the first toe. Height and hyperextension of the first toe together with first toenail pathology should be mandatory in the evaluation of HV.
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Affiliation(s)
- Rosana Giménez-López
- School of Doctorate, Catholic University of Valencia "Saint Vincent Martyr", Plaza de San Agustín, 3 Esc. A, Entresuelo, 46001, Valencia, Spain.
| | - Carlos Barrios-Pitarque
- Institute for Research On Musculoskeletal Disorders, Catholic University of Valencia "Saint Vincent Martyr", Quevedo 2, 46001, Valencia, Spain
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13
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So E, Wilson M, Chu AK, Thompson JM, Prissel MA. Incidence of Nonunion of the First Metatarsophalangeal Joint Arthrodesis After Failed Implant Arthroplasty: A Systematic Review. Foot Ankle Spec 2024; 17:78-86. [PMID: 37165627 DOI: 10.1177/19386400231169364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Joint arthroplasty of the first metatarsophalangeal (MTP) joint is an accepted surgical option for patients with hallux rigidus. However, this procedure has been reported to have a high complication rate and unpredictable survivorship. Implant arthroplasty failure is a devastating complication that results in significant osseous defect with altered biomechanics of the foot. Commonly, salvage options are limited to arthrodesis with bone grafting. However, outcomes are rarely reported. The purpose of this study is to investigate the fusion rates of first metatarsophalangeal joint arthrodesis after conversion from failed implant arthroplasty. A systematic review of electronic databases to find reports of conversion arthrodesis after failed implant arthroplasty was performed. Six studies involving a total of 76 patients with a weighted mean age of 54.9 met the inclusion criteria. Out of the 6 included articles, the nonunion rate was 16.5% at a weighted mean follow-up of 48.1 months. The nonunion rate in the current report is higher than reported nonunion rates of primary arthrodesis. More prospective studies with consistent and standard outcome measures are needed to further determine the success rate of this salvage procedure.Levels of Evidence: 4, Systematic Review of Level 4 Studies.
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Affiliation(s)
- Eric So
- Bryan Medical Center, Lincoln, Nebraska
| | | | - Anson K Chu
- G2 Orthopedics and Sports Medicine, Glen Allen, Virginia
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14
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Elattar O, Andrews NA, Halstrom J, Harrelson WM, Nair P, Shah A. A Novel Plating System for First Metatarsophalangeal Joint Arthrodesis: A Retrospective Comparison of Hybrid and Traditional Locking Plate Constructs. Foot Ankle Spec 2023; 16:537-546. [PMID: 35048726 DOI: 10.1177/19386400211067860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dorsal plate fixation is commonly used for first metatarsophalangeal joint (1st MTPJ) arthrodesis and plate design continues to evolve. A new staple compression plate (SCP) design attempts to utilize the continuous compression of a nitinol staple across the fusion site while simultaneously providing the stability of a dorsal locked plate. Herein, we compare the radiographic, clinical, and patient-reported outcomes of 1st MTPJ joint arthrodesis using 2 dorsal locking plate constructs including a novel SCP construct. METHODS Forty-four patients who underwent 1st MTPJ arthrodesis between 2016 and 2020 were retrospectively evaluated. There were 2 group cohorts. Group 1 cohort included 23 patients who received a CrossRoads Extremity SCP, and Group 2 cohort included 21 patients who received a Stryker dorsal locking precontoured titanium plate (LPP). All patients were evaluated with radiographs, Patient-Reported Outcomes Measures Information System (PROMIS) outcome scores, and Foot Function Index (FFI). RESULTS The complication and union rates did not vary between groups with a fusion rate of 95.7% in the SCP group and 90.5 % in the LPP group. Similarly, we found no significant differences in PROMIS or FFI scores between the SCP and LPP plates. CONCLUSION Use of either dorsal locking plate construct for 1st MTPJ arthrodesis was associated with high union rates and comparable functional outcomes. As locked plate technology continues to evolve for 1st MTPJ arthrodesis, it is important that clinical outcomes are reported. LEVELS OF EVIDENCE Level IV.
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Affiliation(s)
- Osama Elattar
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicholas A Andrews
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jared Halstrom
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Whitt M Harrelson
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Pallavi Nair
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Ashish Shah
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
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15
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Ferreira GF, Pedroso JP, Nunes GA, Del Vecchio JJ, Lewis TL, Mattos E Dinato MC, Nogueira VB, Filho MVP. Treatment of hallux rigidus with percutaneous metatarsophalangeal arthrodesis: a case series with a minimum follow-up of 2 years. Arch Orthop Trauma Surg 2023; 143:6521-6526. [PMID: 37358593 DOI: 10.1007/s00402-023-04948-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/11/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Percutaneous metatarsophalangeal arthrodesis is an option for the treatment of hallux rigidus in more advanced cases. The aim of this study was to investigate the clinical and radiographic results at least 2 years after percutaneous metatarsophalangeal arthrodesis in patients with hallux rigidus. METHODS This is a case series of consecutive patients undergoing percutaneous metatarsophalangeal arthrodesis in patients with hallux rigidus grades III and IV with a minimum of 24 months of clinical and radiographic follow-up. The primary outcome was clinical assessment using the Visual Analog Scale for Pain (VAS). Secondary outcomes included American Orthopedic Foot & Ankle Society (AOFAS) score, patient satisfaction, complications, and bone healing (radiographic analysis). RESULTS Between August 2017 and February 2020, 29 feet (24 patients) underwent percutaneous metatarsophalangeal arthrodesis. The mean follow-up was 38.4 (range 24-54) months. There was an improvement in the pain (VAS) from 7.8 to 0.6 (p < 0.001) and in the AOFAS score from 49.9 to 83.6 (p < 0.001). There was a rate of bone union of 82.8% and screw removal of 13.8%. All patients considered the result to be excellent or good. CONCLUSION The treatment of grade III and IV hallux rigidus with percutaneous metatarsophalangeal arthrodesis demonstrated high patient satisfaction and significantly improves in clinical outcomes but the nonunion rate was higher than reported outcomes for open 1st metatarsophalangeal joint arthrodesis. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Gabriel Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
- Member of Minimally Invasive Foot Ankle Society (MIFAS), Merignac, France
- Instituto Vita, São Paulo, Brazil
| | - João Paulo Pedroso
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
| | | | | | | | - Mauro Cesar Mattos E Dinato
- Department of Orthopaedics, Rheumatology and Traumatology, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Instituto Vita, São Paulo, Brazil
| | | | - Miguel Viana Pereira Filho
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil.
- Instituto Vita, São Paulo, Brazil.
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16
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Haimes MA, Roberts MS, Bougioukas L, Michelson JD. Analysis of the Costs and Complications of First Metatarsophalangeal Joint Arthrodesis Comparing Locked and Non-locked Plate Fixation Constructs. J Am Acad Orthop Surg 2023; 31:e1012-e1020. [PMID: 37352365 DOI: 10.5435/jaaos-d-23-00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/23/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The ideal fixation method for the first metatarsophalangeal joint (first MTP) remains uncertain. This study compares nonunion and revision surgery rates of first MTP arthrodesis between nonlocking semitubular plates and precontoured locking plates. METHODS Demographics, fixation technique, and complications of all patients who underwent primary first MTP arthrodesis between 2013 and 2018 were determined from radiographs and clinical records. Cost data were from a 1-year subset of isolated first MTP fusion surgeries. The primary outcome measures of this study were the nonunion and complication rates, with associated costs of patients undergoing first metatarsophalangeal arthrodesis with either a noncontoured semitubular plate or a precontoured locking plate. RESULTS The study included 189 patients, with a mean follow-up of 18.7 months. The overall nonunion rate was 10.1%, with no difference between the locking and nonlocking plates. The prevalence of a painful implant was also similar. Surgeries using locking plates cost an average of $1,500 more than those using nonlocked plates. CONCLUSIONS Because there was no difference in revision between locking and nonlocking plate fixation for primary first MTP arthrodesis, routine use of the more expensive locking plates may not be justified. LEVEL OF EVIDENCE Level III (Retrospective cohort study).
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Affiliation(s)
- Mark A Haimes
- From the Department of Orthopaedics and Rehabilitation, Larner College of Medicine at the University of Vermont, Burlington, VT
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17
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Balu AR, Baumann AN, Tsang T, Talaski GM, Anastasio AT, Walley KC, Adams SB. Evaluating the Biomechanical Integrity of Various Constructs Utilized for First Metatarsophalangeal Joint Arthrodesis: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6562. [PMID: 37834699 PMCID: PMC10573906 DOI: 10.3390/ma16196562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
The first metatarsophalangeal (MTP) joint is a frequently loaded joint, handling loads up to 90% of bodyweight. First MTP arthrodesis is a frequently performed procedure designed to improve pain in patients with degenerative MTP joint disease. There are a wide variety of fixation constructs for this procedure without consensus on the most effective method. The purpose of this study was to compare the biomechanical integrity of various constructs utilized for first MTP arthrodesis. A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, MEDLINE, and Web of Science databases were searched from inception to 18 June 2023. Articles discussing the biomechanics of first MTP arthrodesis constructs were included. A total of 168 articles were retrieved. A total of 20 articles involving 446 cadaveric and synthetic bone constructs were included in the final review. Of the six articles comparing dorsal plating with compression screws to crossed interfragmentary screws, five found that dorsal plating had significantly higher stiffness. All three studies assessing shape-memory staples found them to be significantly less stable than crossed screws or dorsal plates alone. Both studies evaluating fully threaded screws found them to be stronger than crossed cancellous screws. Wedge resections have been shown to be 10 times stronger than standard planar or conical excision. Dorsal plating with compression screws is the gold standard for MTP arthrodesis. However, more research into newer methods such as fully threaded screws and wedge resections with an increased focus on translation to clinical outcomes is needed.
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Affiliation(s)
- Abhinav R. Balu
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60208, USA
| | - Anthony N. Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA;
| | - Terence Tsang
- Campbell University School of Osteopathic Medicine, Lillington, NC 27546, USA;
| | - Grayson M. Talaski
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA;
| | - Albert T. Anastasio
- Department of Orthopaedic Surgery, Duke University, Durham, NC 27708, USA; (A.T.A.); (S.B.A.)
| | - Kempland C. Walley
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Samuel B. Adams
- Department of Orthopaedic Surgery, Duke University, Durham, NC 27708, USA; (A.T.A.); (S.B.A.)
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18
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Filomeno P, López J. Republication of "First Metatarsophalangeal Joint Arthrodesis: Functional Outcomes Using 2 Different Fixation Techniques. Is More Expensive Better?". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231193424. [PMID: 37566680 PMCID: PMC10408336 DOI: 10.1177/24730114231193424] [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: 08/13/2023] Open
Abstract
Background First metatarsophalangeal (MTP) joint arthrodesis can be fixed using either a dorsal plate or crossed screws. However, there is considerable difference in the cost of these implants, and it is not known if there is sufficient difference in outcome that might justify this cost difference. Our aim was to compare the functional results and patient satisfaction rates after first MTP joint arthrodesis in a group of patients using the same surgical technique except for the fixation devices. Methods A prospective cohort of 27 patients who underwent first MTP joint fusion by the same surgeon using 2 crossed screws or a single screw with a dorsal plate was recruited over a 3-year period. Demographic information, patient satisfaction rates, complications, and union rates were evaluated. American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scoring systems were used pre- and postoperatively to compare the functional outcomes. Thirty consecutive procedures (screws, n = 15; plate, n = 15) were performed. Age (55.8 ± 11.1 vs 63.3 ± 12.4 years for screws and plate respectively; P = .091) and female gender percentages (80% and 73%, P = .666) were similar between groups. Results The overall union rate was 93% with no differences between groups. AOFAS and VAS scores improved significantly postoperatively for each technique, and no differences were found between the two in the improvement in AOFAS (42.4 ± 8.0 vs 44.3 ± 8.2, screws and plate respectively; P = .520) and VAS scores (66.0 ± 5.4 vs 69.0 ± 6.9;P = .195). The implant cost for screws was $40 and for dorsal plate, $328. Conclusions First MTP joint fusion using either screws or plate fixation results in an improvement in AOFAS and VAS scores. Functional improvement and patient satisfaction did not differ between the 2 techniques, despite a considerable difference in cost between the two methods of fixation. Level of Evidence Level III, prospective comparative study.
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Affiliation(s)
- Paola Filomeno
- Instituto Nacional de Otropedia y Traumatología (INOT), Universidad de la Republica del Uruguay, Montevideo, Uruguay
| | - Julio López
- Mutualista Médica Uruguaya (MUCAM), Montevideo, Uruguay
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19
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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: 0.5] [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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20
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von Deimling C, Tondelli T, Brunner S, Andronic O, Graf AD. Achieving high union rates after first metatarsophalangeal joint arthrodesis: Radiographic outcomes and technical pitfalls. World J Orthop 2023; 14:436-442. [PMID: 37377987 PMCID: PMC10292060 DOI: 10.5312/wjo.v14.i6.436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/14/2023] [Accepted: 05/15/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Fusion of the first metatarsophalangeal (MTP1) joint is a common surgery performed to correct hallux rigidus, hallux rigidus et valgus and other painful degenerative diseases of the MTP1.
AIM To assess outcomes of our surgical technique including non-union rates, accuracy and aims of correction.
METHODS Between September 2011 and November 2020 a total 72 of MTP1 fusions were performed using a low profile, pre-contoured dorsal locking plate and a plantar compression screw. Union and revision rates were analyzed with a minimum clinical and radiological follow up of at least 3 mo (range 3-18 mo). The following parameters were evaluated on pre- and postoperative conventional radiographs: Intermetatarsal angle, Hallux-valgus angle, dorsal extension of the proximal phalanx (P1) in relation to the floor and the angle between the Metatarsal 1 and the P1 (MT1-P1 angle). Descriptive statistical analysis was performed. Pearson analysis was used to assess for correlations between radiographic parameters and achievement of fusion.
RESULTS An overall union rate of 98.6% (71/72) was achieved. Two out of 72 patients did not primarily fuse with one patient suffering from a non-union, whilst the other demonstrating a radiological delayed union without clinical symptoms, with eventually complete fusion after 18 mo. There was no correlation between the measured radiographic parameters and the achievement of fusion. We believe the reason for the non-union was mainly attributed to the patient’s incompliance without wearing the therapeutic shoe leading to a fracture of the P1. Furthermore, we didn`t find any correlation between fusion and the degree of correction.
CONCLUSION With our surgical technique, high union rates (98%) can be achieved using a compression screw and a dorsal variable-angle locking plate to treat degenerative diseases of the MTP1.
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Affiliation(s)
- Christian von Deimling
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
| | - Timo Tondelli
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
| | - Samuel Brunner
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
| | - Octavian Andronic
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
| | - Alexander David Graf
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
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21
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Füssenich W, Seeber GH, van Raaij TM, van Lingen CP, Zuurmond RG, Stevens M, Somford MP. Factors Associated With Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Multicenter Retrospective Cohort Study. Foot Ankle Int 2023; 44:508-515. [PMID: 36959744 PMCID: PMC10248293 DOI: 10.1177/10711007231160754] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND Arthrodesis of the first metatarsophalangeal joint is the current treatment of choice for symptomatic advanced hallux rigidus and moderate-to-severe hallux valgus. There are different methods to perform arthrodesis, yet no consensus on the best approach. Therefore, this study aimed to determine the effects of preoperative and postoperative hallux valgus angle (HVA), joint preparation and fixation technique, and postoperative immobilization on the incidence of nonunion. METHODS A retrospective multicenter cohort study was performed that included 794 patients. Univariate and multiple logistic regression was conducted to determine associations between joint preparation, fixation techniques, postoperative immobilization, weightbearing, and pre- and postoperative HVA with nonunion. RESULTS Nonunion incidence was 15.2%, with 11.1% symptomatic and revised. Joint preparation using hand instruments (OR 3.75, CI 1.90-7.42) and convex/concave reamers (OR 2.80, CI 1.52-5.16) were associated with greater odds of a nonunion compared to planar cuts. Joint fixation with crossed screws was associated with greater odds of nonunion (OR 2.00, CI 1.11-3.42), as was greater preoperative HVA (OR 1.02, CI 1.00-1.03). However, the latter effect disappeared after inclusion of postoperative HVA in the model, with a small association identified between residual postoperative HVA and nonunion (OR 1.04, CI 1.01-1.08). Similarly, we found an association between odds of nonunion and higher body weight (OR 1.02, CI 1.01-1.04) but not of body mass index. CONCLUSION Based on our results, first metatarsophalangeal joint arthrodesis with planar cuts and fixation with a plate and interfragmentary screw is associated with the lowest odds of resulting in a nonunion. Higher body weight and greater preoperative HVA were associated with slight increase in rates of nonunion. It is crucial to properly correct the hallux valgus deformity during surgery. LEVEL OF EVIDENCE Level III, retrospective case control study.
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Affiliation(s)
- Wout Füssenich
- Department of Orthopaedic Surgery,
University of Groningen, University Medical Center Groningen, Groningen, the
Netherlands
| | - Gesine H. Seeber
- Department of Orthopaedic Surgery,
University of Groningen, University Medical Center Groningen, Groningen, the
Netherlands
- University Hospital for Orthopaedics
and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg,
Germany
| | - Tom M. van Raaij
- Department of Orthopaedic Surgery,
Martini Hospital, Groningen, the Netherlands
| | | | | | - Martin Stevens
- Department of Orthopaedic Surgery,
University of Groningen, University Medical Center Groningen, Groningen, the
Netherlands
| | - Matthijs P. Somford
- Department of Orthopaedic Surgery,
Rijnstate Hospital, Arnhem, the Netherlands
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22
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Prat D, Haghverdian BA, Pridgen EM, Lee W, Wapner KL, Chao W, Farber DC. High complication rates following revision first metatarsophalangeal joint arthrodesis: a retrospective analysis of 79 cases. Arch Orthop Trauma Surg 2023; 143:1799-1807. [PMID: 35092466 DOI: 10.1007/s00402-022-04342-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/04/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The most common indications for revision of first metatarsophalangeal joint (MTPJ) arthrodesis are symptomatic failures of prior arthrodesis, failed hallux valgus correction, and failed MTPJ arthroplasty implants. However, the outcomes of revision MTPJ arthrodesis have rarely been studied. The purpose of this study was to compare the clinical, radiographic, and patient-reported outcomes of revision MTPJ arthrodesis following different primary procedures. METHODS A retrospective review of revision MTPJ arthrodesis cases between January 2015 and December 2019 was performed. The radiographic results, patient-reported outcomes, and rates of complications, subsequent revisions, and nonunions, were analyzed and compared preoperatively and postoperatively. A multivariate analysis was utilized to determine risk factors for complications and reoperations. RESULTS This study yielded a total of 79 cases of revision MTPJ arthrodesis. The mean follow-up time was 365 days (SD ± 295). The overall complication rate was 40.5%, of which the overall nonunion rate was 19.0%. Seven cases (8.9%) required further revision surgery. The multivariate analysis revealed that Diabetes mellitus was associated with significantly higher overall complication rates (p = 0.016), and nonunion was associated with "in-situ" joint preparation techniques (p = 0.042). Visual Analog Scale (VAS) significantly improved postoperatively (p < 0.001); However, PROMIS-10 physical health and PROMIS-10 mental health did not change significantly during the study period. CONCLUSION Treatment of MTPJ surgery failures is a clinical challenge in orthopedic surgery. In our study, revision of first MTPJ surgery resulted in higher nonunion rates and overall complication rates compared to typical outcomes from primary MTPJ arthrodesis. Diabetes, Tobacco use, and "in-situ" joint preparation technique were found to be independent risk factors for complications and reoperations. LEVEL OF EVIDENCE III-Retrospective Cohort Study.
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Affiliation(s)
- Dan Prat
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
| | - Brandon A Haghverdian
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric M Pridgen
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Wonyong Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Keith L Wapner
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Wen Chao
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel C Farber
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Attia AK, Heier KA. First Metatarsophalangeal Arthrodesis for the Failed Hallux. Foot Ankle Clin 2022; 27:723-744. [PMID: 36368794 DOI: 10.1016/j.fcl.2022.07.001] [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] [Indexed: 11/09/2022]
Abstract
Hallux metatarsophalangeal joint (MTPJ) arthrodesis was first described in 1894 by Clutton, who recommended ankylosing the MTPJ to treat painful hallux valgus (HV). He used ivory pegs to stabilize the MTP joint. Surgeons over the last century have modified the procedure and added indications, including hallux rigidus, rheumatoid arthritis, and revision of failed surgeries. This article addresses many common yet challenging clinical scenarios, and a few hot topics, related to hallux MTPJ arthrodesis, including matarsus primus elevatus, severe hallux valgus, avascular necrosis, and infections. The article provides a condensed evidence-based discussion on how to manage these challenges using MTPJ arthrodesis.
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Affiliation(s)
- Ahmed Khalil Attia
- Orthopedic Surgery and Rehabilitation Department, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
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Schafer KA, Baldini T, Hamati M, Backus JD, Hunt KJ, McCormick JJ. Two Orthogonal Nitinol Staples and Combined Nitinol Staple-Screw Constructs for a First Metatarsophalangeal Joint Arthrodesis: A Biomechanical Cadaver Study. Foot Ankle Int 2022; 43:1493-1500. [PMID: 36036524 DOI: 10.1177/10711007221119157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND End-stage hallux metatarsophalangeal (MTP) joint arthritis is commonly treated with arthrodesis using stainless steel or titanium implants. These implants provide static compression that is maximal at the time of implant insertion. Alternatively, nitinol staples are capable of dynamic compression. They have most frequently been used for midfoot arthrodesis procedures. However, their biomechanical performance during hallux MTP arthrodesis has not been described. METHODS 8 matched pairs of cadaveric feet (4 female, 4 male) were prepared for hallux MTP arthrodesis using cup and cone reamers. Cadaveric pairs were then instrumented with either (1) a transarticular lag screw and dorsal nitinol staple or (2) orthogonal nitinol staples placed dorsally and medially. Walking in a short leg cast for 6 weeks was simulated by applying 90-N forces at 3 Hz to the plantar proximal phalanx for up to 250 000 cycles. Failure was defined as catastrophic implant failure or plantar gapping beyond 7 mm. RESULTS 15 of 16 specimens failed cyclic loading. All 8 specimens fixed with orthogonal staples failed at an average of 37 ± 81 cycles. 7 of 8 specimens fixed with a dorsal staple and crossed screw failed at 14 900 ± 39 000 cycles. Collectively, 5 specimens failed because of bone fracture (1 in orthogonal staples, 4 in staple-screw group) and 10 failed because of excessive gap formation (7 in orthogonal staples, 3 in staple-screw group). The number of cycles to failure was significantly lower (P = .0469) in the orthogonal staple constructs compared with the dorsal staple and crossed screw constructs. CONCLUSION The tested constructs permit significant motion at the first MTP fusion surface during simulated protected weightbearing. Although multiple in vivo factors should be considered when extrapolating results from this cadaveric study, this motion may result in clinical failure with early postoperative weightbearing protocols. CLINICAL RELEVANCE We report the first biomechanical evaluation of hallux MTP arthrodesis using modern nitinol staples in 2 separate constructs.
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Affiliation(s)
- Kevin A Schafer
- Department of Orthopedic Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Todd Baldini
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mary Hamati
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathon D Backus
- Department of Orthopedic Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Kenneth J Hunt
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jeremy J McCormick
- Department of Orthopedic Surgery, Washington University in St Louis, St Louis, MO, USA
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Kang YS, Bridgen A. First metatarsophalangeal joint arthrodesis/fusion: a systematic review of modern fixation techniques. J Foot Ankle Res 2022; 15:30. [PMID: 35468802 PMCID: PMC9040205 DOI: 10.1186/s13047-022-00540-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background First metatarsophalangeal joint arthrodesis is commonly performed for symptomatic end-stage hallux rigidus. It has been postulated to produce good results in the literature. Various fixation techniques offer differences in union rates, complications and functional outcomes, stirring debates about which produces the best outcomes for patients. Therefore, this review aims to synthesise and compare the outcomes of modern fixation techniques used for first metatarsophalangeal joint (FMPJ) arthrodesis. Methods The electronic database searched were PubMed, CINAHL, Cochrane Library, and Google Scholar. The critical appraisal skills programme tool for cohort study was used. The interventions consisted of screw(s), plate(s), and staple(s). Studies comprising outdated fixation techniques such as suture, metallic wire, external fixation, Rush rods or Steinmann pins were excluded. Participants were adults over 18 years, undergoing FMPJ arthrodesis in the UK. Studies with the population consisting primarily of revision cases, patients with rheumatoid arthritis or diabetes were excluded. Results Seven UK studies included 277 feet and a 95.7% overall union rate at a mean union time of 83.5 days. Staples had the highest union rate of 98.2% at mean union time of 84 days, followed by plates (95.2%, 92 days), and finally screws (94.9%, 71 days). The overall complication incidence is 5.8%. All of the fixation techniques produced good functional outcomes postoperatively. Conclusions Whilst staple techniques showed the highest union rate, plating techniques are preferable over screws or staples for better results across several outcome measures, including reduced complication incidence, stability, early ambulation, and good functional outcome. The Manchester-Oxford Foot Questionnaire and EuroQol-5Dimensional are recommended as measurement tools to assess functional outcomes following FMPJ arthrodesis. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00540-9.
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Affiliation(s)
- Yang S Kang
- Department of Podiatry, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.
| | - Andy Bridgen
- Department of Podiatry, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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Tytgat HE, Wuite S, Matricali GA. Arthrodesis of the first metatarsophalangeal joint using an intraosseous fixation device. Acta Orthop Belg 2022; 88:135-142. [PMID: 35512164 DOI: 10.52628/88.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The complication rate for an arthrodesis of the first metatarsophalangeal joint remains high. To improve results, we used a complete intraosseous fixation device (IOFIX) with proposed biomechanical advantages. Our hypothesis is that this technique has at least an equal union rate and less hardware irritation compared to other techniques. Seventy procedures were performed in 55 patients. Average follow-up was 24.5 months. All patients returned to follow-up after 6 weeks and were evaluated for union. Fifty-nine feet (84%) completed full follow- up. Union occurred in 62 of 70 feet (88.5%). Eight feet had nonunion at 1 year follow-up. Average time to fusion was 51 days. Three of 59 feet had malunion. No hardware removal was necessary. In conclusion, an MTP1 arthrodesis using IOFIX provides consistent and good functional outcomes. Due to the low-profile design, no hardware removal was necessary. However, union rates seem slightly lower compared to other techniques.
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Matsumoto T, Takeda R, Kasai T, Chang SH, Izawa N, Hirose J, Takuo J, Tanaka S. Clinical Outcomes After First Metatarsophalangeal Joint Arthrodesis by Flat Cut Joint Preparation With Individual Adjustment for Sagittal Alignment. J Foot Ankle Surg 2022; 61:60-66. [PMID: 34274242 DOI: 10.1053/j.jfas.2020.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 10/03/2020] [Accepted: 10/11/2020] [Indexed: 02/03/2023]
Abstract
Sagittal misalignment is a major cause of patient dissatisfaction and re-operation after first metatarsophalangeal (MTP) joint arthrodesis. The stereotypical application of the fixed angle would be undesirable, especially in cases of flat or cavus foot. We retrospectively reviewed 31 cases (27 patients) in which first MTP joint arthrodesis was performed using the flat cut joint preparation technique with reference to the plantar clearance beneath the pulp of the toe while simulating weightbearing by pushing a board against the sole. The most common underlying cause of surgery was rheumatoid arthritis (22 cases [71%]). Clinical outcomes were evaluated by the Japanese of Surgery of the Foot (JSSF) hallux scale and the self-administered foot evaluation questionnaire (SAFE-Q). Twenty-three cases were also examined by pedobarography to evaluate postoperative walking plantar pressure. At the most recent follow-up of a mean 19.6 months, the toe-to-floor distance of the hallux in static standing posture was a mean of 2.5 mm (range, 0-10 mm). All but 1 foot (97%) achieved bone union. There were no complications or revisions due to misalignment of the fused MTP joint. JSSF hallux scales improved significantly from 47 preoperatively to 82 postoperatively. All subscale scores except general health and well-being in the SAFE-Q improved significantly at final follow-up versus preoperative period. Plantar pressure under the hallux was correlated with the toe-to-floor distance but not radiographic parameter. In conclusion, first MTP joint arthrodesis achieved good clinical outcomes when using toe-to-floor distance and Kirschner wire template for flat cut joint preparation.
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Affiliation(s)
- Takumi Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan; Department of Rheumatology, JCHO Yugawara Hospital, Kanagawa, Japan.
| | - Ryutaro Takeda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taro Kasai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Song Ho Chang
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naohiro Izawa
- Department of Rheumatology, JCHO Yugawara Hospital, Kanagawa, Japan
| | - Jun Hirose
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Juji Takuo
- Department of Rheumatology, JCHO Yugawara Hospital, Kanagawa, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Weigelt L, Redfern J, Heyes GJ, Butcher C, Molloy A, Mason L. Risk Factors for Nonunion After First Metatarsophalangeal Joint Arthrodesis With a Dorsal Locking Plate and Compression Screw Construct: Correction of Hallux Valgus Is Key. J Foot Ankle Surg 2021; 60:1179-1183. [PMID: 34112585 DOI: 10.1053/j.jfas.2020.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/27/2020] [Indexed: 02/03/2023]
Abstract
First metatarsophalangeal joint (MTPJ) arthrodesis is currently the gold standard technique for advanced hallux rigidus. This retrospective study aimed to identify the risk factors for nonunion after first MTPJ arthrodesis with a dorsal locking plate and compression screw construct. Between April 2014 and April 2019, 165 consecutive patients (28 men and 137 women; mean age, 60 (range, 28-84) years) who underwent 178 primary first MTPJ arthrodeses were retrospectively reviewed. All arthrodeses were performed using either a dorsal locking plate with an integrated compression screw (Anchorage CP plate, Stryker, n = 97) or a dorsal locking plate (Anchorage V2 plate, Stryker, n = 81) with a separate compression screw (4 mm cannulated ACE screw). Union was defined as bone bridging across the fusion site on at least 2 of the 3 standard foot radiographs (anteroposterior, lateral, oblique) and no MTPJ movement or pain during clinical examination. Potential risk factors for nonunion were analyzed with the use of univariate and multivariate analyses. The overall nonunion rate was 6.2% (11 of 178 cases). The risk factors identified in the univariate analysis included preoperative hallux valgus deformity, postoperative residual hallux valgus deformity, and diabetes (p < .05). Multivariate analysis confirmed that postoperative residual hallux valgus deformity (odds ratio 6.5; p= .015) and diabetes (odds ratio 7.4; p = .019) are independent risk factors for nonunion after first MTPJ arthrodesis. Diabetes is the most important independent risk factor for nonunion after first MTPJ arthrodesis with a dorsal locking plate and compression screw construct. A residual postoperative hallux valgus deformity is associated with a significantly increased risk for nonunion. It is therefore crucial to correct the hallux valgus deformity to a hallux valgus angle of less than 20°.
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Affiliation(s)
- Lizzy Weigelt
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
| | - James Redfern
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Gavin John Heyes
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Clifford Butcher
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew Molloy
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
| | - Lyndon Mason
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
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Different fixation constructs and the risk of non-union following first metatarsophalangeal joint arthrodesis. Foot Ankle Surg 2021; 27:789-792. [PMID: 33189547 DOI: 10.1016/j.fas.2020.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 09/21/2020] [Accepted: 10/15/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to determine if a single or separate construct with interfragmentary screw was associated with higher rates non-union following first metatarsophalangeal joint (MTPJ) arthrodesis. METHODS A retrospective analysis of patients undergoing first MTPJ arthrodesis between April 2010 and June 2017 was performed. Patients who received either a single (Stryker Anchorage 1 MTP Cross Plate) or separate (Stryker Anchorage 1 MTP locking plate with one Asnis partially threaded compression screw) construct locking plate and interfragmentary compression screw were reviewed. Descriptive statistics were generated for sample demographics and between-group differences were calculated. Multivariable regressions explored internal fixation type and association with non-union. RESULTS A total of 280 first MTPJ arthrodesis met the inclusion criteria and were reviewed. The incidence of non-union was 7.9% of procedures (22 joints). Following multivariable binary logistic regression, the single construct locking plate with interfragmentary compression screw was associated with an increased risk of non-union (OR 3.43, 95% CI 1.26-9.33), adjusting for age, gender and comorbidity. CONCLUSIONS A single construct interfragmentary screw and locking plate (Stryker Anchorage 1 MTP Cross Plate) was associated with an increased incidence of non-union following first MTPJ arthrodesis.
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30
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Gould AER, Logan K, Lin Z, Marsland D, Elliot RR. A Prospective Evaluation of First Metatarsophalangeal Fusion Using an Innovative Dorsal Compression Plating System. J Foot Ankle Surg 2021; 60:891-896. [PMID: 33785240 DOI: 10.1053/j.jfas.2021.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 09/08/2020] [Accepted: 02/24/2021] [Indexed: 02/03/2023]
Abstract
Numerous techniques have been described for first metatarsophalangeal joint (MTPJ) fusion. The aim of this study was to prospectively evaluate an innovative plating system which uses a cross plate compression screw. Thirty consecutive first MTPJ fusions in 28 patients were evaluated. All procedures were performed by a single fellowship trained consultant foot and ankle surgeon. Patient function was evaluated preoperatively at 6 and at 12 months using the Manchester-Oxford Foot Questionnaire (MOXFQ). Union rates and complications were recorded. Postoperative MOXFQ scores demonstrated significant improvement in all domains, with mean improvement at 12 months of 35, 27, 17 and 106 points for pain, walking/standing, social interactions and combined scores respectively (p value ≤.0001). In all 30 cases, clinical and radiological evidence of union was achieved by 6 months. Superficial infection occurred in 1 (3%) case. One (3%) case required plate removal due to soft tissue irritation. There were no plate failures. This evaluation study demonstrates that this cross-plate compression plating system is safe, provides high patient satisfaction and reliable union, with low complication rates. Prospective comparative research is now required to determine the optimal technique for first MTPJ fusion.
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Affiliation(s)
| | - Karl Logan
- Orthopaedic Registrar, Basingstoke and North Hampshire Hospital, England, UK.
| | - Zoe Lin
- Orthopaedic Registrar, Basingstoke and North Hampshire Hospital, England, UK
| | - Daniel Marsland
- Consultant Orthopaedic Surgeon, Royal Hampshire County Hospital, England, UK
| | - Robin R Elliot
- Consultant Orthopaedic Surgeon, Basingstoke and North Hampshire Hospital, England, UK
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31
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Miettinen M, Rämö L, Lähdeoja T, Sirola T, Sandelin H, Ponkilainen V, Repo JP. Treatment of hallux rigidus (HARD trial): study protocol of a prospective, randomised, controlled trial of arthrodesis versus watchful waiting in the treatment of a painful osteoarthritic first metatarsophalangeal joint. BMJ Open 2021; 11:e049298. [PMID: 34452964 PMCID: PMC8404449 DOI: 10.1136/bmjopen-2021-049298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Hallux rigidus is a common problem of pain and stiffness of the first metatarsophalangeal joint (MTPJ) caused mainly by degenerative osteoarthritis. Several operative techniques have been introduced for the treatment of this condition without high-quality evidence comparing surgical to non-surgical care. In this trial, the most common surgical procedure, arthrodesis, will be compared with watchful waiting in the management of hallux rigidus. METHODS AND ANALYSIS Ninety patients (40 years or older) with symptomatic first MTPJ osteoarthritis will be randomised to arthrodesis or watchful waiting in a ratio of 1:1. The primary outcome will be pain during walking, assessed using the 0-10 Numerical Rating Scale (NRS) at 1 year after randomisation. The secondary outcomes will be pain at rest (NRS), physical function (Manchester-Oxford Foot Questionnaire), patient satisfaction in terms of the patient-acceptable symptom state, health-related quality of life (EQ-5D-5L), activity level (The Foot and Ankle Ability Measure Sports subscale), use of analgesics or orthoses and the rate of complications. Our null hypothesis is that there will be no difference equal to or greater than the minimal important difference of the primary outcome measure between arthrodesis and watchful waiting. Our primary analysis follows an intention-to-treat principle. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of Helsinki and Uusimaa Hospital District, Finland. Written informed consent will be obtained from all the participants. We will disseminate the findings of this study through peer-reviewed publications and conference presentations. PROTOCOL VERSION 21 June 2021 V.2.0. TRIAL REGISTRATION NUMBER NCT04590313.
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Affiliation(s)
- Mikko Miettinen
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Lasse Rämö
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
- Finnish Centre for Evidence-Based Orthopaedics, FICEBO, Helsinki, Finland
| | - Tuomas Lähdeoja
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
- Finnish Centre for Evidence-Based Orthopaedics, FICEBO, Helsinki, Finland
| | - Timo Sirola
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Henrik Sandelin
- Department of Orthopaedics and Traumatology, Vaasa Central Hospital and University of Helsinki, Helsinki, Uusimaa, Finland
- Sports Hospital, Mehiläinen, Helsinki, Uusimaa, Finland
| | - Ville Ponkilainen
- Department of Orthopaedics and Traumatology, Central Finland Hospital Nova, Jyväskylä, Central Finland, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, University of Tampere and Tampere University Hospital, Tampere, Finland
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Koutsouradis P, Savvidou OD, Stamatis ED. Arthrodesis of the first metatarsophalangeal joint: The “when and how”. World J Orthop 2021; 12:485-494. [PMID: 34354936 PMCID: PMC8316842 DOI: 10.5312/wjo.v12.i7.485] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/18/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
Arthrodesis of the first metatarsophalangeal (MTP) joint has been established as the “gold standard” for the treatment of several first ray disorders, due to its perceived efficacy and the consistently reported good results in the literature. Arthrodesis is a commonly performed procedure for the treatment of end stage arthritis, rheumatoid arthritis with severe deformity, selected cases of severe hallux valgus (with or without signs of degenerative joint disease), as well as a salvage procedure after failed previous operation of the first ray. The goals of a successful 1st MTP arthrodesis are pain alleviation and deformity correction in order to restore a comfortable gait pattern and to improve shoe wear. Several techniques have been reported with several proposals regarding the preparation of the articular surfaces and the method of definitive fixation. As with any given surgical procedure, various complications may occur after arthrodesis of the 1st MTP joint, namely delayed union, nonunion, malunion, irritating hardware, etc.
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Affiliation(s)
- Panagiotis Koutsouradis
- Department of Foot and Ankle Reconstructive Surgery, Mediterraneo Hospital, Athens 16675, Greece
| | - Olga D Savvidou
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, “ATTIKON” Hospital, Athens 12462, Greece
| | - Emmanouil D Stamatis
- Department of Foot and Ankle Reconstructive Surgery, Mediterraneo Hospital, Athens 16675, Greece
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Lunati M, Mahmoud K, Kadakia R, Coleman M, Bariteau J. Complications Associated with the Surgical Management of Hallux Rigidus. Orthop Clin North Am 2021; 52:291-296. [PMID: 34053574 DOI: 10.1016/j.ocl.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hallux rigidus is the most common arthritic pathology of the foot. This review article discusses the pathophysiology and common clinical presentation of hallux rigidus. Furthermore, we discuss multiple classification systems that categorize the arthritic process and guide management. Surgical interventions include cheilectomy, Moberg osteotomy, synthetic cartilage implants, interpositional arthroplasty, and arthrodesis. The common complications are reviewed, and the rates of these complications highlighted. Surgical options for hallux rigidus globally have successful outcomes with low rates of complications when done on appropriate patients.
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Affiliation(s)
- Matthew Lunati
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Karim Mahmoud
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Rishin Kadakia
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Michelle Coleman
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Jason Bariteau
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA.
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34
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Füssenich W, Brusse-Keizer MGJ, Somford MP. Severe Hallux Valgus Angle Attended With High Incidence of Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Follow-Up Study. J Foot Ankle Surg 2021; 59:993-996. [PMID: 32690233 DOI: 10.1053/j.jfas.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 02/03/2023]
Abstract
The incidence of nonunion after first metatarsophalangeal joint (MTP-1) arthrodesis was found to be high in our clinic. By raising awareness for the problem, making a uniform surgical treatment protocol, banning the commonly used convex-concave reamers, and promoting solely the use of hand instruments to prepare the joint for arthrodesis, we tried to decrease the numbers of nonunion. This prospective cohort study included all patients who underwent MTP-1 fusion between January 2018 and March 2019. Patients were treated according to a standardized protocol, using hand instruments to prepare the joint for fusion. Anthropometric and therapy-related data were collected and compared with an earlier 2015-2016 cohort that was retrospectively assessed. Furthermore, the frequency of nonunion between convex-concave reamers and hand instruments was compared. A total of 53 patients underwent MTP-1 fusion surgery. The incidence of nonunion was 3.8%, significantly lower than the 24.1% in 2015 to 2016 (p = .002). Multivariate regression analysis showed a 7.11 times higher risk of nonunion in 2015 to 2016 compared with 2018 to 2019 (95% confidence interval [CI] 1.55 to 32.55) (p = .012). Furthermore, an increase of 10° in HVA showed a 1.52 risk of occurrence of nonunion (95% CI 1.07 to 2.17) (p = .021). The use of convex/concave reamers was univariately associated with a 3.61 times higher risk of nonunion (95% CI 1.14 to 11.43) (p = .029); however, after correction for preoperative HVA, the preparation method was no longer associated with the occurrence of nonunion (p = .108). Patients suffering from severe hallux valgus had nonunion in 32.1% of cases. Incidence of nonunion after MTP-1 arthrodesis was significantly reduced by raising awareness and by standardizing the treatment protocol. There was no significant difference in nonunion frequency between the methods of joint surface preparation. Severe hallux valgus is prone to nonunion, and more research into this indication for MTP-1 fusion and outcome is needed.
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Affiliation(s)
- Wout Füssenich
- Resident, Department of Orthopedic Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Matthijs P Somford
- Foot and Ankle Surgeon, Department of Orthopedic Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
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35
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Barták V, Štědrý J, Hornová J, Heřt J, Tichý P, Hromádka R. Biomechanical Study Concerning the Types of Resection in Arthrodesis of First Metatarsophalangeal Joint. J Foot Ankle Surg 2021; 59:1135-1138. [PMID: 32732150 DOI: 10.1053/j.jfas.2019.01.024] [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: 02/07/2018] [Revised: 01/01/2019] [Accepted: 01/29/2019] [Indexed: 02/03/2023]
Abstract
This work concerns a biomechanical study aiming to ascertain the optimal type of joint resection when performing a joint arthrodesis. A 3-dimensional digital model of the first metatarsophalangeal joint including the entire first metatarsal bone and proximal phalanx using CT scans of the forefoot was created. Using this computer model, 4 types of resections; ball-and-socket, flat-on-flat, wedge 90°, and wedge 100° were simulated. Parameters measured using this model were the force necessary to separate the 2 fused surfaces, the surface area of the resected surfaces and the shortening of the first ray. By measuring the reactive force necessary to separate the phalanx from the first metatarsal, the 90° wedge resection was found to be the most stable, with comparable results in the case of the 100° wedge resection. Wedge resections are also more favorable when comparing the shortening of the first ray. Wedge resections, though being more technically difficult to perform prove to be the most stable for metatarsophalangeal joint-1 arthrodesis using this model.
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Affiliation(s)
- Vladislav Barták
- Surgeon, FN Motol Teaching Hospital, Department of Orthopaedic Surgery, 1st Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic.
| | - Jan Štědrý
- Surgeon, FN Motol Teaching Hospital, Department of Orthopaedic Surgery, 1st Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Jana Hornová
- Engineer, Faculty of Mechanical Engineering, Department of Mechanics, Biomechanics and Mechatronics, Czech Technical University, Prague, Czech Republic
| | - Jan Heřt
- Surgeon, FN Motol Teaching Hospital, Department of Orthopaedic Surgery, 1st Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Petr Tichý
- Engineer, Faculty of Mechanical Engineering, Department of Mechanics, Biomechanics and Mechatronics, Czech Technical University, Prague, Czech Republic
| | - Rastislav Hromádka
- Surgeon, FN Motol Teaching Hospital, Department of Orthopaedic Surgery, 1st Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic; Assisting Professor, Institute of Anatomy, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Restuccia G, Cosseddu F, Del Chiaro A, Ceccoli M, Lippi A, Shytaj S. First metatarsophalangeal fusion with dorsal plate: clinical outcomes. J Orthop Surg Res 2021; 16:361. [PMID: 34092260 PMCID: PMC8183079 DOI: 10.1186/s13018-021-02453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND First metatarsophalangeal joint (MTPJ) fusion is the most effective technique for the treatment of MTPJ primary arthritis, severe hallux valgus and failure of primary corrective surgery of these conditions. It can be achieved through different techniques. We evaluated the outcomes in a cohort of patients treated with dorsal plate arthrodesis. MATERIALS AND METHODS We treated 30 feet for 28 patients; the mean follow-up was 35 months. For each foot, we collected radiological and clinical assessment, with the visual analogue scale (VAS) for pain and the Manchester and Oxford Foot questionnaire (MOFQ). The technique consisted in a cup and cone arthrodesis with the application of a low profile dorsal plate. Patients were allowed for immediate weight bearing. RESULTS Consolidation was achieved in all cases; in 29 cases, radiographic union was recorded within 6 months from surgery, in one case after 9 months. Comparison between the preoperative and postoperative of VAS and MOXFQ values showed a statistically significant difference (p < 0.05). Only one case developed wound dehiscence as complication. CONCLUSIONS Even if there is still a debate regarding the best system for MTPJ fusion, we believe cup and cone fusion with dorsal plating is an effective method. Moreover, the stability of the osteosynthesis obtained allows for immediate post-operative weight bearing, making patients able to return soon to their normal life. TRIAL REGISTRATION We present a retrospective study; all patients enrolled were retrospectively registered.
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Affiliation(s)
- Giuseppe Restuccia
- Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, 56123, Pisa, Italy
| | - Fabio Cosseddu
- Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, 56123, Pisa, Italy
| | - Andrea Del Chiaro
- Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, 56123, Pisa, Italy
| | - Matteo Ceccoli
- Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, 56123, Pisa, Italy
| | - Alessandro Lippi
- Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, 56123, Pisa, Italy
| | - Sheila Shytaj
- Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, 56123, Pisa, Italy.
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Kunovsky R, Kocis J, Navrat T, Vosynek P, Pink T, Joukal M, Cizmar I. Lapidus arthrodesis in combination with arthrodesis of the first metatarsophalangeal joint-biomechanical cadaver study comparing two methods of fixation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:334-342. [PMID: 33976433 DOI: 10.5507/bp.2021.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
AIMS To assess the results of a biomechanical test of cadaveric specimens, comparing 2 methods of fixation of modified Lapidus arthrodesis in combination with arthrodesis of the first metatarsophalangeal joint. METHODS A total of 12 cadaveric specimens were used in the test. Arthrodesis of the first MTP joint was in all patients fixed with a Variable Angle LCP 1st MTP Fusion Plate 2.4/2.7. Two methods of fixation of the Lapidus arthrodesis were compared, i.e. fixation with two screws in the PS (plate-screw) version versus fixation with X-Locking Plate 2.4/2.7 in the PP (plate-plate) version. Measurements were obtained with the use of a testing machine ZWICK Z 020-TND with an optical device Mercury RT for measuring deformities. Each specimen was subjected to 3 loading options, a. displacement 5 mm, the support is placed under the proximal phalanx, b. displacement 5 mm, the support is placed under the first metatarsal head and c. load to failure, the support is placed under the first metatarsal head. RESULTS In all specimens the PS construct showed a statistically considerably higher stiffness than the PP construct. In all specimens treated with the PP construct the load to failure was lower than in the PS construct. For loading mode a., at a significance level of 0.05 (P<0.05), the P-value was 0.036, for mode b. the P-value was 0.007 and for loading mode c. the P-value was 0.006. In addition, age-related decrease in stiffness of the specimen was proved at a significance level of 5% (P=0.004). CONCLUSION In all the three loading modes, the PS (plate-screw) construct showed a statistically higher stiffness than the PP (plate-plate) construct.
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Affiliation(s)
- Radek Kunovsky
- Department of Clinical Orthopedics, Trauma Hospital, Brno, Czech Republic
| | - Jan Kocis
- Department of Trauma Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Navrat
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, Technical University, Brno, Czech Republic
| | - Petr Vosynek
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, Technical University, Brno, Czech Republic
| | - Tomas Pink
- Department of Clinical Orthopedics, Trauma Hospital, Brno, Czech Republic.,Department of Trauma Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marek Joukal
- Institute of Anatomy, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Igor Cizmar
- Educational Center for Practical Anatomy, Brno, Czech Republic
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LaCoste KL, Andrews NA, Ray J, Harrelson WM, Shah A. First Metatarsophalangeal Joint Arthrodesis: A Narrative Review of Fixation Constructs and Their Evolution. Cureus 2021; 13:e14458. [PMID: 33996318 PMCID: PMC8117946 DOI: 10.7759/cureus.14458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
First metatarsophalangeal (MTP) joint arthrodesis is a surgical procedure in which the first metatarsal head is fused to the proximal phalanx of the great toe in order to permanently stiffen the first MTP joint. It was originally proposed as a treatment for severe cases of hallux valgus deformity, but the procedure's indications and utilization have expanded since its initial development. Despite a wide variety of indications, first MTP arthrodesis has been shown to have reliable, satisfactory outcomes. As a result, the development of a wide array of surgical approaches, joint preparation techniques, and fixation devices used in the procedure has occurred. In this narrative review, we highlight the evolution of fixation constructs used in first MTP arthrodesis in order to provide a frame of reference for the various types of fixation constructs available.
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Affiliation(s)
- Ketrick L LaCoste
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Nicholas A Andrews
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Jessyca Ray
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Whitt M Harrelson
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Ashish Shah
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
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Garcia-Ortiz MT, Talavera-Gosalbez JJ, Moril-Peñalver L, Fernandez-Ruiz MD, Alonso-Montero C, Lizaur-Utrilla A. First Metatarsophalangeal Arthrodesis After Failed Distal Chevron Osteotomy for Hallux Valgus. Foot Ankle Int 2021; 42:425-430. [PMID: 33143483 DOI: 10.1177/1071100720968831] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare the clinical outcomes after first metatarsophalangeal (MTP) joint arthrodesis for hallux rigidus between patients who underwent primary arthrodesis and those who had had a prior surgery for hallux valgus. METHODS Our design was a retrospective cohort study comparing 29 patients who underwent primary arthrodesis (primary group) and 34 patients with hallux rigidus after hallux valgus surgery (secondary group). The clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score and a visual analog scale (VAS) for pain. Radiological evaluation was also performed. Overall, the mean postoperative follow-up was 3.4 (range, 2-5) years. RESULTS At final follow-up, AOFAS and VAS pain scores significantly improved in both groups (P = .001). However, the mean AOFAS (P = .001) and VAS pain (P = .008) scores were significantly better in the primary group than in the secondary group. Radiologically, there were no significant differences between the groups in any angle after arthrodesis. Revision surgeries were not required in the primary group. In the secondary group, there was 1 revision due to deep infection, and 3 other patients required dorsal plate removal. Excluding plate removal, the Kaplan-Meier survival at 3 years was not significantly different between groups (P = .775). CONCLUSION Although arthrodesis of the first MTP joint was an effective procedure for hallux rigidus, the clinical outcomes in patients who had prior hallux valgus surgery were worse than those for patients who underwent primary surgery for hallux rigidus. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
| | | | - Lorena Moril-Peñalver
- Department of Orthopaedic Surgery, Elche University Hospital, Elche, Alicante, Spain
| | | | - Carolina Alonso-Montero
- Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain
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Migliorini F, Eschweiler J, Tingart M, Maffulli N. Revision surgeries for failed hallux valgus correction: A systematic review. Surgeon 2021; 19:e497-e506. [PMID: 33423923 DOI: 10.1016/j.surge.2020.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/13/2020] [Accepted: 11/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Failure of hallux valgus (HV) correction is not uncommon, and its management can be challenging. The available literature is not exhaustive. Therefore, we conducted a systematic review to investigate the current evidence on the role of revision surgery for failed HV correction, including clinical presentation, indications, surgical strategies and outcomes. MATERIAL AND METHODS The present systematic review was performed according to the PRISMA guidelines. Pubmed, EMBASE, Google Scholar and Scopus online databases were accessed in November 2020. All the clinical studies on revision for failed HV correction were analysed, and only studies reporting quantitative data under the outcomes of interest were considered for inclusion. RESULTS Data from 20 studies (586 procedures) were retrieved. The HV angle, the intermetatarsal angle and the distal metatarsal articular angle were reduced of 17.8° (P < 0.001), 3.3° (P = 0.05) and 7.3° (P < 0.001) respectively. The American Orthopaedic Foot & Ankle Society score improved of 24.7% (P < 0.001). The visual analogue scale improved by 40.8% (P < 0.001). Dorsiflexion and plantar flexion of the first metatarso-phalangeal joint remained similar to their preoperative values (P = 0.2 and P = 0.4, respectively). After revision surgery the following complications were further detected: recurrences 5.1% (30 of 586 patients), non-unions 4.1% (24/586), additional surgical procedures 8.7% (51 of 586 patients). CONCLUSION Revision surgery for failed primary HV correction can yield satisfying results. Accurate preoperative planning is necessary to try and identify the causes of failure, and address them appropriately.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK.
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Carlucci S, Parise AC, Santini-Araujo MG, Conti LA, Villena DS, Dozo CM, Carrasco NM, Sotelano P. Minimally-invasive hallux arthrodesis with endomedullary and a crossed screw fixation. Foot Ankle Surg 2020; 26:744-749. [PMID: 31601463 DOI: 10.1016/j.fas.2019.09.005] [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: 06/11/2019] [Revised: 08/24/2019] [Accepted: 09/19/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Minimally invasive surgery has several advantages: minor pain, smaller incisions and less tissue damage than traditional open surgery. Hallux arthrodesis with an endomedullary screw fixation provides compression and axial stability. The aim of this study was to describe the procedure and evaluate our first results of the minimally invasive first metatarsophalangeal arthrodesis with an endomedullary screw combined with a crossed screw fixation. METHODS We retrospectively studied 15feet, with a minimum 1year follow-up. Patients were evaluated with full-load radiographs and AOFAS score preoperatively and at last follow-up. RESULTS Consolidation rate was 93.3%, radiological consolidation time was 18 weeks (14-60). Radiographic alignment was achieved with satisfactory results. The preoperative AOFAS score improved from a mean 49 to 90 (p=0.001). There was one postoperative superficial site infection, which healed and a patient developed a pseudarthrosis but it was asymptomatic. CONCLUSIONS The minimally invasive metatarsophalangeal arthrodesis with an intramedullary screw is a secure procedure with comparable results to open techniques. LEVEL OF CLINICAL EVIDENCE 4.
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Affiliation(s)
- Sofia Carlucci
- Hospital Italiano de Buenos Aires, Potosi 4247, C1199ABB, Buenos Aires, Argentina.
| | - Ana C Parise
- Hospital Italiano de Buenos Aires, Potosi 4247, C1199ABB, Buenos Aires, Argentina.
| | | | - Leonardo A Conti
- Hospital Italiano de Buenos Aires, Potosi 4247, C1199ABB, Buenos Aires, Argentina.
| | - Daniel S Villena
- Hospital Italiano de Buenos Aires, Potosi 4247, C1199ABB, Buenos Aires, Argentina.
| | - Carlos M Dozo
- Hospital Italiano de Buenos Aires, Potosi 4247, C1199ABB, Buenos Aires, Argentina.
| | - Nelly M Carrasco
- Hospital Italiano de Buenos Aires, Potosi 4247, C1199ABB, Buenos Aires, Argentina.
| | - Pablo Sotelano
- Hospital Italiano de Buenos Aires, Potosi 4247, C1199ABB, Buenos Aires, Argentina.
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Hodel S, Viehöfer A, Wirth S. Minimally invasive arthrodesis of the first metatarsophalangeal joint: A systematic literature review. Foot Ankle Surg 2020; 26:601-606. [PMID: 31582288 DOI: 10.1016/j.fas.2019.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 09/02/2019] [Accepted: 09/05/2019] [Indexed: 02/04/2023]
Abstract
AIM Currently, cohort studies reported the use of minimally invasive arthrodesis of the first metatarsophalangeal joint (MTP I). The aim of this systematic literature review was to analyse clinical, radiological outcome and complications with this technique. METHODS A systemic literature search of the databases Google Scholar, PubMed, Scopus, EMBASE and Cochrane to identify studies reporting on clinical, radiological outcome or complications of minimally invasive MTP I arthrodesis was conducted. RESULTS A total of 6 studies (1 Level V, 5 Level IV) reporting on 109 minimally invasive MTP arthrodesis in 105 patients were included. Validated scores were reported in 103 cases. Clinical outcome improved in 57 cases from a mean of 36.9 to 82.6 points American Orthopedic Foot and Ankle Score (AOFAS) and in 46 cases from 38.7 to 18.4 points Manchester Oxford Foot Questionnaire (MOXFQ). Radiological fusion rate was 87% (n = 94 out of 109) achieved after 6-12 weeks. Overall complication rate was 11.9% (13 cases) leading to revision surgeries in 5.5% (6 cases). Most common complications Most common complications were symptomatic non-union (n = 6, 5.5%), asymptomatic non-union (n = 2, 1.8%) and subsequent interphalangeal joint arthritis (n = 2, 1.8%). CONCLUSION Minimally invasive MTP I arthrodesis is a promising technique with comparable clinical, radiological outcome and complication rates to open surgery in hallux rigidus and rigido-valgus. Future studies are needed providing higher level of evidence to prove the potential benefit of minimally invasive compared to open MTP I arthrodesis.
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Affiliation(s)
- Sandro Hodel
- Universitätsklinik Balgrist, CH-8008, Zürich, Switzerland.
| | - Arnd Viehöfer
- Universitätsklinik Balgrist, CH-8008, Zürich, Switzerland.
| | - Stephan Wirth
- Universitätsklinik Balgrist, CH-8008, Zürich, Switzerland.
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Dureja K, Bhardwaj SH. The Functional Outcome of Hallux Metatarsophalangeal Joint Arthrodesis Using Hallux Intramedullary Fusion Device. Indian J Orthop 2020; 55:103-109. [PMID: 34122762 PMCID: PMC8149532 DOI: 10.1007/s43465-020-00194-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/04/2020] [Indexed: 02/04/2023]
Abstract
Functional outcome of first metatarsophalangeal joint (MTPJ) arthrodesis using intramedullary implant was reviewed in retrospective series of 12 patients who had MTPJ arthritis. The outcome measures were improvements seen in VAS for pain and AOFAS scores recorded pre-operatively and post-operatively at the time of achieving complete union. VAS for pain improved from mean of 7.5 pre-operative to 1.8 post-operative (p < 0.001). AOFAS Score improved from mean of 35.58 pre-operative to 80.91 post-operative (p < 0.001). The fusion rate was 100 percent and mean time needed for fusion was 9.6 weeks. Only one patient had malunion which was acceptable to patient and was not revised. The fusion using intramedullary intra-osseous Hallux Fusion implant is a promising technique with good functional outcome and low complications.
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Affiliation(s)
- Kamal Dureja
- Foot and Ankle Unit, Max Smart Super-Specialty Hospital, Saket, New Delhi, 110017 India
| | - Shantanu H. Bhardwaj
- Foot and Ankle Surgery, Max Smart Super-Specialty Hospital, Saket, Delhi, 110017 India ,Maharashtra Jalgaon, India
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Tan CY, Bin Mohd Fadil MF. Biomechanical consequences of first metatarsaophalangeal joint arthrodesis on flexor digitorum longus function: A cadaveric study. J Orthop Surg (Hong Kong) 2020; 27:2309499019826325. [PMID: 30798770 DOI: 10.1177/2309499019826325] [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: 11/16/2022] Open
Abstract
BACKGROUND First metatarsophalangeal joint (MTPJ) arthrodesis is a common treatment modality for hallux rigidus with successful outcomes. However, the effect of arthrodesis on flexor digitorum longus (FDL) is poorly understood. The purpose of this study was to investigate this effect in a biomechanical model. METHODS Ten cadaveric trans-knee amputated specimens were studied. Lesser toe range of motion (ROM) and FDL excursion on simulated FDL contraction were measured in the following three scenarios: (1) before 1st MTPJ arthrodesis, (2) after 1st MTPJ arthrodesis, and (3) after the knot of Henry release. RESULTS 1st MTPJ arthrodesis reduced both mean lesser toe ROM and FDL excursion. However, there was improvement in these parameters after the knot of Henry release. CONCLUSIONS FDL function was reduced following 1st MTPJ arthrodesis. This effect was contributed by soft tissue connections at the knot of Henry, where FDL crosses flexor hallucis longus (FHL). Therefore, with restriction of FHL movement after 1st MTPJ arthrodesis, FDL movement was also restricted. CLINICAL RELEVANCE This result improved our understanding of 1st MTPJ arthrodesis biomechanics and suggested potential benefits of the knot of Henry release in 1st MTPJ arthrodesis to improve FDL function, thereby decreasing the rate of metatarsalgia and other associated problems.
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Bernasconi A, Cailliez J, de Cesar Netto C, Wargny M, Mehdi N, Colombier JA, Lintz F. Is adjunction of advanced platelet-rich fibrin (A-PRF) useful in first metatarsophalangeal joint arthrodesis? A retrospective cohort study. Foot (Edinb) 2020; 42:101648. [PMID: 32035404 DOI: 10.1016/j.foot.2019.10.003] [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: 08/15/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE First metatarsophalangeal (MTPJ1) fusion represents the gold standard treatment for end-stage hallux rigidus (HR). The aim of this study was to assess efficacy and safety of A-PRF in promoting union after MTPJ1 arthrodesis. Our hypothesis was that the use of A-PRF may reduce the non-union rate and the time to fusion in the treatment of HR. METHODS 14 patients that had undergone MTPJ1 arthrodesis with A-PRF adjunction with 21 standard MTPJ1 fusions were retrospectively reviewed. The fusion rate and time to fusion (clinically and radiographically) were assessed at 6, 12 weeks and at the longest follow-up; the clinical status at final follow-up through forefoot AOFAS, EQ5d, SEFAS and VAS-pain scores; the complication rate. RESULTS At 6-weeks, bony union was achieved in 100% of patients in the A-PRF group compared to 70% in the control group, but this difference was not statistically significant (p=0.22). At final follow-up (41 months), union rate in the control group reached 92% (one non-union). AOFAS, VAS and EQ-5d scores showed similar results for the two groups (p=0.86, p=0.12 and p=0.61, respectively); only SEFAS score revealed a difference favoring the A-PRF group (p=0.04). No revision surgery or complication was recorded in any group. CONCLUSIONS A tendency for increased union rate was mainly found at 6 weeks in patients treated with MTPJ1 fusion associated to A-PRF compared to isolated fusion. The use of A-PRF was not associated with an increased complication rate at final follow-up. LEVEL OF EVIDENCE Level 3, therapeutic study, retrospective comparative study.
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Affiliation(s)
- Alessio Bernasconi
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, London, United Kingdom; Orthopaedic and Traumatology Unit, Department of Public Health, "Federico II" Naples University, Napoli, Italy.
| | | | - Cesar de Cesar Netto
- University of Iowa school of Medicine, Department of Orthopedic Foot and Ankle Surgery, Iowa City, IA, USA.
| | | | - Nazim Mehdi
- Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Saint-Jean, France.
| | - Jean Alain Colombier
- Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Saint-Jean, France.
| | - François Lintz
- Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Saint-Jean, France.
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Patel S, Garg P, Fazal MA, Ray PS. First Metatarsophalangeal Joint Arthrodesis Using an Intraosseous Post and Lag Screw With Immediate Bearing of Weight. J Foot Ankle Surg 2019; 58:1091-1094. [PMID: 31679663 DOI: 10.1053/j.jfas.2019.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Indexed: 02/03/2023]
Abstract
Arthrodesis is the gold standard procedure for advanced arthrosis of the first metatarsophalangeal joint. Having a strong construct is preferable for allowing immediate bearing of weight, which facilitates patient rehabilitation. Plate and screw fixation is currently in favor but can lead to prominent metalware necessitating removal. The aim of this study is to report the results of a series of 54 first metatarsophalangeal joint arthrodeses performed in 52 patients treated with an implant composed of an intraosseous post and lag screw. All of the patients had a minimum follow-up of 1 year, and the indication for the surgery was end-stage hallux rigidus in 44 (81.5%) feet, severe hallux valgus in 8 (14.8%) feet, and rheumatoid arthritis in 2 (3.7%) feet. Arthrodesis was achieved in 52 (96.3%) feet at a mean of 61 ± 16 (range 39 to 201) days with nonunion observed in 2 (3.7%) feet; neither of the 2 patients had known risk factors. Metalware impinging on soft tissues necessitating removal was observed in 3 (5.6%) feet, and there were no cases of loss of position or implant breakage. The mean Manchester-Oxford Foot Questionnaire score improved from 46.4 ± 13.3 to 18.4 ± 9.4 (p < .001) at latest follow-up. In conclusion, our results suggest the intraosseous post and lag screw device was safe and effective, and it can be considered an alternative method of stabilizing the first metatarsophalangeal joint when undertaking arthrodesis surgery.
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Affiliation(s)
- Shelain Patel
- Consultant Orthopaedic Surgeon, Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
| | - Parag Garg
- Clinical Fellow, Barnet General Hospital, Barnet, United Kingdom
| | - M Ali Fazal
- Consultant Orthopaedic Surgeon, Barnet General Hospital, Barnet, United Kingdom
| | - Pinak S Ray
- Consultant Orthopaedic Surgeon, Barnet General Hospital, Barnet, United Kingdom
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Surgical options for hallux rigidus: state of the art and review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:57-65. [DOI: 10.1007/s00590-019-02528-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 12/14/2022]
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Fuld RS, Kumparatana P, Kelley J, Anderson N, Baldini T, Younger ASE, Hunt KJ. Biomechanical Comparison of Low-Profile Contoured Locking Plate With Single Compression Screw to Fully Threaded Compression Screws for First MTP Fusion. Foot Ankle Int 2019; 40:836-844. [PMID: 30880450 DOI: 10.1177/1071100719837524] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Open metatarsophalangeal (MTP) arthrodesis using locked plates produces good clinical outcomes. However, arthroscopic fusion with new-generation fully threaded compression screws is emerging as an alternative. The purpose of this study was to compare low-profile contoured locked plates with fully threaded compression screws for first MTP fusion, in a biomechanical cadaveric model. METHODS The first rays of 8 matched pairs of fresh frozen cadaveric feet underwent dissection and dual-energy x-ray absorptiometry (DEXA) scanning to measure bone mineral density (BMD). The "plate" group was prepared with cup-and-cone reamers, and fixation of the MTP joint with 1 compression screw and low-profile dorsal locked plate. The matched-pair "screws" group was prepared through a simulated arthroscopic technique, achieving fixation with 2 new-generation fully threaded compression screws. The plantar MTP gap was recorded with an extensometer during 250 000 90-N cyclic loads followed by a single load to failure. RESULTS The screw group demonstrated significantly greater stiffness, 31.6 N/mm (plates) and 51.7 N/mm (screws) (P = .0045). There was no significant difference in plantar gapping or load to failure, 198.6 N (plates) and 290.1 N (screws) (P = .2226). Stiffness and load to failure were highly correlated to BMD for the screw group, r =0.79 and r = 0.94, respectively, but less so for the plate group, r = 0.36 and r = 0.62, respectively. The maximum metatarsal head height measured on the lateral view was strongly correlated with load to failure for both the plate- and screw-only groups (r > 0.9). CONCLUSION These data demonstrate that hallux MTP arthrodesis utilizing fully threaded compression screws had similar plantar gapping and load to failure when compared with the low-profile locking plate, but with significantly more stiffness. These results support an increased role of fully threaded screws for MTP arthrodesis using either the arthroscopic or open technique. However, with decreased BMD plate fixation may remain the better fixation choice. CLINICAL RELEVANCE Our data suggest that with regard to construct stability, fully threaded headless compression screws may be just as effective as low-profile locking plates, but BMD and MTP joint fluoroscopic measurements should be considered in the decision-making process for fixation.
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Affiliation(s)
- Richard S Fuld
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Pam Kumparatana
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Judas Kelley
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Nicholas Anderson
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Todd Baldini
- 2 Orthopedics Biomechanics Laboratory, University of Colorado, Aurora, CO, USA
| | - Alastair S E Younger
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, BC, USA
| | - Kenneth J Hunt
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
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Latif A, Dhinsa BS, Lau B, Abbasian A. First metatarsophalangeal fusion using joint specific dorsal plate with interfragmentary screw augmentation: Clinical and radiological outcomes. Foot Ankle Surg 2019; 25:132-136. [PMID: 29409296 DOI: 10.1016/j.fas.2017.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/18/2017] [Accepted: 09/24/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study reports the outcome of a plating system for arthrodesis of the first metatarsophalangeal joint (1st MTPJ) that incorporates a lag compression screw within a low profile titanium plate with a predetermined contour. This is the first report of the outcomes of this implant from a non-affiliated centre. PATIENT AND METHODS This is a prospective cohort study of 40 consecutive primary 1st MTPJ arthrodesis procedures. The mean age of the cohort was 56 years (range, 20-74 years). The diagnosis was hallux rigidus in 31 patients and inflammatory arthropathy in 7 patients. RESULTS All patients achieved clinical union at 6 weeks and radiological union was confirmed on plain radiographs between 6-16 weeks. One case of hardware removal was reported. CONCLUSION The cohort achieved consistently satisfactory results with a reliable and reproducible MTPJ position and a 100% union rate. There was a low rate of hardware removal. LEVEL OF EVIDENCE Level IV evidence. Prospective cohort study.
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Affiliation(s)
- Ahmed Latif
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Baljinder S Dhinsa
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom.
| | - Benjamin Lau
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Ali Abbasian
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
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Maleki F, Ramesh A, Cassar-Gheiti AJ, Fox C, Kelly P, Stephens MM, McKenna JV. Comparison of 4 different techniques in first metatarsophalangeal joint arthrodesis. Ir J Med Sci 2019; 188:885-891. [PMID: 30617457 DOI: 10.1007/s11845-018-01961-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/29/2018] [Indexed: 12/11/2022]
Abstract
AIMS The aim of this study was to evaluate outcomes and fusion rates of 4 different methods of first metatarsophalangeal joint (MTPJ) arthrodesis. METHODS We performed a retrospective analysis of first MTPJ fusion using Bold® and Acutrak® compression screws, universal 1/3 tubular plate and Hallu®-S non-locking plate in 6 hospitals in Dublin over 4 years. A cohort of 300 patients (351 feet) was operated on by 3 feet and ankle fellowship trained orthopaedic surgeons (PK, MMS, JVMcK) over 4 years. Mean age was 62.4 years. There were 261 females and 39 males. One hundred three patients had a fusion of first MTPJ using two Acutrak® screws and 90 with two Bold® screws. Sixty-five were fused with the Hallu-S® plate and 42 with the universal 1/3 tubular plate. Patients were evaluated clinically and radiographically at 6 weeks, 3 months and 12 months. RESULTS Functional outcome scores performed using Manchester-Oxford Foot Questionnaire (MOXFQ). Failure rate in those fused with the Hallu®-S plate was 0%, Acutrak® screws 2.4%, Bold® screws 9.5% and universal 1/3 tubular plate 12.5% (p > 0.12). All treatment groups demonstrated significantly reduced MOXFQ scores (p value < 0.05). CONCLUSION In this retrospective study for first MTPJ fusion, a low profile, pre-contoured plate in combination with a screw mode had the best results with no failure rates and improved MOXFQ scores. LEVEL OF CLINICAL EVIDENCE IV, retrospective study.
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Affiliation(s)
- Farshid Maleki
- Orthopaedic Department, St. James's Hospital, James's Street, Dublin, D08 NHY1, Ireland
| | - Ashwanth Ramesh
- Orthopaedic Department, St. James's Hospital, James's Street, Dublin, D08 NHY1, Ireland
| | - Adrian J Cassar-Gheiti
- Orthopaedic Department, St. James's Hospital, James's Street, Dublin, D08 NHY1, Ireland.
| | - Ciara Fox
- Orthopaedic Department, St. James's Hospital, James's Street, Dublin, D08 NHY1, Ireland
| | - Paula Kelly
- Orthopaedic Department, Tallaght University Hospital, Tallaght, Dublin, D24 NR0A, Ireland
| | - Michael M Stephens
- Orthopaedic Department, Cappagh National Orthopaedic Hospital, Finglas, Dublin, D11 EV29, Ireland
| | - Johnny V McKenna
- Orthopaedic Department, St. James's Hospital, James's Street, Dublin, D08 NHY1, Ireland
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