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Arceri A, Di Paola G, Mazzotti A, Zielli SO, Artioli E, Langone L, Sgubbi F, Faldini C. Reviewing Evidence and Patient Outcomes of Cheilectomy for Hallux Rigidus: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:7299. [PMID: 39685757 DOI: 10.3390/jcm13237299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 11/22/2024] [Accepted: 11/28/2024] [Indexed: 12/18/2024] Open
Abstract
Background: Cheilectomy is a joint-sparing surgery for the treatment of moderate stages of Hallux Rigidus (HR). The purpose of this systematic review was to assess the clinical outcomes, range of motion (ROM), complications, and revision rates associated with cheilectomy. Methods: A literature search of the PubMed, Scopus, and Cochrane databases was performed. PRISMA guidelines were used. Risk of bias was assessed through the Newcastle-Ottawa Scale. Meta-analysis of the clinical outcomes scores was performed. Results: The initial search identified 317 articles, with 16 included. Cheilectomy improved ROM by 51.15% (41.23° to 62.32°), with greater gains in traditional (67.72%) vs. minimally invasive (48.74%) techniques. VAS decreased by 72.61%, more in traditional (79.35%) than minimally invasive (64.97%). AOFAS improved by 33.99%, from 61.83 to 82.85. Complications occurred in 11% (11.68% traditional, 9.73% minimally invasive), with residual pain (7.46%) more common in traditional and nerve injury (3.78%) in minimally invasive procedures. Revision rates were 7.4% overall (6.1% traditional, 8.8% minimally invasive). Conclusions: This procedure showed satisfactory results regardless of whether the traditional or minimally invasive technique is used. Current evidence does not allow for a definitive indication, but careful patient selection is advisable, particularly for mild to moderate cases.
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Affiliation(s)
- Alberto Arceri
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
| | - Gianmarco Di Paola
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Antonio Mazzotti
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
| | - Simone Ottavio Zielli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Elena Artioli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Laura Langone
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Sgubbi
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
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Roukis TS, Piraino JA, Hollawell S, Kuruvilla B, Kuruvilla B, McMillen R, Zimmerman M, Hentges MJ, West T. ACFAS Clinical Consensus Statements: Hallux Rigidus. J Foot Ankle Surg 2024; 63:624-630. [PMID: 39094959 DOI: 10.1053/j.jfas.2024.07.006] [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: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 08/04/2024]
Abstract
The following are clinical consensus statements (CCS) on the topic of hallux rigidus sponsored by the American College of Foot and Ankle Surgeons. A core panel synthesized the data and divided the topic in to twelve sections, each section contained a variable number of consensus statements, based upon complexity. Overall there were 24 consensus statements synthesized for this subject matter. The 24 statements were provided to the expert panel with all available evidence to come to a consensus utilizing all available evidence.
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Affiliation(s)
- Thomas S Roukis
- Clinical Professor, University of Florida College of Medicine-Jacksonville, Department of Orthopaedic Surgery & Rehabilitation, Division of Foot & Ankle Surgery, Jacksonville, FL
| | - Jason A Piraino
- Associate Professor Chief of Foot and Ankle Surgery, Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
| | | | | | | | - Ryan McMillen
- Faculty, Division of Foot and Ankle Surgery, Jefferson Hospital, Allegheny Health Network, Pittsburgh, PA
| | | | - Matthew J Hentges
- Attending Faculty of Residency, Training Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburg, PA
| | - Tenaya West
- Palo Alto Medical Foundation Mountain View, Department of Podiatry and Orthopedics, Fremont, CA
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Budde K, Claassen L, Plaass C, Stukenborg-Colsman C, Daniilidis K, Yao D. Synthetic cartilage implant vs. first metatarsophalangeal arthrodesis for the treatment of hallux rigidus. Arch Orthop Trauma Surg 2024; 144:4343-4354. [PMID: 39287788 PMCID: PMC11564238 DOI: 10.1007/s00402-024-05534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 09/01/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND This study evaluated the outcome of the Cartiva synthetic cartilage implant (SCI) in the treatment of hallux rigidus. METHODS In the present retrospective matched case-control study, we compared 18 patients with Cartiva SCI (mean follow-up: 17.7 months) to 18 patients with metatarsophalangeal joint arthrodesis (mean follow-up: 20 months) using multiple function measures, along with four specified visual analog subscales for pain. Pre- and postoperative radiographs were compared, and radiographic abnormalities were documented. RESULTS We observed no significant differences in function measures between groups. While both groups experienced significant pain reduction, the arthrodesis group reported significantly lower exertion pain than the Cartiva SCI group (p = 0.004). Radiographic abnormalities, including implant site enlargement (6/18, 33.3%), erosive changes of the metatarsal bone (11/18, 61.1%) or articular surfaces (10/18, 55.6%), and bright sclerotic margins (12/18, 66.7%), occurred in the Cartiva SCI group. CONCLUSION The present study showed good functional results and a high satisfaction rate after MTP joint arthrodesis, which is considered the gold standard surgical treatment for higher grade hallux rigidus. While the Cartiva SCI group did not show significant differences from the arthrodesis in most aspects of function and clinical scores, the arthrodesis group tended to have better results in terms of satisfaction, residual pain, and revision rate. Even after the short follow-up period, there were some remarkable radiographic findings in the Cartiva SCI group, the long-term effects of which are not yet evident, but which may lead to implant loss. Cartiva SCI has advantages for patients who prioritize postoperative mobility, but the potential risks should be considered in the patient's informed consent. Therefore, the present study highlights the importance of MTP joint arthrodesis for the treatment of hallux rigidus. LEVEL OF EVIDENCE Level IV - Retrospective matched case-control study.
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Affiliation(s)
- Konrad Budde
- Orthopedic Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Leif Claassen
- Orthopedic Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Rueckenprofis Hannover, Luisenstraße 10-11, 30159, Hannover, Germany
| | - Christian Plaass
- Orthopedic Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | | | | | - Daiwei Yao
- Orthopedic Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Emma Klinik, Klinik für operative Medizin GmbH & Co. KG, Frankfurter Straße 51, 63500, Seligenstadt, Germany
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Chopra A, Fletcher AN, Madi NS, Parekh SG. Revision Surgery After Failed Index Synthetic Cartilage Implant Resurfacing for Hallux Rigidus: Single-Surgeon 5-Year Experience. Foot Ankle Spec 2024; 17:365-374. [PMID: 36727310 DOI: 10.1177/19386400221147773] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND While metatarsophalangeal joint (MTPJ) arthrodesis is regarded as the gold standard treatment option for end-stage hallux rigidus (HR), synthetic cartilage implant (SCI) resurfacing has gained popularity. This study aimed to identify the SCI resurfacing failure rate for a single surgeon, while also comparing clinical outcomes of patients who underwent SCI replacement or MTPJ arthrodesis after failed index SCI resurfacing. METHODS Health records were queried from 2016 to 2021 for patients with HR who were treated with SCI resurfacing by a single surgeon. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, and hallux valgus angles were compared. A subgroup analysis was performed on patients who underwent revision with SCI replacement or MTPJ arthrodesis. SCI replacement included the use of bone graft, bone putty, or a custom 3D printed baseplate to prevent implant subsidence. RESULTS A total of 219 SCI resurfacing procedures were performed by a single surgeon, including 23 revisions. When analyzing index procedures, an 8.2% revision rate was determined. The revision cohort (n = 23) consisted of 19 female patients and presented with a mean body mass index of 29.5 ± 5 kg/m2, mean age of 52.8 ± 11 years, mean follow-up duration of 22.3 (range, 3-54) months, and mean time to a revision surgery of 12.1 ± 12 (range, 1-50) months. Specifically, 12 procedures resulted in an SCI replacement, while 11 procedures resulted in arthrodesis. While all patients experienced significant improvement in their VAS pain scores (P < .001), the arthrodesis cohort experienced a greater improvement than the SCI revision cohort (P = .04). CONCLUSION When analyzing SCI revision procedures, MTPJ arthrodesis reduced pain more significantly than SCI replacement. LEVELS OF EVIDENCE Level IV: Retrospective case series.
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Affiliation(s)
- Aman Chopra
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Amanda N Fletcher
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Naji S Madi
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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Scheurer F, Zimmermann SM, Fischer P, Wirth SH, Beeler S, Viehöfer AF. Ten-Year Minimum Follow-up Study of First Metatarsophalangeal Joint Fusion in Young vs Old Patients. Foot Ankle Int 2024; 45:217-222. [PMID: 38158798 PMCID: PMC10960322 DOI: 10.1177/10711007231205567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Painful degenerative joint disease (DJD) of the first metatarsophalangeal joint (MTP I), or hallux rigidus, mainly occurs in later stages of life. For end-stage hallux rigidus, MTP I arthrodesis is considered the gold standard. As young and active patients are affected considerably less frequently, it currently remains unclear, whether they benefit to the same extent. We hypothesized that MTP I arthrodesis in younger patients would lead to an inferior outcome with decreased rates of overall with lower rates of patient postoperative pain and function compared to an older cohort. METHODS All patients aged <50 years who underwent MTP I arthrodesis at our institution between 1995 and 2012 were included in this study. This group was then matched and compared with a group of patients aged >60 years. Minimum follow-up was 10 years. Outcome measures were Tegner activity score (TAS), a "Virtual Tegner activity score" (VTAS), the visual analog scale (VAS), and the Foot Function index (FFI). RESULTS Sixty-one MTP I fusions (n = 28 young, n = 33 old) in 46 patients were included in our study at an average of 14 years after surgery. Younger patients experienced significantly more pain relief as reflected by changes in VAS and FFI Pain subscale scores. No difference in functional outcomes was found with change in the FFI function subscale or in the ability to have desired functional outcomes using the ratio of TAS to VTAS. Revision rate did not differ between the two groups apart from hardware removal, which was significantly more likely in the younger group. CONCLUSION In patients below the age of 50 years with end-stage DJD of the first metatarsal joint, MTP I arthrodesis not only yielded highly satisfactory postoperative results at least equal outcome compared to an older cohort of patients aged >60 years at an average 14 years' follow-up. Based on these findings, we consider first metatarsal joint fusion even for young patients is a valid option to treat end-stage hallux rigidus. LEVEL OF EVIDENCE Level III, a case-control study.
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Di Caprio F, Mosca M, Ceccarelli F, Caravelli S, Di Ponte M, Zaffagnini S, Ponziani L. Interposition Arthroplasty in the Treatment of End-Stage Hallux Rigidus: A Systematic Review. Foot Ankle Spec 2023; 16:547-557. [PMID: 34724832 DOI: 10.1177/19386400211053947] [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: 11/16/2022]
Abstract
PURPOSE Patients affected by moderate to severe hallux rigidus may opt for interposition arthroplasty to avoid the movement restrictions of arthrodesis and the complications related to prosthetic replacement. The propose of this article was to review the current literature about interposition arthroplasty to examine the overall outcomes and to evaluate the advantages and disadvantages of different types of technique, compared with more consolidated procedures. METHODS A literature PubMed search was performed. Studies reporting the results of interposition arthroplasty in moderate to severe hallux rigidus were included. The data were pooled and weighted for number of patients in every study. RESULTS The overall results for interposition arthroplasties are comparable to other alternatives for end-stage hallux rigidus, providing better plantar load distribution than arthrodesis and avoiding the drawbacks of prosthetic replacement. Among the various interposition arthroplasty techniques, the Modified Oblique Keller Capsular Interposition Arthroplasty technique preserves toe length and flexor hallucis brevis function, showing the highest satisfaction rate, with lowest metatarsalgia and revision rate. CONCLUSION Although long-term randomized controlled trials are lacking for interposition arthroplasty, it represents a valid alternative for the treatment of end-stage hallux rigidus also in the young active patient who wants to avoid a definitive intervention immediately. LEVEL OF EVIDENCE III (systematic review of level III-IV-V studies).
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Affiliation(s)
| | - Massimiliano Mosca
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | | | - Silvio Caravelli
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Marco Di Ponte
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Stefano Zaffagnini
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Lorenzo Ponziani
- Operating Unit of Orthopaedics and Traumatology, ISS, Cailungo, San Marino
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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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Prat D, Sourugeon Y, Haghverdian BA, Pridgen EM, Lee W, Wapner KL, Farber DC. "In Situ" Joint Preparation Technique for First Metatarsophalangeal Arthrodesis: A Retrospective Comparative Review of 388 Cases. J Foot Ankle Surg 2023; 62:855-861. [PMID: 37220866 DOI: 10.1053/j.jfas.2023.05.004] [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: 01/05/2023] [Revised: 04/08/2023] [Accepted: 05/13/2023] [Indexed: 05/25/2023]
Abstract
"Cup-shaped power reamers" and "flat cuts" (FC) are common joint preparation techniques in first metatarsophalangeal (MTP) joint arthrodesis. However, the third option of an "in situ" (IS) technique has rarely been studied. This study aims to compare the clinical, radiographic, and patient-reported outcomes (PROMs) of the IS technique for various MTP pathologies with other MTP joint preparation techniques. A single-center retrospective review was performed for patients who underwent primary MTP joint arthrodesis between 2015 and 2019. In total, 388 cases were included in the study. We found higher nonunion rates in the IS group (11.1% vs 4.6%, p = .016). However, the revision rates were similar between the groups (7.1% vs 6.5%, p = .809). Multivariate analysis revealed that diabetes mellitus was associated with significantly higher overall complication rates (p < .001). The FC technique was associated with transfer metatarsalgia (p = .015) and a more first ray shortening (p < .001). Visual analog scale, PROMIS-10 physical, and PROMIS-CAT physical scores significantly improved in IS and FC groups (p < .001, p = .002, p = .001, respectively). The improvement was comparable between the joint preparation techniques (p = .806). In conclusion, the IS joint preparation technique is simple and effective for first MTP joint arthrodesis. In our series, the IS technique had a higher radiographic nonunion rate that did not correlate with a higher revision rate, and otherwise similar complication profile to the FC technique while providing similar PROMs. The IS technique resulted in significantly less first ray shortening when compared to the FC technique.
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Affiliation(s)
- Dan Prat
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA; Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
| | - Yosef Sourugeon
- Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Eric M Pridgen
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Wonyong Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Keith L Wapner
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Daniel C Farber
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
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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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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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11
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Roth W, Hoch C, Gross CE, Scott DJ. First metatarsophalangeal arthrodesis outcomes for hallux rigidus versus hallux valgus. Foot Ankle Surg 2023; 29:50-55. [PMID: 36210270 DOI: 10.1016/j.fas.2022.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/04/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study compared radiographic and functional patient outcomes of 1st MTP arthrodesis between hallux rigidus (HR) and hallux valgus (HV) cohorts. METHODS A retrospective review was conducted at an academic medical center on patients who underwent 1st MTP arthrodesis during 2009-2021. In total, 136 patients (148 feet: HR=57, HV=47, combined=44) met the inclusion criteria of minimum three-month follow-up (mean=1.25 years, range=0.25-6.14 years). Data collection included patient-reported outcome measures (PROMs), radiographic markers, and complication and reoperation rates. RESULTS PROMs improved overall, with HV patients significantly improving the least. The HR group had a significantly smaller improvement in HV angle (HR=-3.6, HV=-17, Combined=-15 p < .001), intermetatarsal angle (H=-0.16, HV=-2.8, Combined=-2.6 p < .001), and 1st-5th metatarsal width (HR=-0.98, HV=-4.6, Combined=-4.6, p < .001). Complication and reoperation rates did not differ by group. CONCLUSION Outcomes of 1st MTP arthrodesis does not appear to differ between diagnostic indications of hallux rigidus, hallux valgus, or both. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
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Affiliation(s)
- Warren Roth
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA
| | - Caroline Hoch
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA
| | - Christopher E Gross
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA
| | - Daniel J Scott
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA.
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Stevens J, de Bot RTAL, Hermus JPS, Schotanus MGM, Meijer K, Witlox AM. Gait analysis of foot compensation in symptomatic Hallux Rigidus patients. Foot Ankle Surg 2022; 28:1272-1278. [PMID: 35717495 DOI: 10.1016/j.fas.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 03/31/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Compensatory motion of foot joints in hallux rigidus (HR) are not fully known. This study aimed to clarify the kinematic compensation within the foot and to detect whether this affects plantar pressure distribution. METHODS Gait characteristics were assessed in 16 patients (16 feet) with HR and compared with 15 healthy controls (30 feet) with three-dimensional gait analysis by using the multi-segment Oxford Foot Model, measuring spatio-temporal parameters, joint kinematics and plantar pressure. RESULTS HR subjects showed less hallux plantar flexion during midstance and less hallux dorsiflexion during push-off, while increased forefoot supination was detected during push-off. No significant differences in plantar pressure were detected. Step length was significantly smaller in HR subjects, while gait velocity was comparable between groups. CONCLUSIONS HR significantly affects sagittal hallux motion, and the forefoot compensates by an increased supination during push-off. Despite this kinematic compensatory mechanism, no significant differences in plantar loading were detected.
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Affiliation(s)
- Jasper Stevens
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Robin T A L de Bot
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Joris P S Hermus
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Martijn G M Schotanus
- Department of Orthopedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, Heerlen, the Netherlands; School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Adhiambo M Witlox
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands.
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13
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Kim JS, Amendola A, Barg A, Baumhauer J, Brodsky JW, Cushman DM, Gonzalez TA, Janisse D, Jurynec MJ, Lawrence Marsh J, Sofka CM, Clanton TO, Anderson DD. Summary Report of the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society's Symposium on Targets for Osteoarthritis Research: Part 2: Treatment Options. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221127013. [PMID: 36262470 PMCID: PMC9575443 DOI: 10.1177/24730114221127013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED This second of a 2-part series of articles recounts the key points presented in a collaborative symposium sponsored jointly by the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society with the intent to survey current treatment options for osteoarthritis (OA) of the foot and ankle. A meeting was held virtually on December 10, 2021. A group of experts were invited to present brief synopses of the current state of knowledge and research in this area. Topics were chosen by meeting organizers, who then identified and invited the expert speakers. Part 2 overviews the current treatment options, including orthotics, non-joint destructive procedures, as well as arthroscopies and arthroplasties in ankles and feet. Opportunities for future research are also discussed, such as developments in surgical options for ankle and the first metatarsophalangeal joint. The OA scientific community, including funding agencies, academia, industry, and regulatory agencies, must recognize the importance to patients of addressing the foot and ankle with improved basic, translational, and clinical research. LEVEL OF EVIDENCE Level V, review article/expert opinion.
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Affiliation(s)
- Jason S. Kim
- The Arthritis Foundation, Atlanta, GA,
USA,Jason S. Kim, PhD, The Arthritis
Foundation, 1355 Peachtree St NE, Suite 600, Atlanta, GA 30309, USA.
| | | | - Alexej Barg
- Department of Orthopaedics, University
of Utah, Salt Lake City, UT, USA
| | - Judith Baumhauer
- Department of Orthopaedic Surgery,
University of Rochester Medical Center, Rochester, NY, USA
| | | | - Daniel M. Cushman
- Division of Physical Medicine &
Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Tyler A. Gonzalez
- Department of Orthopaedic Surgery,
University of South Carolina, Lexington, SC, USA
| | | | - Michael J. Jurynec
- Department of Orthopaedics and Human
Genetics, University of Utah, Salt Lake City, UT, USA
| | - J. Lawrence Marsh
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | | | - Donald D. Anderson
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
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Metatarsophalangeal Joint Reconstruction Using Talar Osteochondral Allograft following a Failed Dorsal Cheilectomy. Case Rep Orthop 2022; 2022:6359108. [PMID: 36171795 PMCID: PMC9512608 DOI: 10.1155/2022/6359108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 08/18/2022] [Indexed: 12/03/2022] Open
Abstract
Dorsal cheilectomy is often used as a first-line surgical treatment for hallux rigidus; however, revision surgery is needed in nearly 9% of cases. One option for revision surgery is interpositional arthroplasty, which is designed to preserve joint motion and is favorable in young, active populations. This case discusses a young female patient with persistent, painful hallux rigidus and a large osteochondral defect despite prior dorsal cheilectomy. We performed an interpositional arthroplasty of the first metatarsophalangeal joint using an osteochondral allograft from the talus. At three-year follow-up, she had greatly improved function and was able to run without pain. To our knowledge, this is the first documented use of an osteochondral allograft from the talus in conjunction with metatarsophalangeal joint interpositional arthroplasty for treatment of hallux rigidus and a severe osteochondral defect. This technique introduces osseous subchondral scaffolding as well as mature hyaline cartilage into an osteochondral lesion, thereby reestablishing proper joint architecture and congruent articulation and ultimately improving range of motion and reducing pain. We present this technique as an experimental treatment option for restoring both the integrity and function of the metatarsophalangeal joint following trauma, osteochondritis dissecans, or prior operative failure in patients who wish to delay metatarsophalangeal joint fusion.
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15
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Retrospective Comparison of Two Different Fixation Methods for First Metatarsophalangeal Joint Arthrodesis. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1091385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background and Purpose: Arthrosis of the first MTP joint is a common condition. Among the available arthrodesis methods, plate/screw and screw methods are the current treatment methods of choice. In this study, we investigate whether there is a difference between these two methods.
Methods: Thirty-four toes of 32 patients with advanced arthrosis were included in the study. Eighteen toes were fixed with plates/screws and 16 with cross-screws. In the radiological evaluations, malunion and nonunion were examined. Clinical evaluation was made according to AOFAS-HMI scoring.
Results: The mean age of the patients was 57.74 years and the mean follow-up period was 22.21 months. There was no statistically significant difference in clinical scores or union times between the two groups. As complications, superficial skin problems developed in 2 (5.9%) cases, deep infection in 3 (8.8%) cases, and nonunion in 3 (8.8%) cases. There was no statistically significant difference between the two groups in this regard.
Conclusion: Plate/screw and cross-screw techniques give similar clinical and radiological results in cases of arthrodesis of the first MTP joint. The cross-screw technique, which can be performed more easily and has lower costs, should be the first choice.
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16
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Zanzinger C, Harrasser N, Gottschalk O, Dolp P, Hinterwimmer F, Hoerterer H, Walther M. One-year Follow-Up Results with Hydrogel Implant in Therapy of Hallux Rigidus: Case Series with 44 Patients. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:414-421. [PMID: 33647994 DOI: 10.1055/a-1365-9655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Cartiva implant (CI) is being increasingly used in the surgical therapy of hallux rigidus. Despite a growing number of studies, numerous questions regarding patient selection remain unanswered. PATIENTS AND METHODS As part of a retrospective case series with prospective follow-up (average follow-up period: 12 months), a total of 44 patients (male/female = 16/28; mean age at the time of surgery: 55.4 years) with 44 CI were analysed (VAS, EFAS-, AOFAS-score). Using a correlation analysis and a machine learning algorithm, risk factors for therapy failure were investigated. RESULTS The overall survival rate of the CI was 93% at 12 months. The VAS, EFAS and AOFAS scores showed a significant improvement in comparison to the preoperative condition. The mobility of the metatarsophalangeal joint showed no increase. Patients with a medium osteoarthritis grade and a medium level of clinical restraint showed the greatest improvement in relation to their preoperative condition. CONCLUSION The CI can be seen as an effective therapy for hallux rigidus. Nonetheless, realistic patient expectations must be communicated.
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Affiliation(s)
- Christoph Zanzinger
- Specialist Centre for Foot and Ankle Joint Surgery, Schön Clinic Munich-Harlaching, Munich, Germany
| | - Norbert Harrasser
- Orthopaedics, Clinics Rechts der Isar of the Technical University of Munich, Germany
| | - Oliver Gottschalk
- Specialist Centre for Foot and Ankle Joint Surgery, Schön Clinic Munich-Harlaching, Munich, Germany.,Department of Gerneral, Trauma and Reconstructive Surgery, LMU Munich, Germany
| | - Patrick Dolp
- Specialist Centre for Foot and Ankle Joint Surgery, Schön Clinic Munich-Harlaching, Munich, Germany
| | - Florian Hinterwimmer
- Orthopaedics, Clinics Rechts der Isar of the Technical University of Munich, Germany
| | - Hubert Hoerterer
- Specialist Centre for Foot and Ankle Joint Surgery, Schön Clinic Munich-Harlaching, Munich, Germany.,Department of Gerneral, Trauma and Reconstructive Surgery, LMU Munich, Germany
| | - Markus Walther
- Specialist Centre for Foot and Ankle Joint Surgery, Schön Clinic Munich-Harlaching, Munich, Germany
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17
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Hanslik-Schnabel B, Flöry D, Borchert GH, Schanda JE. Clinical and Radiologic Outcome of First Metatarsophalangeal Joint Arthrodesis Using a Human Allogeneic Cortical Bone Screw. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221112944. [PMID: 35924004 PMCID: PMC9340918 DOI: 10.1177/24730114221112944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Different fixation techniques are established for first metatarsophalangeal joint (MTPJ) arthrodesis, including compression screws, plates, Kirschner wires, metal- and bioabsorbable screws as well as staples. The purpose of this study was to investigate and present first clinical and radiologic results using a novel human, allogeneic cortical bone screw for arthrodesis of the first MTPJ. Methods: Arthrodesis of the first MTPJ was performed in 31 patients with hallux rigidus. Percentage union and time to union were the first outcomes; visual analog scale for pain, hallux valgus angle (HVA), intermetatarsal angle, and American Orthopaedic Foot & Ankle Society (AOFAS) hallux score were secondary outcomes. Results: Median time to union was 89 days, and union was observed in all patients. There were 4 complications (2 osteolysis margin, 1 cystic brightening, and 1 severe swelling at the first follow-up) all of that resolved at last follow-up. Pain significantly decreased from visual analog scale 8.0 to 0.2 points ( P < .0001). The HVA decreased from 30.4 to 10.2 degrees in the patient group with deformities. The total AOFAS score increased significantly from 48 to 87 ( P < .0001). Conclusion: Primary and revision arthrodesis of hallux rigidus with the human, allogeneic cortical bone screw reveals satisfying results similar to clinical and radiologic outcomes of other surgical techniques. Within 1 year, the human, allogeneic cortical bone screw is fully remodeled to host bone. Level of Evidence: Level IV, retrospective case series without control group.
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Affiliation(s)
- Beatrice Hanslik-Schnabel
- Sickness Welfare Institution for the Employees of the City of Vienna, Sanatorium Hera, Vienna, Austria
| | - Daniel Flöry
- Department for Radiology, Diakonissenhospital Linz, Linz, Austria
| | | | - Jakob E. Schanda
- AUVA Trauma Center Vienna-Meidling, Vienna, Austria
- Ludwig Boltzmann Institut for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
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18
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Balesar VV, Koster LA, Kaptein BL, Keizer SB. Five-Year Prospective Roentgen Stereophotogrammetric and Clinical Outcomes of the BioPro MTP-1 Hemiarthroplasty. Foot Ankle Int 2022; 43:637-645. [PMID: 34962173 DOI: 10.1177/10711007211061366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mixed results for functional outcomes and long-term fixation have been reported for first metatarsophalangeal arthroplasty. This prospective study was designed to evaluate the migration of the BioPro metatarsophalangeal-1 (MTP-1) joint hemiprosthesis with Roentgen stereophotogrammetric analysis (RSA). Migration patterns of the prosthesis, prosthesis-induced erosion of the metatarsal bone, and clinical outcomes were evaluated sequentially to 5 years postoperation (PO). METHODS Eleven female patients received the BioPro-1 hemiprosthesis. Prosthesis translation and metatarsal erosion were measured with RSA at immediately PO, 6 weeks, and 3, 6, 12, 36, and 60 months postoperatively. Clinical assessment was done by patient questionnaires. RESULTS RSA data of 9 patients were available for analysis. Median (range) number of markers used in RSA analysis, condition number, and mean error of markers around the prosthesis were 4 (3-7), 320 (208-862), and 0.13 (0.02-0.28), respectively. Progressive subsidence was seen up to 3 years PO (mean 2.1 mm, SE 0.32). Progressive metatarsal erosion was found from 1 year PO (mean 0.49 mm, SE 0.15). Pain, function, and quality scores improved after surgery and did not deteriorate at later follow-up moments. CONCLUSION Model-based RSA of the BioPro-1 prosthesis shows nonstabilizing medial and distal translation and metatarsal erosion. Despite the measured migration and erosion, clinical outcomes improved and remained similar up to 5 years postoperation. LEVEL OF EVIDENCE Level II, prospective analysis of MTP-1 hemiprosthesis.
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Affiliation(s)
| | | | - Bart L Kaptein
- Leiden Universitair Medisch Centrum, Leiden, the Netherlands
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19
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Saur M, Lucas Y Hernandes J, Barouk P, Bejarano-Pineda L, Maynou C, Laffenetre O. Average 4-Year Outcomes of Distal Oblique First Metatarsal Osteotomy for Stage 1 to 3 Hallux Rigidus. Foot Ankle Int 2022; 43:463-473. [PMID: 34747650 DOI: 10.1177/10711007211052298] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux rigidus is the second most frequent pathology of the first ray. Surgical options for degenerative metatarsophalangeal joint disease are either joint destructive or conservative procedures. The hypothesis was that oblique distal shortening osteotomy of the first metatarsal is an effective conservative technique for the management of stage 1 to 3 hallux rigidus. METHODS We conducted a retrospective cohort study of 87 feet with Coughlin and Shurnas's stage 1-3 hallux rigidus, operated between 2009 and 2019. The cohort consisted in 72 patients (87 feet) with an average age of 57±9 (30/79) years; 22 of 87 (25.3%) feet had the first metatarsal surgery performed in isolation; 65 of 87 (74.7%) had concomitant forefoot procedures, including 31 of 87 (35.6%) with Akin phalangeal osteotomies and 34 of 87 (39.1%) with Moberg phalangeal osteotomies.We evaluated the American Orthopaedic Foot & Ankle Society (AOFAS) Scale, subjective satisfaction, joint amplitudes, shortening rate, and occurrence of postoperative complications with a mean follow-up of 51 months (16/134). RESULTS The AOFAS score increased from 54.2±11.3 (25/70) preoperatively to 92.2±7.8 (62/100) postoperatively (P < .001). Patients reported excellent or good outcome in 95.4% of cases. The 40-point self-reported pain subscale score improved from 19.6 (± 10.0) to 37.4 (± 5.4), P < .001.The overall range of motion increased from 61±21 (20/110) degrees to 69±17 (35/120) degrees (P < .001). The mean first metatarsal shortening rate (SRpo) was 9.6%. Neither the Coughlin grade, the metatarsal index, or the SRpo influenced the AOFAS score. At 6-month follow-up, 15 patients had transfer metatarsalgia compared with 5 at last follow-up without requiring another surgical procedure. The risk was not significantly different according to Coughlin's stage, preoperative metatarsal index, or SRpo. CONCLUSION Oblique distal osteotomy of the first metatarsal for stage 1-3 hallux rigidus, often in combination with other first ray procedures, performed well during our follow-up time period, with a high subjective satisfaction rate and few complications. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Maurise Saur
- Centre Médico-Universitaire du Pied, Hôpital Pellegrin, Centre Hospitalier Universitaire, Bordeaux, France
| | - Julien Lucas Y Hernandes
- Centre Médico-Universitaire du Pied, Hôpital Pellegrin, Centre Hospitalier Universitaire, Bordeaux, France
| | - Pierre Barouk
- Centre de Chirurgie Orthopédique et Sportive, Centre du pied, Mérignac, France
| | - Lorena Bejarano-Pineda
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, USA
| | - Carlos Maynou
- Service d'Orthopédie A, Hôpital Roger Salengro, Centre Hospitalier Régional Universitaire, Lille, France
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20
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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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21
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Nurmukhametov MR, Makarov MA, Makarov SA, Bialik EI, Biaik VE, Nesterenko VA. The Use of Autologous Matrix-Induced Chondrogenesis as a Surgical Treatment for Patients with the First Metatarsophalangeal Joint Osteoarthritis: Immediate and Medium-Term Results. Cartilage 2021; 13:1354S-1365S. [PMID: 32917097 PMCID: PMC8808820 DOI: 10.1177/1947603520958127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIM To demonstrate the immediate and medium-term results of the surgical treatment of patients with first metatarsophalangeal (MTP) joint osteoarthritis (OA) using the autologous matrix-induced chondrogenesis (AMIC) technique and to evaluate the effectiveness. MATERIALS AND METHODS Preoperatively the range of motion (ROM) in the first MTP joint was determined, and the following questionnaires were used: Visual Analogue Scale (VAS) of pain, American Orthopedic Foot & Ankle Society (AOFAS) score, and Functional Foot Index (FFI). All of the patients experienced a significant restriction of the ROM in the first MTP joint. The VAS of pain median was 70, AOFAS 52, and FFI 5.8. RESULTS AMIC was performed in 19 patients with first MTP joint OA. All the patients experienced a significant restriction of ROM in the first MTP joint. The VAS of pain median was 70, AOFAS 52, and FFI 5.8. By the third month, VAS of pain decreased to 25, FFI to 2.2; AOFAS median increased to 77, ROM to 60°. Six months after the surgery VAS of pain decreased to 10, FFI to 1.1; AOFAS median increased to 90, ROM to 65°. After a year of observation, VAS of pain decreased to 5, FFI to 1,0; AOFAS median increased to 92.5, ROM to 71.5°. CONCLUSION The results showed that a first MTP joint AMIC procedure can be a fairly effective method of surgical treatment that can relieve pain and significantly improve the quality of life of patients with first MTP joint OA.
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Affiliation(s)
- Maxim Rinatovich Nurmukhametov
- V.A. Nasonova Research Institute of
Rheumatology, Moscow, Russian Federation,Maxim Rinatovich Nurmukhametov, V.A.
Nasonova Research Institute of Rheumatology, Kashirskoe Sh., 34A, Moscow 115522,
Russian Federation.
| | - Maxim Anatolievich Makarov
- V.A. Nasonova Research Institute of
Rheumatology, Moscow, Russian Federation,Maxim Rinatovich Nurmukhametov, V.A.
Nasonova Research Institute of Rheumatology, Kashirskoe Sh., 34A, Moscow 115522,
Russian Federation.
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22
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[Distal osteotomy of the first metatarsal bone with plantarization for the treatment of hallux limitus due to metatarsus primus elevatus]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2021; 33:487-494. [PMID: 34709414 DOI: 10.1007/s00064-021-00744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/20/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Joint-preserving procedure with plantarization of the 1st metatarsal and improvement of range of motion. INDICATIONS Mild and moderate arthrosis of the 1st metatarsophalangeal joint with pain and shoe discomfort due to elevation of 1st ray and failed conservative treatment. CONTRAINDICATIONS Severe degenerative conditions 1st metatarsophalangeal joint with significant loss of range of motion preoperatively. General contraindications for surgical treatment/anesthesia. SURGICAL TECHNIQUE Dorsomedial approach to 1st metatarsophalangeal joint, mild cheilectomy and arthrolysis, v‑shaped osteotomy of metatarsal 1 from dorsal with plantarization of the metatarsal head, screw fixation from proximal dorsal to distal plantar. POSTOPERATIVE MANAGEMENT Full weightbearing in rocker bottom shoe for 6 weeks. RESULTS Improvement of range of motion from 35° dorsal extension to 50° in all cases after 6 months. Reduction of painful movement from VAS 6-7 to VAS 2-3 in 80% of patients.
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23
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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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25
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Fung J, Sherman A, Stachura S, Eckles R, Doucette J, Chusid E. Nonoperative Management of Hallux Limitus Using a Novel Forefoot Orthosis. J Foot Ankle Surg 2021; 59:1192-1196. [PMID: 32736972 DOI: 10.1053/j.jfas.2019.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 02/03/2023]
Abstract
Hallux limitus is among the most common arthritides of the foot and ankle, with increasing incidence in the aging population. Despite its prevalence and disease burden, treatment of the condition remains poorly understood. Many patients will fail initial conservative management, whereas controversy exists surrounding indications for and outcomes of surgery. The present study sought to examine the impact of a novel forefoot orthosis on foot function, pain, and plantar pressure distributions in patients with symptomatic hallux limitus. Nineteen adult patients completed a questionnaire consisting of the 23-item Foot Function Index and a 10-point visual analogue scale measuring pain. Standing pedobarographic maps were generated using a foot scanning system. Participants were instructed to wear the orthosis in athletic shoes for 4 weeks. Eighteen participants (94.7%) experienced improvements in foot function and pain, with 12 (63.2%) reporting complete resolution of pain at the end of the 4-week trial. Mean Foot Function Index scores improved significantly from 43.0% at baseline to 11.0% with the orthosis (p < .001). Similarly, mean visual analogue scale pain scores decreased significantly from 4.87 to 1.18 (p < .001). Pedobarographic analysis while wearing the orthosis demonstrated increased ability of participants to bear weight on the arthritic hallux metatarsophalangeal joint and restoration of physiologic stance. Compared to existing products, the device was well tolerated and did not require footwear modifications or impede normal gait. Overall, the orthosis offers an appealing solution to patients dissatisfied with existing treatment options as well as those who may be averse to or ineligible for surgery.
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Affiliation(s)
- Jonathan Fung
- Podiatrist, New York College of Podiatric Medicine, New York, NY
| | - Alain Sherman
- Medical Student, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Sara Stachura
- Podiatrist, New York College of Podiatric Medicine, New York, NY
| | - Robert Eckles
- Dean of Clinical and Graduate Medical Education, New York College of Podiatric Medicine, New York, NY
| | - John Doucette
- Associate Professor of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eileen Chusid
- Dean and Associate Professor of Pre-Clinical Sciences, New York College of Podiatric Medicine, New York, NY
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26
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Hollawell S, Moen R, Coleman M, Carson M. Osteochondral Fresh Allograft Transfer to Address Osteochondral Defect of the First Metatarsal Head in Early Hallux Limitus. J Foot Ankle Surg 2021; 60:157-162. [PMID: 33160835 DOI: 10.1053/j.jfas.2020.04.003] [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: 09/15/2019] [Revised: 11/05/2019] [Accepted: 04/01/2020] [Indexed: 02/03/2023]
Abstract
Osteochondral fresh allograft transfer of the first metatarsal can be an accepted surgical management option for early stages of hallux limitus. This study consisted of evaluating clinical outcomes with patients who underwent this procedure. Thirteen (N=13) patients were included in this study, 10 (76.9%) were female and 3 (23.1%) were male. The mean age was 52.2 (range, 27-61) years and the mean body mass index was 25.3 (range, 33.8-19.4) kg/m2. Intraoperative evaluation of osteochondral defects of the first metatarsal demonstrated a mean diameter size of 8.2 mm. Ten (76.9%) patients had a concomitant cheilectomy procedure performed. The mean follow-up was 41.0 (range, 3.5-89.1) months. American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale questionnaire and patient satisfaction survey were completed. The mean AOFAS Hallux Metatarsophalangeal-Interphalangeal score, which was determined postoperatively, was 71.2 (range, 55-85) of 100. Four (30.8%) patients with overall scores below 60 (range, 55-59) reported moderate daily pain at the first metatarsophalangeal joint. Mean AOFAS pain score was 26.9 (range, 20-30) of 40. Mean AOFAS function score was 30.8 (range, 24-35) of 45. Mean AOFAS alignment score was 13.4 (range, 8-15) of 15. There was statistical significance in mean AOFAS total score when comparing hallux limitus grade 1 versus grade 2, as well as when comparing grade 1 versus grade 3, p < .05. There was no significance in mean AOFAS total score when comparing number of plugs used, body mass index, and size of defect. However, an overall improvement in preoperative symptoms and patient satisfaction was documented and therefore osteochondral fresh allograft transfer can be considered a reasonable option in treating defects found at the first metatarsal head.
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Affiliation(s)
- Shane Hollawell
- Fellowship Director, Orthopaedic Institute of Central Jersey, Manasquan, NJ
| | - Ruth Moen
- Past Fellow, Foot and Ankle Surgeon, Northwest Kaiser Permanente, Portland, OR
| | - Meagan Coleman
- Fellow, Orthopaedic Institute of Central Jersey, Manasquan, NJ.
| | - Michael Carson
- Vice Chair of Research/Outcomes, Department of Medicine, Jersey Shore Medical Center, Neptune, NJ
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27
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Weber C, Yao D, Schwarze M, Andersson K, Andric V, Kinkelin M, Claassen L, Stukenborg-Colsman C, Waizy H. Risk Analysis of Nonunion After First Metatarsophalangeal Joint Arthrodesis. Foot Ankle Spec 2021; 14:120-125. [PMID: 31990223 DOI: 10.1177/1938640019899829] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The standard therapy for a symptomatic hallux rigidus is still the arthrodesis of the first metatarsophalangeal (MTP) joint. A nonunion of the arthrodesis is a possible postoperative complication. This study aimed to evaluate the incidence of nonunion associated with first MTP joint arthrodesis and identify risk factors influencing this. Methods: This retrospective study included 197 patients who were treated with an isolated first MTP joint arthrodesis. The severity of MTP-related osteoarthritis was assessed clinically and radiologically prior to surgery according to the Waizy classification. Patient characteristics and radiological parameters were evaluated postoperatively. Results: A full clinical and radiological data set was collected from 153 out of 197 patients. We identified 14 cases of nonunion and found that nonunion was associated with higher incidence of male gender (P = .29), comorbidity (P = .035), higher grade of osteoarthritis (P = .01), and increased postoperative great toe dorsiflexion (P = .022). Conclusions: Arthrodesis of the first MTP joint is a safe operative treatment, as demonstrated by a nonunion rate of 9.2%. Negative influencing factors were the presence of preexisting diseases, higher grades of osteoarthritis, and a relative increased dorsiflexion position of the great toe after surgery. These factors should be considered during pre-, intra-, and postoperative planning.Levels of Evidence: Therapeutic, Level IV: Retrospective.
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Affiliation(s)
- Carla Weber
- Clinic for Foot and Ankle Surgery, Hessing Stiftung, Augsburg, Germany (CW, KA, VA, MK, HW).,Department for Orthopaedic Surgery, Hannover Medical School, Hannover, Germany (DY, LC, CSC).,Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany (MS, HW)
| | - Daiwei Yao
- Clinic for Foot and Ankle Surgery, Hessing Stiftung, Augsburg, Germany (CW, KA, VA, MK, HW).,Department for Orthopaedic Surgery, Hannover Medical School, Hannover, Germany (DY, LC, CSC).,Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany (MS, HW)
| | - Michael Schwarze
- Clinic for Foot and Ankle Surgery, Hessing Stiftung, Augsburg, Germany (CW, KA, VA, MK, HW).,Department for Orthopaedic Surgery, Hannover Medical School, Hannover, Germany (DY, LC, CSC).,Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany (MS, HW)
| | - Karolina Andersson
- Clinic for Foot and Ankle Surgery, Hessing Stiftung, Augsburg, Germany (CW, KA, VA, MK, HW).,Department for Orthopaedic Surgery, Hannover Medical School, Hannover, Germany (DY, LC, CSC).,Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany (MS, HW)
| | - Vlatka Andric
- Clinic for Foot and Ankle Surgery, Hessing Stiftung, Augsburg, Germany (CW, KA, VA, MK, HW).,Department for Orthopaedic Surgery, Hannover Medical School, Hannover, Germany (DY, LC, CSC).,Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany (MS, HW)
| | - Michaela Kinkelin
- Clinic for Foot and Ankle Surgery, Hessing Stiftung, Augsburg, Germany (CW, KA, VA, MK, HW).,Department for Orthopaedic Surgery, Hannover Medical School, Hannover, Germany (DY, LC, CSC).,Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany (MS, HW)
| | - Leif Claassen
- Clinic for Foot and Ankle Surgery, Hessing Stiftung, Augsburg, Germany (CW, KA, VA, MK, HW).,Department for Orthopaedic Surgery, Hannover Medical School, Hannover, Germany (DY, LC, CSC).,Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany (MS, HW)
| | - Christina Stukenborg-Colsman
- Clinic for Foot and Ankle Surgery, Hessing Stiftung, Augsburg, Germany (CW, KA, VA, MK, HW).,Department for Orthopaedic Surgery, Hannover Medical School, Hannover, Germany (DY, LC, CSC).,Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany (MS, HW)
| | - Hazibullah Waizy
- Clinic for Foot and Ankle Surgery, Hessing Stiftung, Augsburg, Germany (CW, KA, VA, MK, HW).,Department for Orthopaedic Surgery, Hannover Medical School, Hannover, Germany (DY, LC, CSC).,Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany (MS, HW)
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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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Galli SH, Ferguson CM, Davis WH, Anderson R, Cohen BE, Jones CP, Odum S, Ellington JK. Cheilectomy With or Without Cryopreserved Amniotic Membrane-Umbilical Cord Allograft for Hallux Rigidus. FOOT & ANKLE ORTHOPAEDICS 2021; 6:2473011420967999. [PMID: 35097420 PMCID: PMC8564935 DOI: 10.1177/2473011420967999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND For hallux rigidus, dorsal cheilectomy remains a treatment option even with advances in interposition techniques and devices. Cheilectomy aims to alleviate dorsal impingement and improve pain and function as well as range of motion. Cryopreserved umbilical cord allograft, with properties to mitigate inflammation and scar formation, has theoretical benefit for improving outcomes following cheilectomy. In this first prospective randomized and blinded cheilectomy study reported, we aimed to compare outcomes between cheilectomy alone and cheilectomy with umbilical cord allograft. METHODS Patients were randomized to cheilectomy alone (CA) or cheilectomy with cryopreserved umbilical cord (ie, amniotic membrane-umbilical cord [AM-UC]). Patients were evaluated with American Orthopaedic Foot & Ankle Society (AOFAS), Foot Function Index (FFI), and visual analog scale (VAS) pain outcomes collected preoperatively and at 6 months and 1 year postoperatively. In addition, radiographic range of motion data were collected using stress radiographs. Fifty-one patients (26 AM-UC, 25 CA) completed the study, with 5 bilateral surgeries in the AM-UC group and 2 in the CA group, totaling 31 and 27 feet, respectively. RESULTS The AM-UC group had statistically significant improved AOFAS and FFI scores at 1 year compared with the CA group, but there was no difference at 6 months. There was no significant difference between groups for VAS-pain scores at any time point, but overall VAS-pain improved in both groups from preoperative values. There was no significant difference in range of motion (total arc) between groups and changes in range of motion (total arc) in both groups from preoperative to 1 year postoperative were small. CONCLUSION We present the results of the first randomized and blinded prospective study of cheilectomy surgery patients. When appropriately selected, cheilectomy remains a good option for patients with symptomatic hallux rigidus. Cryopreserved umbilical cord is a potential adjuvant to cheilectomy, with 1-year results showing improvements in functional outcome scores. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
| | | | | | | | - Bruce E. Cohen
- OrthoCarolina Foot and Ankle Institute, Charlotte, NC, USA
| | | | - Susan Odum
- OrthoCarolina Foot and Ankle Institute, Charlotte, NC, USA
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30
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Slullitel G, López V, Calvi JP, D'Ambrosi R, Usuelli FG. Youngswick osteotomy for treatment of moderate hallux rigidus: Thirteen years without arthrodesis. Foot Ankle Surg 2020; 26:890-894. [PMID: 31836404 DOI: 10.1016/j.fas.2019.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the need for first metatarsophalangeal joint (MTPJ) arthrodesis as a measure of the Youngswick osteotomy survival, or any other secondary procedures in the long term follow up in patients with stage II and III hallux rigidus. METHODS We retrospectively evaluated 61 patients with stage II and III hallux rigidus who had undergone Youngswick osteotomy and analyzed their outcomes in the long term using first metatarsophalangeal arthrodesis as an end point. The candidates for inclusion underwent clinical and radiographic evaluation, including the Foot and Ankle Outcome Score (FAOS). RESULTS Mean follow-up time was 54.8 months. All patients had improved their FAOS, with all achieving postoperative scores >75 points at the final follow up (P<0.05). Although 49 % (P<0.05) of the patients depicted worsening of the radiological aspect of the MTPJ, over the long time, no patient needed a first MTPJ arthrodesis. CONCLUSION Our results show satisfying long-term outcomes with regard to function, pain relief, and patient satisfaction of the Youngswick osteotomy in grade II as well as grade III hallux rigidus that sustained over the follow up period; even in patients followed up for over 13 years. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Gastón Slullitel
- Institute of Orthopaedics, "Dr. Jaime Slullitel" San Luis 2534, Rosario, Santa Fe, Argentina.
| | - Valeria López
- Institute of Orthopaedics, "Dr. Jaime Slullitel" San Luis 2534, Rosario, Santa Fe, Argentina.
| | - Juan P Calvi
- Institute of Orthopaedics, "Dr. Jaime Slullitel" San Luis 2534, Rosario, Santa Fe, Argentina.
| | - Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, Milan, 20161, Italy.
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31
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Sansone V, Maiorano E, Melato M, Martinelli N, Pascale V. Novel treatment for hallux rigidus using a temporary metal interpositional device. Foot Ankle Surg 2020; 26:630-636. [PMID: 31439504 DOI: 10.1016/j.fas.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this prospective study is to evaluate the results of a consecutive series of patients suffering from grade II-III hallux rigidus who underwent a mobility preserving surgical technique consisting of resection arthroplasty with implantation of a temporary metal spacer. METHODS Thirty consecutive patients, 18 female and 12 male with a diagnosis of a grade II-III hallux rigidus, not responding to conservative treatment, underwent a minimal resection arthroplasty followed by the implantation of a temporary metal interpositional device by the same surgeon. All spacers were removed after 6 months through a minimal incision under regional anaesthesia. Patients were clinically and radiographically evaluated at 3, 6, 12 months, and 5 years after spacer removal. RESULTS The clinical AOFAS scores improved already at first follow-up and continued to improve over time with a statistically significant change until the first year. At 3, 6, and 12 months follow-ups, the number of patients with severely limited ROM (i.e. under 30°, that means grade II-III according to Coughlin and Shaurnas classification) significantly decreased. There were only two minor complications, so defined as both of which resolved spontaneously and did not affect the procedure's effectiveness. CONCLUSIONS We observed good to excellent results with the use of this mobility preserving surgical technique for the treatment of symptomatic grades II and III hallux rigidus. The never before published procedure is easy to perform and inexpensive. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Valerio Sansone
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Emanuele Maiorano
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Marco Melato
- Department of Orthopaedic, Hospital SS. Antonio and Biagio and Cesare Arrigo Alessandria, Italy
| | - Nicoló Martinelli
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy.
| | - Valerio Pascale
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
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Mao DW, Zheng C, Amatullah NN, Kam C, Kon Kam King C. Salvage arthrodesis for failed first metatarsophalangeal joint arthroplasty: A network meta-analysis. Foot Ankle Surg 2020; 26:614-623. [PMID: 31439502 DOI: 10.1016/j.fas.2019.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aim to provide an evidence-based literature review of salvage arthrodesis for failed first metatarsophalangeal joint arthroplasty with a network meta-analysis. METHODS A search of PubMed, Embase and Cochrane databases was conducted in December 2016 which identified 12 relevant articles out of 340 articles assessing the efficacy of salvage arthrodesis for failed joint arthroplasty of the first metatarsophalangeal joint. The 12 studies were assigned a level of evidence (I-V) and interventions were graded a level of recommendation (A-C, I) in support of or against the treatment modality. RESULTS There is fair evidence (grade B) to support salvage arthrodesis with structural bone graft. There is poor evidence (grade C) for salvage arthrodesis without bone graft. There was no good evidence (grade A) to recommend either intervention. Meta-analysis showed that salvage arthrodesis resulted in improved functional outcome over time. CONCLUSIONS Salvage arthrodesis showed good bone union rates and patient satisfaction. LEVEL OF CLINICAL EVIDENCE III - Systematic Review of Level III studies.
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Affiliation(s)
- David Weijia Mao
- Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore.
| | - Charles Zheng
- Singapore Clinical Research Institute, 31 Biopolis Way, Singapore 138669, Singapore.
| | - Nurun Nisa Amatullah
- Singapore Clinical Research Institute, 31 Biopolis Way, Singapore 138669, Singapore.
| | - Carmen Kam
- Clinical Trials & Research Unit, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore.
| | - Charles Kon Kam King
- Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore.
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Massimi S, Caravelli S, Fuiano M, Pungetti C, Mosca M, Zaffagnini S. Management of high-grade hallux rigidus: a narrative review of the literature. Musculoskelet Surg 2020; 104:237-243. [PMID: 32030657 DOI: 10.1007/s12306-020-00646-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/02/2020] [Indexed: 01/13/2023]
Abstract
Hallux rigidus is a disease characterized by an osteoarthritic degeneration of the first metatarsophalangeal joint. Aetiology of hallux rigidus is not clear in the literature. History of trauma is considered one of the most common causes of unilateral hallux rigidus. Also, repetitive microtraumas or inflammatory and metabolic causes such as gout, rheumatoid arthritis and seronegative arthropathy can cause degeneration of the joint. The aim of this literature narrative overview is to summarize and expose the great amount of management concepts and information, including the well-codified main operative procedures to treat of hallux rigidus. This may provide current information for med-school students, researchers and physicians. A comprehensive literature search using PubMed database has been performed. The management for hallux rigidus can involve a variety of therapeutic interventions, conservative or operative. High-grade hallux rigidus represents a complex disease characterized by several clinical and pathological findings, and to achieve optimal results, surgical treatment should be chosen between several surgical techniques depending on the degree of arthritis and other different clinical conditions.
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Affiliation(s)
- S Massimi
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - S Caravelli
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - M Fuiano
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - C Pungetti
- Department of Orthopaedic Surgery, Ospedale Maggiore "Pizzardi", Bologna, Italy
| | - M Mosca
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - S Zaffagnini
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
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Cassinelli SJ, Chen S, Charlton TP, Thordarson DB. Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States. Foot Ankle Int 2019; 40:1140-1148. [PMID: 31195830 DOI: 10.1177/1071100719855049] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to determine the early outcomes and complications following the implantation of a hydrogel synthetic cartilage implant (SCI, Cartiva) for the treatment of hallux rigidus by a single surgeon. METHODS A retrospective chart review was performed of consecutive patients who underwent treatment for hallux rigidus with an SCI between August 2016 and April 2018 by a single surgeon. Demographic information, radiographic assessment, and concomitant operative procedures performed were evaluated for all patients. Postoperatively, PROMIS physical function (PF) and pain interference (PI) scores, patient satisfaction, reoperation, conversion to arthrodesis, and need for further clinical treatment were collected. Sixty-four SCIs were implanted in 60 patients. Follow-up averaged 18.5 months (range 12-30 months). RESULTS 14% (9/64) of patients were very satisfied, 28% (18/64) satisfied, 20% (13/64) neutral, 11% (7/64) unsatisfied, and 27% (17/64) very unsatisfied with their outcome. In addition, 45% of patients underwent additional procedures at the time of SCI, and 23% had a history of surgery on the hallux before implantation. PROMIS PF scores averaged 42 and PROMIS PI scores averaged 60. Overall, 63% completed PROMIS PI, 66% completed PROMIS PF, and 100% completed a satisfaction survey. In addition, 30% (19/64) underwent magnetic resonance imaging (MRI) postoperatively due to pain. There was a 20% reoperation rate, which included an 8% rate of conversion to arthrodesis. CONCLUSION Synthetic cartilage implantation yielded neutral patient satisfaction, mild pain, and physical dysfunction at early follow-up. We believe patient selection and counseling regarding early postoperative limitations are important before proceeding with SCI. LEVEL OF EVIDENCE Level IV, case series.
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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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Emmons BR, Carreira DS. Outcomes Following Interposition Arthroplasty of the First Metatarsophalangeal Joint for the Treatment of Hallux Rigidus: A Systematic Review. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011418814427. [PMID: 35097316 PMCID: PMC8696831 DOI: 10.1177/2473011418814427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Interposition arthroplasty of the first MTP joint has recently experienced renewed interest as a treatment for hallux rigidus. The purpose of this study was to systematically review the rapidly expanding literature on PRO following interposition arthroplasty of the first MTP joint. Methods: PubMed Central, Embase, and the Cochrane Central Register for Controlled Trials (CENTRAL) were searched. Inclusion criteria included length of time to follow-up, number of patients, outcome measure, and use of allogeneic or autogenous soft tissue or a synthetic matrix as interposition. Results: 20 studies were included in the review, comprising 498 patients and 539 feet with mean time to follow-up of 4.5 years. The most common substance used for interposition in the included studies was autogenous first MTPJ capsular tissue, a technique reported on in 12 (60.0%) of the included articles. In studies reporting preoperative and postoperative outcomes by way of a standardized outcome scoring system, mean group improvements exceed minimal clinically important differences in the majority of studies. Eighty-five percent of the studies included in this review were of Level IV quality evidence, and of this subset of studies, 70.6% were of a retrospective nature. Progression to further surgery was observed in 3.8% of toes. The most common complication reported was transfer metatarsalgia of 1 or more lesser toes, observed in up to 57.9% of patients in one study. Conclusion: Interposition arthroplasty appears to be a viable option for the treatment of moderate to severe hallux rigidus in patients looking to salvage motion through the first metatarsophalangeal joint. A wide array of autogenous, allogeneic, and synthetic implant materials have surfaced in recent years, but long-term follow-up and prospective, comparative study designs with low risk of bias are limited. Level of Evidence: Level IV, systematic review of Level III-IV studies
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Glazebrook M, Blundell CM, O'Dowd D, Singh D, de Vries G, Le ILD, Nielsen D, Pedersen ME, Sakellariou A, Solan M, Wansbrough G, Younger ASE, Baumhauer JF, Daniels TR. Midterm Outcomes of a Synthetic Cartilage Implant for the First Metatarsophalangeal Joint in Advanced Hallux Rigidus. Foot Ankle Int 2019; 40:374-383. [PMID: 30501401 DOI: 10.1177/1071100718815469] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: A prospective, randomized, noninferiority clinical trial of synthetic cartilage implant hemiarthroplasty for hallux rigidus demonstrated functional outcomes and safety equivalent to first metatarsophalangeal (MTP) joint arthrodesis at 24 months. We prospectively assessed safety and efficacy outcomes for synthetic cartilage implant hemiarthroplasty at a minimum of 5 years. METHODS: Of 135 eligible patients from the original trial, 112 (83.0%) were enrolled (mean age, 58.2 ± 8.8 years; 87 females). Pain visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL), and FAAM Sports subscales were completed preoperatively and 2 and 5 years postoperatively. Great toe active dorsiflexion, weightbearing radiographs, secondary procedures, and safety parameters were also evaluated. RESULTS: At 24 months, 14/152 (9.2%) patients had undergone implant removal and conversion to arthrodesis. In years 2 to 5, 9/119 (7.6%) patients underwent implant removal and conversion to arthrodesis. At mean 5.8 ± 0.7 (range, 4.4-8.0) years' follow-up, pain VAS, FAAM ADL, and FAAM Sports scores improved by 57.9 ± 18.6 points, 33.0 ± 17.6 points, and 47.9 ± 27.1 points, respectively, from baseline. Clinically significant changes in VAS pain, FAAM ADL, and FAAM Sports were reported by 103/106 (97.2%), 95/105 (90.5%), and 97/104 (93.3%) patients, respectively. Patient-reported outcomes at 24 months were maintained at 5.8 years in patients who were not revised. Active MTP joint peak dorsiflexion was maintained. Ninety-nine of 106 (93.4%) patients would have the procedure again. CONCLUSION: Clinical and safety outcomes for synthetic cartilage implant hemiarthroplasty observed at 2 years were maintained at 5.8 years. The implant remains a viable treatment option to decrease pain, improve function, and maintain motion for advanced hallux rigidus. LEVEL OF EVIDENCE: Level IV, case series.
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Affiliation(s)
- Mark Glazebrook
- 1 Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada
| | | | | | - Dishan Singh
- 3 Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Gwyneth de Vries
- 4 Dalhousie University and Memorial University of Newfoundland, Fredericton, NB, Canada
| | - Ian L D Le
- 5 University of Calgary, Calgary, AB, Canada
| | | | | | | | - Matthew Solan
- 9 Royal Surrey County Hospital, Guildford, Surrey, UK
| | | | - Alastair S E Younger
- 11 Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Judith F Baumhauer
- 12 Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Timothy R Daniels
- 13 Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, ON, Canada
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Rushing CJ, Rathnayake VR, Oxios AJ, Galan GP, Ramil M, Spinner SM, Hardigan P. Patient-Perceived Recovery and Outcomes After Silastic Implant Arthroplasty. J Foot Ankle Surg 2019; 57:1080-1086. [PMID: 30172719 DOI: 10.1053/j.jfas.2018.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Indexed: 02/03/2023]
Abstract
In some chronic musculoskeletal conditions, patients with persistent pain and disability have still achieved recovery through behavioral adaptations (readjustment) or cognitive coping (redefinition). Although the pendulum shift from physician-reported clinical indicators to patient-reported outcomes measures (PROMs) has recently focused on quantifying residual pain and disability to determine recovery (resolution), whether patients are capable of coping with any ongoing deficits and achieving other forms of recovery has not been considered. We performed a retrospective case series to assess patient-perceived recovery and outcomes after silastic implant arthroplasty for hallux rigidus. From July 2006 to July 2016, 28 patients at a single institution were enrolled. PROMs were prospectively obtained and compared between patients considering themselves recovered without or with residual deficits (recovered-resolved, recovered-not resolved) and those not recovered. Holistic satisfaction, procedure-specific satisfaction, complications, reoperations, and failure rates were recorded. Overall, 50.0% perceived themselves as recovered-resolved, 43% as recovered-not resolved, and 7% as not recovered. The mean modified Foot Function Index was 17.26, the verbal analog scale for pain score was 2.03, and implant survivorship 100% at a median of 67 (interquartile range 28.4 to 103.5) months. Although only 50% of patients reported complete symptom resolution, satisfaction was high, and most perceived themselves as recovered, suggesting recovery in hallux rigidus might not always be predicated by the complete resolution of all symptomatology. Although PROMs relying on pain inference and functional disability will continue to be utilized with increasing frequency, foot and ankle surgeons should be cognizant of their inherent limitations in assessing other forms of recovery.
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Affiliation(s)
| | | | - Adam J Oxios
- Resident, Westside Regional Medical Center, Plantation, FL
| | | | - Madelin Ramil
- Research Director, Westside Regional Medical Center, Plantation, FL
| | - Steven M Spinner
- Residency Director, Westside Regional Medical Center, Plantation, FL
| | - Patrick Hardigan
- Director, Statistical Consulting Center, Nova Southeastern University, Fort Lauderdale, FL
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Watson TS, Panicco J, Parekh A. Allograft Tendon Interposition Arthroplasty of the Hallux Metatarsophalangeal Joint: A Technique Guide and Literature Review. Foot Ankle Int 2019; 40:113-119. [PMID: 30379090 DOI: 10.1177/1071100718807738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The "anchovy" interpositional arthroplasty technique can be used as a salvage option for failed hallux rigidus procedures. The operative technique utilized by the senior author is described. Careful soft-tissue handling, meticulous joint space and graft preparation, and interposition graft stabilization using a bone tunnel and suture anchors are unique aspects of this technique, which in the authors' experience have contributed to improved outcomes. Current literature regarding indications and outcomes is limited and controversial. The proposed benefits of soft-tissue interposition arthroplasty of the hallux metatarsophalangeal joint for patients with prior failed implant arthroplasty are improved pain scores and preservation of range of motion. Level of Evidence: Level V, technique guide.
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Affiliation(s)
- Troy S Watson
- 1 Foot and Ankle Institute, Desert Orthopaedic Center, Las Vegas, NV, USA
| | - Jordan Panicco
- 1 Foot and Ankle Institute, Desert Orthopaedic Center, Las Vegas, NV, USA
| | - Amit Parekh
- 2 Valley Hospital Medical Center, Las Vegas, NV, USA
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Baumhauer JF, Daniels T, Glazebrook M. New Technology in the Treatment of Hallux Rigidus with a Synthetic Cartilage Implant Hemiarthroplasty. Orthop Clin North Am 2019; 50:109-118. [PMID: 30477700 DOI: 10.1016/j.ocl.2018.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Synthetic cartilage implant surgery is an excellent option for the patient with great toe arthritis and good alignment of the toe who wishes to retain first metatarsophalangeal motion and obtain 90% improved pain relief and function. Patients with osteoporosis, osteopenia, or bone defects from surgery or disease may not maintain the implant position due to poor bone quality, resulting in less than desired outcomes. Despite this being a straightforward surgery, patients need to be aware that the pain relief may not begin until 3+ months after surgery because this procedure does require bone resection and implant placement.
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Affiliation(s)
- Judith F Baumhauer
- Ortho Department, University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
| | - Timothy Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, 800-55 Queen Street East, Toronto, Ontario M5C 1R6, Canada
| | - Mark Glazebrook
- Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax Infirmary, Room 4867, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada
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Glazebrook M, Younger ASE, Daniels TR, Singh D, Blundell C, de Vries G, Le ILD, Nielsen D, Pedersen ME, Sakellariou A, Solan M, Wansbrough G, Baumhauer JF. Treatment of first metatarsophalangeal joint arthritis using hemiarthroplasty with a synthetic cartilage implant or arthrodesis: A comparison of operative and recovery time. Foot Ankle Surg 2018; 24:440-447. [PMID: 29409199 DOI: 10.1016/j.fas.2017.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/02/2017] [Accepted: 05/11/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND First metatarsophalangeal joint (MTPJ1) hemiarthroplasty using a novel synthetic cartilage implant was as effective and safe as MTPJ1 arthrodesis in a randomized clinical trial. We retrospectively evaluated operative time and recovery period for implant hemiarthroplasty (n=152) and MTPJ1 arthrodesis (n=50). METHODS Perioperative data were assessed for operative and anaesthesia times. Recovery and return to function were prospectively assessed with the Foot and Ankle Ability Measure (FAAM) Sports and Activities of Daily Living (ADL) subscales and SF-36 Physical Functioning (PF) subscore. RESULTS Mean operative time for hemiarthroplasty was 35±12.3min and 58±21.5min for arthrodesis (p<0.001). Anaesthesia duration was 28min shorter with hemiarthroplasty (p<0.001). At weeks 2 and 6 postoperative, hemiarthroplasty patients demonstrated clinically and statistically significantly higher FAAM Sport, FAAM ADL, and SF-36 PF subscores versus arthrodesis patients. CONCLUSION MTPJ1 hemiarthroplasty with a synthetic cartilage implant took less operative time and resulted in faster recovery than arthrodesis. LEVEL OF EVIDENCE III, Retrospective case control study.
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Affiliation(s)
- Mark Glazebrook
- Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax Infirmary (Room 4867), 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada.
| | - Alastair S E Younger
- Department of Orthopaedics, University of British Columbia, 560-1144 Burrard Street, Vancouver, British Columbia V6Z 2A5, Canada.
| | - Timothy R Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital, 55 Queen St. E, Suite 800, Toronto, ON M5C 1R6, Canada.
| | - Dishan Singh
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA74LP, United Kingdom.
| | - Chris Blundell
- Northern General Hospital, Herries Road, Sheffield S7 5AU, United Kingdom.
| | - Gwyneth de Vries
- Dalhousie University and Memorial University of Newfoundland, 440 King Street, Suite 405, Fredericton, NB E3B 5H8, Canada.
| | - Ian L D Le
- University of Calgary and LifeMark Health Centre, 2225 Macleod Trail South, Calgary, Alberta T2G 5B6, Canada.
| | - Dominic Nielsen
- St. George's Hospital, St. James Wing, 5th Floor, Blackshaw Road, London SW170QT, United Kingdom.
| | - M Elizabeth Pedersen
- University of Alberta, Orthopedic Research, 8440-112 Street, 6-110 Clinical Sciences Bldg., Edmonton, Alberta T6G 2B7, Canada.
| | - Anthony Sakellariou
- Frimley Park Hospital, Portsmouth Road, Frimley, Camberley GU167UJ, United Kingdom.
| | - Matthew Solan
- Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU27XX, United Kingdom.
| | - Guy Wansbrough
- Torbay Hospital, Lawes Bridge, Torquay, Devon TQ27AA, United Kingdom.
| | - Judith F Baumhauer
- Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
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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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Nurmukhametov MR. PRINCIPLES OF SURGICAL TREATMENT IN PATIENTS WITH OSTEOARTHRITIS OF THE FIRST METATARSOPHALANGEAL JOINT. RHEUMATOLOGY SCIENCE AND PRACTICE 2018. [DOI: 10.14412/1995-4484-2018-363-372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
At present, there is no general approach to choosing surgical tactics for hallux rigidus. Many surgical procedures are used to treat osteoarthritis (OA) of the first metatarsophalangeal joint (FMPJ), which are relevant at different stages of the disease. Nevertheless, this fact also suggests that all proposed methods have one or other disadvantages. At the same time, FMPJ arthrodesis that relieves pain and is functionally inferior to joint-sparing surgery remains the gold standard. However, due to the fact that not only persons over the age of 50 years, but also younger patients often suffer from FMPJ OA, the most non-damaging option of joint-sparing surgery is cheilectomy with chondroplasty of the FMPJ, which allows restoration of painless joint motions, thus sparing the anatomy of the foot. Chondroplasty using the authologous matrix-induced chondrogenesis (AMIC®) technique for knee, hip, and ankle cartilage defects is described. There are no reports on FMPJ chondroplasty with the AMIC method in either Russian or foreign literature.
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Abstract
Arthritis of the first metatarsophalangeal (MTP) joint, hallux rigid, is a common and disabling source of foot pain in the adult population. Hallux rigidus is characterized by diseased cartilage and large, periarticular osteophytes that result in a stiff, painful joint. Activity modification, sensible shoes, orthotics, anti-inflammatory medications and occasional intra-articular steroid injections can be attempted to alleviate the discomfort associated with hallux rigidus. A number of surgical options exist for the treatment of recalcitrant hallux rigidus. Cheilectomy is a useful treatment for dorsal impingement pain seen in mild hallux rigidus. A new polyvinyl alcohol hemi-arthroplasty implant has shown promising early and midterm results in the treatment of advanced hallux rigidus; however, arthrodesis of the first MTP joint remains the gold standard treatment for advanced hallux rigidus because of unpredictable outcomes after early-generation joint replacement implants.
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Walther M, Chomej P, Kriegelstein S, Altenberger S, Röser A. [Minimally invasive cheilectomy]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2018; 30:161-170. [PMID: 29696322 DOI: 10.1007/s00064-018-0543-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Treatment of hallux rigidus by minimally invasive resection of the dorsal osteophytes, synovectomy and resection of the dorsal part of the metatarsal head. INDICATIONS Hallux rigidus grades II and III CONTRAINDICATIONS: End-stage osteoarthritis of the first metatarsophalangeal joint with beginning ankylosis. SURGICAL TECHNIQUE Osteophytes around the metatarsophalangeal joint are removed using a 1 cm incision dorsomedial, approximately 3 cm proximal of the joint space. The dorsal third of the metatarsal head is resected with a burr to improve dorsiflexion. The extent of bone resection is checked with an image intensifier. Loose bone fragments removed with a rangeur. An arthroscopy can be performed to check the completeness of bone resection, the irrigation of the joint and, if needed, to extend the synovectomy. POSTOPERATIVE MANAGEMENT Removal of the sutures after 2 weeks. Depending on pain, the patient can change from the postoperative shoe to a normal soft, comfortable and wide shoe after 1-2 weeks. Nonsteroidal drugs can be prescribed as needed. Active and passive mobilization of the metatarsophalangeal joint is also recommended. RESULTS The technique allows a soft-tissue-preserving resection of the osteophytes and a partial resection of the metatarsal head. The main advantages are limited soft-tissue trauma and rapid rehabilitation. In all, 21 women and 17 men with hallux rigidus stages II and III (Vanore) underwent surgery. Minimum follow-up was 12 months. In 1 patient, injury of the extensor hallucis longus tendon was observed. Two patients underwent revision surgery. One patient was converted to a metatarsophalangeal fusion, while another patient received a resection arthroplasty. At the latest follow-up, the AOFAS (American Orthopaedic Foot & Ankle Society) score averaged 88.7 points.
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Affiliation(s)
- M Walther
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547, München, Deutschland.
| | - P Chomej
- St. Elisabeth-Krankenhaus Leipzig, Leipzig, Deutschland
| | - S Kriegelstein
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547, München, Deutschland
| | - S Altenberger
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547, München, Deutschland
| | - A Röser
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547, München, Deutschland
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Karpe P, Killen MC, Chauhan A, Pollock R, Limaye R. Early results of Roto-glide joint arthroplasty for treatment of hallux rigidus. Foot (Edinb) 2018; 34:58-62. [PMID: 29306736 DOI: 10.1016/j.foot.2017.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 11/10/2017] [Accepted: 11/12/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Traditionally severe hallux rigidus is treated with arthrodesis. Recently arthroplasty has been used in order to retain motion at the metatarsophalangeal joint. AIM To assess the early to mid-term functional and radiological outcomes in patients undergoing first metatarsophalangeal arthroplasty using the Rotoglide implant. MATERIALS AND METHODS A prospective review was undertaken to assess functional and radiological outcomes of all patients undergoing an un-cemented three-component first metatarsophalangeal arthroplasty for hallux rigidus. Thirty four implants were performed in 28 patients over a 2-year period. Mean age was 60.5 years (range 45-77 years). Mean follow-up was 27.7 months (range 7-44 months). RESULTS Mean AOFAS score improved from 41.2 pre-operatively to 89.1 at final follow-up (47.9; 95% CI=43.6-54.3; p<0.0001). The mean metatarsophalangeal (MTP) range of motion improved from 29.5° pre-operatively to 68.2° post-operatively (38.7; 95% CI=35.1-42.2; p<0.0001). The mean AOFAS pain scores improved from 8.8 preoperatively to 35.0 postoperatively (26.2; 95% CI=22.4-29.9; p<0.0001). Three patients required revision surgery. No radiological complications were observed in any other patients. CONCLUSIONS This un-cemented prosthesis provides pain relief, while maintaining range of motion of the joint. The authors have observed clinically and statistically significant improvement in functional outcomes, with a low early complication rate and high patient satisfaction levels.
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Affiliation(s)
- Prasad Karpe
- University Hospital of North Tees, Hardwick, Stockton on Tees, TS19 8PE, United Kingdom.
| | - Maire-Clare Killen
- University Hospital of North Tees, Hardwick, Stockton on Tees, TS19 8PE, United Kingdom.
| | - Amit Chauhan
- University Hospital of North Tees, Hardwick, Stockton on Tees, TS19 8PE, United Kingdom.
| | - Raymond Pollock
- University Hospital of North Tees, Hardwick, Stockton on Tees, TS19 8PE, United Kingdom.
| | - Rajiv Limaye
- University Hospital of North Tees, Hardwick, Stockton on Tees, TS19 8PE, United Kingdom.
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Van Dyke B, Berlet GC, Daigre JL, Hyer CF, Philbin TM. First Metatarsal Head Osteochondral Defect Treatment With Particulated Juvenile Cartilage Allograft Transplantation: A Case Series. Foot Ankle Int 2018; 39:236-241. [PMID: 29110501 DOI: 10.1177/1071100717737482] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Focal damage to articular cartilage, also called an osteochondral defect (OCD), can be a cause of pain and decreased range of motion. Recent advancements have led to transplantation techniques using particulated juvenile articular cartilage allograft. This technique has been applied to the first metatarsal head to a very limited degree, with no published results to our knowledge. The aim of this study was to review the clinical results of patients who underwent particulated juvenile cartilage allograft implantation for first metatarsal head OCDs. METHODS We performed a retrospective consecutive case series study. Nine patients, at an average age of 41 years, were treated for symptomatic focal osteochondral defects of the first metatarsal head with particulate cartilage grafting from 2010 to 2016. Patients were contacted by phone to assess interest in returning to the office for follow-up, where weightbearing radiographs of the foot were obtained and a foot examination was performed. RESULTS At an average follow-up of 3.3 years, 7 of 9 patients reported no pain with recreational activities and no patient required further operations. This patient cohort was physically active, with 6 of 9 listing running as a regular activity. The average overall American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale questionnaire score was 85 (maximum 100), AOFAS pain 35.6 (maximum 40), and AOFAS function 40.1 (maximum 45). Patient satisfaction surveys correlated with the AOFAS scores and revealed that 7 of 9 patients were very satisfied with their results, 1 was satisfied, and 1 patient was very dissatisfied. CONCLUSION Particulated juvenile cartilage allograft transplantation is a promising treatment option for symptomatic first metatarsophalangeal focal articular cartilage lesions. Further study is needed to demonstrate which lesions respond better to this type of cartilage graft versus traditional marrow-stimulating procedures. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Paredes-Carnero X, Fernández-Cebrián AM, Villardefrancos-Gil S. Do Postoperative Hallux Angles Correlate With Outcome in MP1 Fusion? Our Experience With 71 Cases. Foot Ankle Spec 2018; 11:1938640017751186. [PMID: 29310462 DOI: 10.1177/1938640017751186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine if the postoperative alignment of the hallux influences the final clinical outcome of hallux metatarsophalangeal joint (first MTPJ) arthrodesis. METHODS A total of 71 consecutive cases (hallux rigidus) were studied in stages 3 and 4. They were operated through arthrodesis between 2008 and 2014. The follow-up mean was 7.3 years. The AOFAS (American Orthopaedic Foot and Ankle Society) test was performed preintervention and per annum. In radiology, both the hallux valgus angle and the dorsiflexion angle of the first MTPJ were studied. Furthermore, clinical outcomes were evaluated according to the type of implant used. RESULTS Preoperative AOFAS score was 27.5, rising to 91.3 after the intervention ( P < .01). The improvement test average was 63.6. There were 17 local complications (23%), 7 of them were considered to be major complications (9%), 6 of which needed reoperation (8.5%). The dorsiflexion angle postoperative mean was 21.7°. The hallux valgus angle postoperative mean was 10.9°. No correlations between both angles, and improved AOFAS score or complications ( P > .4 and P > .5, respectively), were found. Patients who had a dorsiflexion angle higher than 20° had greater improvement in the AOFAS score compared with those who had angles lower than 20° (64.5 vs 59.6 points). Nevertheless, this result was not statistically significant ( P = .059). No differences in AOFAS score improvement regarding arthrodesis plate ( P > .1) were found. CONCLUSION First MTPJ arthrodesis is a good alternative for patients in advanced hallux rigidus stages when conservative treatment fails. We could not confirm if a better postoperative alignment may influence in clinical outcomes. However, better results are obtained with dorsiflexion angle greater than 20° than with those with less than 20°. Likewise, any differences between the 2 arthrodesis plates have been able to confirm. LEVELS OF EVIDENCE Level III: Retrospective cohort study.
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Affiliation(s)
- Xavier Paredes-Carnero
- Servizo de Cirurxía Ortopédica e Traumatoloxía, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | - Silvia Villardefrancos-Gil
- Servizo de Cirurxía Ortopédica e Traumatoloxía, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
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Stevens J, de Bot RT, Hermus JP, van Rhijn LW, Witlox AM. Clinical Outcome Following Total Joint Replacement and Arthrodesis for Hallux Rigidus. JBJS Rev 2017; 5:e2. [DOI: 10.2106/jbjs.rvw.17.00032] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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50
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Goldberg A, Singh D, Glazebrook M, Blundell CM, De Vries G, Le ILD, Nielsen D, Pedersen ME, Sakellariou A, Solan M, Younger ASE, Daniels TR, Baumhauer JF. Association Between Patient Factors and Outcome of Synthetic Cartilage Implant Hemiarthroplasty vs First Metatarsophalangeal Joint Arthrodesis in Advanced Hallux Rigidus. Foot Ankle Int 2017; 38:1199-1206. [PMID: 28820949 DOI: 10.1177/1071100717723334] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We evaluated data from a clinical trial of first metatarsophalangeal joint (MTPJ1) implant hemiarthroplasty and arthrodesis to determine the association between patient factors and clinical outcomes. METHODS Patients ≥18 years with hallux rigidus grade 2, 3, or 4 were treated with synthetic cartilage implant MTPJ1 hemiarthroplasty or arthrodesis. Pain visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM) sports and activities of daily living (ADL) scores, and Short Form-36 Physical Function (SF-36 PF) subscore were obtained preoperatively, and at 2, 6, 12, 24, 52, and 104 weeks postoperatively. Final outcome data, great toe active dorsiflexion motion, secondary procedures, radiographs, and safety parameters were evaluated for 129 implant hemiarthroplasties and 47 arthrodeses. The composite primary endpoint criteria for clinical success included VAS pain reduction ≥30%, maintenance/improvement in function, no radiographic complications, and no secondary surgical intervention at 24 months. Predictor variables included hallux rigidus grade; gender; age; body mass index (BMI); symptom duration; prior MTPJ1 surgery; preoperative hallux valgus angle, range of motion (ROM), and pain. Two-sided Fisher exact test was used ( P < .05). RESULTS Patient demographics and baseline outcome measures were similar. Success rates between implant MTPJ1 hemiarthroplasty and arthrodesis were similar ( P > .05) when stratified by hallux rigidus grade, gender, age, BMI, symptom duration, prior MTPJ1 surgery status, and preoperative VAS pain, hallux valgus, and ROM. CONCLUSION Synthetic cartilage implant hemiarthroplasty was appropriate for patients with grade 2, 3, or 4 hallux rigidus. Its results in those with associated mild hallux valgus (≤20 degrees) or substantial preoperative stiffness were equivalent to MTPJ1 fusion, irrespective of gender, age, BMI, hallux rigidus grade, preoperative pain or symptom duration. LEVEL OF EVIDENCE Level II, randomized clinical trial.
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Affiliation(s)
- Andy Goldberg
- 1 Stanmore Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom.,2 Division of Surgery & Interventional Science, UCL, London, United Kingdom
| | - Dishan Singh
- 1 Stanmore Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Mark Glazebrook
- 3 Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
| | | | - Gwyneth De Vries
- 5 Dalhousie University and Memorial University of Newfoundland, Fredericton, New Brunswick, Canada
| | - Ian L D Le
- 6 University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Matthew Solan
- 10 Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - Alastair S E Younger
- 11 Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy R Daniels
- 12 Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Judith F Baumhauer
- 13 Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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