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Jimenez Mosquea TR, Colasanti CA, Ubillus HA, Walls RJ. Revision Surgery for Failed Polyvinyl Alcohol Hydrogel Implant in the First MTP Joint: A Case Report and Comprehensive Review. FOOT & ANKLE ORTHOPAEDICS 2025; 10:24730114251330300. [PMID: 40297397 PMCID: PMC12033773 DOI: 10.1177/24730114251330300] [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: 04/30/2025] Open
Abstract
Background Hallux rigidus is a degenerative condition of the first metatarsophalangeal (MTP) joint that can significantly impair function and quality of life. The introduction of polyvinyl alcohol (PVA) hydrogel implants, such as Cartiva, offered an alternative to arthrodesis by preserving joint motion. However, failures of these implants, often resulting in bone loss and joint instability, present a challenge for revision surgery. Methods We report the case of a 43-year-old woman with persistent pain and functional limitations after a failed PVA hydrogel implant in the first MTP joint. The revision surgery involved a biologic resurfacing using the Osteochondral Autograft Transfer System (OATS) with a graft harvested from the ipsilateral femoral condyle, complemented by interpositional arthroplasty with a dermal graft and a proximal phalanx closing wedge osteotomy to correct residual hallux valgus. Results At the 3-year follow-up, the patient-reported complete resolution of pain and returned to full activity with improved range of motion (40 degrees dorsiflexion, 15 degrees plantarflexion). Radiographic evaluation demonstrated graft incorporation and restoration of joint space, confirming the success of the procedure. Conclusion This case highlights the potential of OATS combined with interpositional arthroplasty as a viable option for revision surgery in complex cases of failed synthetic cartilage implants in hallux rigidus. By addressing bone loss and preserving joint function, this approach provides a patient-specific alternative to traditional arthrodesis. Further studies are warranted to establish the long-term efficacy of this technique in similar cases. Level of Evidence Level V, case report.
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Affiliation(s)
| | | | - Hugo A. Ubillus
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Raymond J. Walls
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Mariano AA, Fallat LM. Comparison outcomes of cheilectomy, hemi-implant arthroplasty and decompression osteotomy for the treatment of hallux rigidus: A retrospective study of 153 patients. J Foot Ankle Surg 2025:S1067-2516(25)00061-4. [PMID: 40119870 DOI: 10.1053/j.jfas.2025.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 02/23/2025] [Accepted: 03/04/2025] [Indexed: 03/24/2025]
Abstract
This retrospective case series investigated the treatment outcomes for hallux rigidus. A total of 153 patients (130 females, 49 males) were included. Of the 153 patients, 26 were bilateral and 179 procedures met the inclusion criteria. The patients had undergone 1 of the following procedures: cheilectomy (Group 1), hemi-implant arthroplasty (Group 2), decompression metatarsal osteotomy (DMO) (Group 3), and DMO with hemi-implant (Group 4). Mean patient age was 57 years (range 18-82), and the mean follow-up period was 26 months (range 12-72). All patients regardless of procedure had improvement in pain score with Group 4 demonstrating the greatest reduction in pain at 99 %. The majority of patients in the study had Stage II hallux limitus/rigidus (HL/HR) (67 patients), followed by 62 patients with Stage III and 49 patients with Stage IV. Preoperatively, the majority of patients lacked dorsiflexion at the first metatarsophalangeal joint. Group 1 gained 16° in dorsiflexion from preoperative to postoperative, Group 2 gained 20°, Group 3 gained 30° and Group 4 gained 24° by the 12 month followup. The results revealed that adhesions were the most common complication for all 4 surgical groups. These four surgical procedures for the treatment of Stage II, III and IV hallux rigidus are viable options and lead to satisfactory long-term outcomes that restore function, relieve pain and improve joint range of motion. Each procedure has demonstrated satisfactory long-term outcomes and high patient satisfaction.
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Affiliation(s)
- Ashley A Mariano
- Corewell Health Wayne Hospital, Podiatric Foot and Ankle Surgical Residency, 7300 N Canton Center Rd, Wayne, MI 48187, United States.
| | - Lawrence M Fallat
- Corewell Health Wayne Hospital, Podiatric Foot and Ankle Surgical Residency, Wayne, MI, United States
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Longo UG, Papalia R, Mazzola A, De Salvatore S, Marinozzi A, Campi S, Piergentili I, D'Hooghe M, Zaffagnini S, Samuelsson K, Denaro V. Epidemiology of hallux valgus surgery in Italy: A nationwide study from 2001 to 2016. J Exp Orthop 2025; 12:e70142. [PMID: 39949710 PMCID: PMC11822264 DOI: 10.1002/jeo2.70142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 10/18/2024] [Accepted: 11/19/2024] [Indexed: 02/16/2025] Open
Abstract
Purpose This study intended to estimate the annual number of hallux valgus surgical procedures in Italy and the patients' epidemiological features. A secondary goal was to compare the demographic differences in access to hallux valgus surgery amongst three Italian macroregions. Methods The analysis was conducted by using the National Hospital Discharge Records database provided by the Italian Ministry of Health. Results 721,514 surgical procedures for Acquired Hallux valgus were performed. The cumulative incidence was 88.2 procedures for every 100,000 Italian residents. The highest number of procedures was found in the 60-64 age class. 91.2% of patients were females. The mean length of hospitalisation was 2.1 ± 2.2 days. Patients aged 95-99 had more days of hospitalisation on average. 51.9% of procedures were performed in the North, 25.7% in the Centre and 22.4% in the South. 98.5% of patients from the North received surgical treatment in the same macroregion of domicile: 90% in the Centre and 78.5% in the South. The main primary procedure was: bunionectomy with soft tissue correction and osteotomy of the first metatarsal (79.9%, 77.51 International Classification of Diseases, Ninth Revision, Clinical Modification code). Conclusions The socio-economic burden of hallux valgus surgery in Italy is relevant. The incidence of hallux valgus surgery has progressively increased between 2001 and 2012 and decreased from 2012 to 2016. A geographically unequal distribution of procedures between the three Italian macroregions was pointed out. Migratory flows of patients from the South to the North for undergoing the procedure were observed. Level of Evidence Level III.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
| | - Alessandro Mazzola
- Fondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
| | | | - Andrea Marinozzi
- Fondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
| | - Stefano Campi
- Fondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
| | - Ilaria Piergentili
- CNR‐IASI, Laboratorio di Biomatematica, Consiglio Nazionale delle RicercheIstituto di Analisi dei Sistemi ed InformaticaRomeItaly
| | | | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine CenterGothenburgSweden
- Department of OrthopaedicsInstitute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of OrthopaedicsSahlgrenska University HospitalMölndalSweden
| | - Vincenzo Denaro
- Fondazione Policlinico Universitario Campus Bio‐MedicoRomaItaly
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and SurgeryUniversità Campus Bio‐Medico di RomaRomaItaly
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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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Lewis TL, Trowbridge S, Franklin S, Lau B, Shehata R, Lyle S, Ray R. Cartiva interpositional arthroplasty versus arthrodesis in the treatment of Hallux rigidus: A retrospective comparative study with mean 2 year follow up. Foot Ankle Surg 2024; 30:587-593. [PMID: 38744636 DOI: 10.1016/j.fas.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Hallux rigidus is a common condition characterised by first metatarsophalangeal joint (MTPJ) degeneration, pain and limited range of motion (ROM). The gold standard surgical treatment is arthrodesis, providing good pain relief, but sacrifices ROM. The Cartiva synthetic cartilage implant (SCI) has been utilised as an interpositional arthroplasty, aiming to reduce pain whilst preserving range of motion. Current evidence for Cartiva SCI is limited. The aim was to evaluate the clinical outcomes of Cartiva SCI compared to arthrodesis undertaken in our centre. METHODS A retrospective cohort study was conducted, enrolling all adult patients who underwent primary first MTPJ SCI arthroplasty or arthrodesis for the treatment hallux rigidus. The primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire (MOXFQ). Secondary outcomes included EQ-5D, complication rates, VAS Pain and FAAM (ADL). RESULTS Between 2017 and 2020 there were 33 cases divided into two groups (17 Cartiva SCI, 16 arthrodesis, mean age 59.0 ± 9.9 years) with a mean follow up of 2.3 years. There was no statistically significant difference in any of the MOXFQ, EQ-5D, VAS Pain or FAAM (ADL) outcome scores between the Arthrodesis and SCI groups (p > 0.05). The mean MOXFQ Index score was 7.2 ± 6.4 for the SCI group and 3.9 ± 5.8 for the Arthrodesis group at final follow up (p = 0.15). Although complications were high in both groups, the overall hallux reoperation rate was 29.4 % in the SCI cohort and 0.0 % for arthrodesis. CONCLUSION This retrospective comparative study found no significant superiority of Cartiva SCI over arthrodesis in terms of PROMs. Due to the higher rate of further surgical intervention in the SCI cohort, we recommend arthrodesis as the preferred surgical option for hallux rigidus. LEVEL OF EVIDENCE III.
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Affiliation(s)
- T L Lewis
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom.
| | - S Trowbridge
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - S Franklin
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - B Lau
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - R Shehata
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - S Lyle
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - R Ray
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
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6
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Michelson JD, Charlson MD, Bernknopf JW, Carpenter RL, Brand SJ. The Role of the Flexor Hallucis Longus in the Treatment of the Painful Hallux Metatarsophalangeal Joint. Foot Ankle Int 2024; 45:1051-1058. [PMID: 39080927 DOI: 10.1177/10711007241266842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2024]
Abstract
BACKGROUND Pain in the hallux metatarsophalangeal joint (MTPJ) is very common, yet the underlying etiology remains unknown. Previous clinical research and biomechanical research has implicated stenosing flexor hallucis longus (FHL) tendonitis as a possible cause. The hypothesis of this study was that treatment solely focusing on alleviating restricted FHL excursion would be beneficial in patients with hallux MTPJ pain. METHODS This is a retrospective study of those treated in the Foot & Ankle Division between January 2009, and December 2018, who were diagnosed with FHL tendonitis with associated pain in the hallux MTPJ. Demographics, comorbidities, examination findings, imaging results, pain scores, treatment instituted, and outcome was obtained from the electronic medical record. The primary outcome was the improvement in the pain score (visual analog scale [VAS]). The surgical patients were included if their procedure was solely related to the FHL (posteromedial ankle release ± os trigonum resection). The decision to have surgery was analyzed by univariate and multivariable statistics using demographics, comorbidities, and clinical findings as potential factors (P < .05). RESULTS In 75% (59 of 79 feet), nonoperative treatment of FHL stenosis resulted in a decrease in pain scores that the patients felt was satisfactory. The operative group that had an FHL release showed decreased pain in 90% (18 of 20 feet). Multivariable analysis identified the need for immobilization (OR 9.8, 95% CI 1.8-55.2, P = .009), participating in athletics (OR 8.7, 95% CI 1.8-42.2, P = .007), and higher initial VAS (OR 1.7, 95% CI 1.3-2.3, P < .001) as being associated with the decision for surgery. CONCLUSION Previous biomechanical studies have suggested that stenosing FHL synovitis can cause increased intraarticular loading in the hallux MTPJ. The current clinical study supports this hypothesis, demonstrating that treatment focused on relieving restricted FHL excursion can ameliorate pain in the hallux MTPJ in select cases.
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Affiliation(s)
- James D Michelson
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Mark D Charlson
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Jacob W Bernknopf
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Rachel L Carpenter
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Stephen J Brand
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, USA
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Acker AS, Mendes de Carvalho KA, Hanselman AE. Hallux Rigidus: Update on Conservative Management. Foot Ankle Clin 2024; 29:405-415. [PMID: 39068017 DOI: 10.1016/j.fcl.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Hallux rigidus is a degenerative arthritic condition affecting the first metatarsophalangeal joint. Prevalence in patients aged 50 years and above is estimated at 20% to 30%, with a portion being symptomatic. Conservative treatment's efficacy is linked to initial pain levels; though shoe modifications and insoles are commonly recommended, their true effectiveness lacks strong evidence. Injection therapy, including corticosteroids and hyaluronic acid, demonstrates varied outcomes, with about 50% of patients undergoing surgery within 1 to 2 years. The condition's etiology remains elusive, but recent biomechanical hypotheses hold promise.
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Affiliation(s)
- Antoine S Acker
- Department of Orthopaedic Surgery, Research Scholar, Duke University, Durham, NC, USA; Centre of Foot and Ankle Surgery, Clinique La Colline, Geneva, Switzerland.
| | | | - Andrew E Hanselman
- Department of Orthopaedic Surgery, Research Scholar, Duke University, Durham, NC, USA
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8
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Williams BT, Hunt KJ. Hallux Rigidus: Anatomy and Pathology. Foot Ankle Clin 2024; 29:371-387. [PMID: 39068015 DOI: 10.1016/j.fcl.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Hallux rigidus is a common degenerative condition of the hallux metatarsophalangeal joint (MTPJ) characterized by pain, swelling, stiffness, and limited range of motion with characteristic corresponding clinical, physical examination, and radiographic findings. Many historical risks factors including trauma and family history and patient factors including hallux valgus interphalangeus and inflammatory arthropathies have a well-substantiated etiologic role in the disease process. The purpose of this section is to review the normal and pathologic anatomy and biomechanics of the hallux MTPJ while providing an overview of the current understanding and remain debate regarding the disease process.
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Affiliation(s)
- Brady T Williams
- Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, University of Colorado, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA
| | - Kenneth J Hunt
- Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, University of Colorado, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA.
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9
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Acker AS, Liles J, Easley ME. Arthrodesis for Hallux Rigidus. Foot Ankle Clin 2024; 29:507-520. [PMID: 39068025 DOI: 10.1016/j.fcl.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
First metatarsophalangeal (MTP) joint fusion, or arthrodesis, has been a cornerstone treatment for advanced joint degeneration since the 1950s, benefiting not only older patients but also younger individuals. The procedure boasts favorable long-term outcomes and a low rate of revision when fusion is successful. However, complications such as interphalangeal arthritis may occur, and nonunion or malunion can necessitate revision. While the first MTP fusion provides significant relief, its applicability varies, underscoring the need for careful patient selection.
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Affiliation(s)
- Antoine S Acker
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA; Centre of Foot and Ankle Surgery, Clinique La Colline, Geneva, Switzerland.
| | - Jeffrey Liles
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
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10
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Kim KC, Schmidt E, de Carvalho KAM, Lalevee M, Mansur N, Dibbern K, Auch E, Behrens A, Netto CDC. Prevalence of midfoot arthritis and lesser toe deformities. Foot Ankle Surg 2024; 30:423-431. [PMID: 38490924 DOI: 10.1016/j.fas.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/23/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The aim of this study was to investigate the epidemiology of Midfoot Arthritis (MA) and Lesser toe deformity (LTD) using Weight-Bearing Computed Tomography (WBCT). METHODS 606 cases (247 male, 359 female) among 1316 consecutive cases with WBCT data from September 2014 to April 2022 were retrospectively reviewed at a single referral institution. The Cochran-Armitage test was performed to evaluate the trend of prevalence with respect to age group and obesity classification. RESULTS 139 male (56.3%) and 210 female cases (58.5%) showed MA. 157 male (63.6%) and 222 female cases (61.6%) showed LTD. 115 male (19.0%) and 157 female cases (25.9%) showed both MA and LTD. The prevalence of MA and LTD increased with age in both genders. The incidence of MA in males showed an increasing tendency until obesity class II and then was slightly decreased in obesity class III. This is contrary to females whose prevalence increased with increasing obesity groups. LTD had a similar pattern in both genders to obesity classification. CONCLUSIONS The prevalence of MA and LTD increased with age and increasing obesity groups for both genders. LEVEL OF EVIDENCE Level III, Retrospective Comparative Study.
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Affiliation(s)
- Ki Chun Kim
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea.
| | - Eli Schmidt
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Matthieu Lalevee
- Department of Orthopedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000 Rouen, France
| | - Nacime Mansur
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kevin Dibbern
- Orthopaedic and Rehabilitation Engineering Center, Marquette and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elijah Auch
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Andrew Behrens
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Lee W, Wang C, Prat D, Wapner KL, Chao W, Farber DC. Patient Satisfaction Following Hallux Rigidus Treatment With a Synthetic Cartilage Implant. Foot Ankle Spec 2023; 16:527-536. [PMID: 33769110 DOI: 10.1177/19386400211001993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There remains no clear consensus on patient satisfaction and functional outcomes following synthetic cartilage implant (SCI) implantation for hallux rigidus. The purpose of this study was to review our experience at a single academic institution using an SCI for treatment of hallux rigidus. METHODS A retrospective review was performed of patients who underwent the SCI procedure for treatment of hallux rigidus between January 2017 and May 2019. Functional outcomes were evaluated using Patient-Reported Outcome Measures Informational System (PROMIS)-10 scores as well as a survey investigating patient satisfaction, self-reported clinical improvement, and changes in sporting ability. Patients were divided into satisfied versus unsatisfied subgroups, and between-group differences in preoperative variables and complications were reviewed. A total of 90 patients (96 implants) were included in this study. The mean follow-up time was 26.4 months. RESULTS In all, 81.2% of patients reported that their foot was "much improved" (55.2%) or "improved" (26.0%) since undergoing the SCI procedure, whereas a slightly lower percentage, 74.0%, stated that they were "extremely satisfied" (41.7%) or "satisfied" (32.3%) at final follow-up. Patients were able to tolerate higher impact sporting activities after the procedure, and 75.0% of patients stated they would have the same surgery again. PROMIS-10 T-scores averaged 54.2 points for physical health and 57.4 points for mental health. Only 2.1% of patients required conversion to arthrodesis. Significant differences between the satisfied versus unsatisfied subgroups were found in preoperative corticosteroid injection use (21.1% vs 41.1%, respectively; P = .029) and preoperative VAS pain score (8.2 vs 7.1, respectively; P = .036). CONCLUSION The SCI procedure can be a viable option for treating hallux rigidus with high satisfaction overall, increased sport activity levels, and a very low revision rate. However, maximizing patient satisfaction may require more careful consideration of preoperative prognosticators and extensive patient counseling to ensure realistic expectations for recovery time and individual outcome. LEVEL OF EVIDENCE Level IV: Retrospective case series.
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Affiliation(s)
- Wonyong Lee
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Carol Wang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dan Prat
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Keith L Wapner
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Wen Chao
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Daniel C Farber
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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12
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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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Elattar O, Andrews NA, Halstrom J, Harrelson WM, Nair P, Shah A. A Novel Plating System for First Metatarsophalangeal Joint Arthrodesis: A Retrospective Comparison of Hybrid and Traditional Locking Plate Constructs. Foot Ankle Spec 2023; 16:537-546. [PMID: 35048726 DOI: 10.1177/19386400211067860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dorsal plate fixation is commonly used for first metatarsophalangeal joint (1st MTPJ) arthrodesis and plate design continues to evolve. A new staple compression plate (SCP) design attempts to utilize the continuous compression of a nitinol staple across the fusion site while simultaneously providing the stability of a dorsal locked plate. Herein, we compare the radiographic, clinical, and patient-reported outcomes of 1st MTPJ joint arthrodesis using 2 dorsal locking plate constructs including a novel SCP construct. METHODS Forty-four patients who underwent 1st MTPJ arthrodesis between 2016 and 2020 were retrospectively evaluated. There were 2 group cohorts. Group 1 cohort included 23 patients who received a CrossRoads Extremity SCP, and Group 2 cohort included 21 patients who received a Stryker dorsal locking precontoured titanium plate (LPP). All patients were evaluated with radiographs, Patient-Reported Outcomes Measures Information System (PROMIS) outcome scores, and Foot Function Index (FFI). RESULTS The complication and union rates did not vary between groups with a fusion rate of 95.7% in the SCP group and 90.5 % in the LPP group. Similarly, we found no significant differences in PROMIS or FFI scores between the SCP and LPP plates. CONCLUSION Use of either dorsal locking plate construct for 1st MTPJ arthrodesis was associated with high union rates and comparable functional outcomes. As locked plate technology continues to evolve for 1st MTPJ arthrodesis, it is important that clinical outcomes are reported. LEVELS OF EVIDENCE Level IV.
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Affiliation(s)
- Osama Elattar
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicholas A Andrews
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jared Halstrom
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Whitt M Harrelson
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Pallavi Nair
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Ashish Shah
- The University of Toledo, Toledo, and Ohio and Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
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14
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Alshehri AS, Alzahrani FA, Alqahtani LS, Alhadlaq KH, Alshabraqi HA, Aljaafri ZA. Outcomes of Operative Versus Nonoperative Management for Hallux Rigidus: A Tertiary Care Center Experience. Cureus 2023; 15:e46991. [PMID: 38022308 PMCID: PMC10640908 DOI: 10.7759/cureus.46991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background This study aims to investigate and report the outcomes of various management modalities used for hallux rigidus, a common form of degenerative joint disease affecting the foot and ankle. The research focuses on understanding the pathophysiology, classification systems, and nonoperative approaches such as medical therapy, intra-articular injections, shoe modifications, and physical therapy. Surgical techniques, including joint-sparing and joint-sacrificing procedures, are explored, considering factors such as disease stage and patient preferences. Methods A retrospective cohort study was conducted at King Abdulaziz Medical City (KAMC), Riyadh. The study included all patients who were diagnosed with hallux rigidus from the period 2016 to 2022. Data were collected through the BESTCare system at KAMC. All the data were collected through Microsoft Excel (Microsoft Corporation, Redmond, Washington) and transferred for analysis. Statistical analysis was performed using the IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York). Frequencies and percentages were used to detail categorical variables, whereas continuous variables were examined by the mean and standard deviation. A p-value of <0.05 was considered to report the statistical significance. Results A total of 84 patients were included. The majority were women (60.7%). Diabetes and hypertension were prevalent comorbidities, affecting 21.4% and 35.7% of patients, respectively. Nonoperative management was the most common approach (66.7%). Complications were minimal (2.4% infections, 1.2% metatarsalgia), and 67.9% of patients reported no persistence of symptoms after treatment. Conclusion The low complication rates and the lack of significant associations between treatment modalities and outcomes suggest the generally safe and effective nature of the employed interventions. These findings can guide clinicians in making informed decisions regarding the management of hallux rigidus, while also highlighting areas for further research to improve treatment strategies and outcomes.
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Affiliation(s)
- Ali S Alshehri
- Orthopedic Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, SAU
- Orthopedic Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Faisal A Alzahrani
- Orthopedic Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, SAU
- Orthopedic Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Lujain S Alqahtani
- Orthopedic Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, SAU
- Orthopedic Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Khalid H Alhadlaq
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Orthopedic Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Halah A Alshabraqi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Orthopedic Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Ziad A Aljaafri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Orthopedic Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
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15
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Cai Y, Song Y, He M, He W, Zhong X, Wen H, Wei Q. Global prevalence and incidence of hallux valgus: a systematic review and meta-analysis. J Foot Ankle Res 2023; 16:63. [PMID: 37726760 PMCID: PMC10510234 DOI: 10.1186/s13047-023-00661-9] [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: 02/02/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Though hallux valgus is a common foot deformity, the integrated information on its global prevalence and incidence is relatively lacking. The aim of this research was to assess the global prevalence and incidence of hallux valgus, thus providing reliable data reference for clinical practice. METHODS A systematic review of global hallux valgus research publications concerning its prevalence and incidence was performed based on six electronic databases ((PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), China Online Journals and CQVIP)) from their inception to November 16, 2022. The search terms included "hallux valgus or bunion and prevalence or incidence or epidemiology." All languages were included. Data were extracted by country, continent, age group, gender and other information. The risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Instrument for Studies Reporting Prevalence Data by using random-effects models to synthesize available evidence. RESULTS A total of 45 studies were included in the meta-analysis. The overall pooled estimated prevalence was 19% (95% CI, 13% to 25%) (n=186,262,669) for hallux valgus. In subgroup meta-analyses, the prevalence of hallux valgus was 21.96% (95% CI, 10.95% to 35.46%) in Asia, 3% (95% CI, 0% to 15%) in Africa, 18.35% (95% CI, 11.65% to 26.16%) in Europe, 29.26% (95% CI, 4.8% to 63.26%) in Oceania, and 16.1% (95% CI, 5.9% to 30.05%) in North America, respectively. The pooled prevalence of hallux valgus by gender was 23.74% (95% CI, 16.21% to 32.21%) for females and 11.43% (95% CI, 6.18% to 18%) for males. The prevalence was 11% (95% CI, 2% to 26%) in individuals younger than 20 years old, 12.22% in adults aged 20-60 years (95% CI, 5.86% to 20.46%) and 22.7% in elderly people aged over 60 years (95% CI, 13.1% to 33.98%). CONCLUSION This research provided the global prevalence and incidence of hallux valgus in terms of its spatial, temporal, and population distribution. The global estimated pooled prevalence and incidence of hallux valgus was 19%. A higher prevalence of hallux valgus was found in females, Oceania countries, and among people aged over 60 years. Due to the high heterogeneity of the included studies, the findings should be interpreted with caution.
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Affiliation(s)
- Yangting Cai
- Guangzhou University of Chinese Medicine, NO.12, Jichang Road, Baiyun District, Guangzhou, 510405, P. R. China
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China
| | - Yuke Song
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China
| | - Mincong He
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China
| | - Wei He
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China
| | - Xianxin Zhong
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China
| | - Hao Wen
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China.
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China.
| | - Qiushi Wei
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China.
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, NO.261, Longxi Road, Liwan District, Guangzhou, 510378, P. R. China.
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16
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Footwear-to-feet examination and analysis: Comparing worn footwear to persons and human remains. Sci Justice 2023; 63:54-60. [PMID: 36631181 DOI: 10.1016/j.scijus.2022.11.002] [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: 07/25/2022] [Revised: 09/29/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
Footwear-to-feet examination and analysis refers to the process of examining and analyzing footwear in regard to criminal matters. This examination and analysis has been done to include or exclude an individual as the wearer of the footwear in question and to help associate or disassociate human remains to footwear. This review of the subject describes its investigative applications, the research that underpins the process, and considers its legal admissibility. The process of footwear-to-feet examination and analysis is scientifically valid and has been widely accepted. As a result, law enforcement and forensic scientists should be aware of the use of this process to assist in criminal investigations.
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17
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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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18
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Abstract
Hallux rigidus can be treated with a variety of surgical procedures, including joint preserving techniques, arthrodesis, and arthroplasty. The most commonly reported complications for joint preserving techniques consist of progression of arthritis, continued pain, and transfer metatarsalgia. Although good outcomes have been reported for arthrodesis overall, careful attention must be paid to technique and positioning of the toe to avoid nonunion or malunion. Arthroplasty preserves motion but in the case of failure can present the additional challenge of bone loss. In these scenarios, the authors recommend distraction bone block arthrodesis with structural autograft.
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Affiliation(s)
- Maj Patrick D Grimm
- Dwight D. Eisenhower Army Medical Center, 300 West Hospital Road, Fort Gordon, GA 30905, USA
| | - Todd A Irwin
- OrthoCarolina Foot and Ankle Institute, Atrium Health Musculoskeletal Institute, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207, USA.
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19
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Merian M, Kaim A. The Plantar Fascia Talar Head Correlation: A Radiographic Parameter With a Distinct Threshold to Validate Flatfoot Deformity and Its Corrective Surgery on Conventional Weightbearing Radiographs. Foot Ankle Int 2022; 43:414-425. [PMID: 34802299 DOI: 10.1177/10711007211052258] [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 Corrective surgery for flexible flatfoot deformity (FD) remains controversial, and one of the main reasons for this is the lack of standardized radiographic measurements to define an FD. Previously published radiographic parameters to differentiate between a foot with and without an FD do not have a commonly accepted and distinct threshold. METHODS The plantar fascia-talar head correlation (PTC) with its defined threshold was assessed by measuring the distance between the medial border of the plantar fascia and the center of the talar head (DPT) on conventional dorsoplantar and lateral weightbearing radiographs; the authors were blinded to the clinical diagnosis of the 189 patients' first visits. Feet were sorted into groups with and without an FD based on their clinical examination. The effect of operative corrections of FD on the PTC was retrospectively evaluated on an additional 38 patients. RESULTS The sensitivity of the PTC was 0.98 (95% CI: 0.9-1) and specificity 0.96 (95% CI: 0.92-0.98), respectively, to identify an FD, consistent with the clinical examination. Thirty-five of 38 surgeries sufficiently corrected the FD and the PTC comparable to that in subjects without an FD. Three corrections with a residual FD did not adequately correct the PTC. CONCLUSION The PTC is a reliable radiographic parameter with a distinct threshold that is sensitive and specific for the differentiation of feet with and without an FD including feet with and without residual FD after corrective surgery. The PTC is applicable to monitor the needed intraoperative amount of correction using simulated weightbearing fluoroscopy. LEVEL OF EVIDENCE Level III, diagnostic.
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Affiliation(s)
- Marc Merian
- Praxis für Fuss- und Sprunggelenkschirurgie, Klinik Birshof Hirslanden AG, Münchenstein, Switzerland
| | - Achim Kaim
- Department of Radiology, Klinik Birshof Hirslanden AG, Münchenstein, Switzerland
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20
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Avidos LMMA, Diz JCG, Ribeiro FN, Padin-Iruegas ME, Neves JM. The influence of subtalar axis orientation on the foot posture of older adults in a closed kinetic chain. GERIATRICS, GERONTOLOGY AND AGING 2022. [DOI: 10.53886/gga.e0220014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives: This study compared the influence of subtalar axis position on foot behavior in a closed kinetic chain in older and younger adults. Methods: The sample included 50 older adults and a control group of 50 younger adults. The variables were initially analyzed for both feet together, and were later analyzed separately, comparing each foot (right and left) between groups. Range of motion was assessed by validated goniometric procedures: the position of subtalar axis was evaluated by the palpation technique, while the Foot Posture Index was used to assess behavior in a closed kinetic chain. Student’s t-test / Mann-Whitney test compared the main variables according to sample distribution, while Student’s t-test / Wilcoxon test was used for paired samples. A standardized Haberman residuals test was also used to determine the connection between the position of subtalar joint axis and the Foot Posture Index. Results: Data from the right and left feet were similar for all variables. The older group had reduced mobility in the ankle and first metatarsophalangeal joint (5.42º [SD (Standard Deviation), 4.49] and 76.12º [SD, 19.24], respectively) with statistically significant values, (p < 0.001). The difference in subtalar axis position was not significant (p = 0.788), with more internal deviations in both groups. There was a significant difference in Foot Posture Index (p = 0.006, by applying the chi-square test), with the normal position more prevalent in the older group and the prone position more prevalent in the younger group. Conclusions: Regarding internal deviations in the subtalar joint axis, the older group had a higher frequency of feet in the normal position, while the younger group had a higher frequency of feet in the prone position which, in this case, agrees with the rotational balance theory. For the normal axis position, a higher frequency of normal position was found in both groups. Regarding external deviations of the subtalar joint axis, neither group followed the pattern expected in rotational balance theory. The most consistent connection in the older group was between external axis position and supine foot position, whereas in the younger group it was between normal axis position and normal foot position.
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21
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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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22
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Joo PY, Baumhauer JF, Waldman O, Hoffman S, Houck J, Kohring JM, Flemister AS, Ketz JP, DiGiovanni BF, Oh I. Physical Function and Pain Interference Levels of Hallux Rigidus Patients Before and After Synthetic Cartilage Implant vs Arthrodesis Surgery. Foot Ankle Int 2021; 42:1277-1286. [PMID: 34024138 DOI: 10.1177/10711007211007843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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 a common and painful degenerative condition of the great toe limiting a patient's physical function and quality of life. The purpose of this study was to investigate pre- and postoperative physical function (PF) and pain interference (PI) levels of patients undergoing synthetic cartilage implant hemiarthroplasty (SCI) vs arthrodesis (AD) for treatment of hallux rigidus using the Patient-Reported Outcomes Measurement Information System (PROMIS). METHODS PROMIS PF and PI t scores were analyzed for patients who underwent either SCI or AD. Postoperative final PROMIS t scores were obtained via phone survey. Linear mixed model analysis was used to assess differences in PF and PI at each follow-up point. Final follow-up scores were analyzed using independent sample t tests. RESULTS Total 181 (59 SCI, 122 AD) operatively managed patients were included for analysis of PROMIS scores. Final phone survey was performed at a minimum of 14 (mean 33, range, 14-59) months postoperatively, with 101 patients (40 SCI, 61 AD) successfully contacted. The mean final follow-up was significantly different for SCI and AD: 27 vs 38 months, respectively (P < .01). The mean age of the SCI cohort was lower than the AD cohort (57.5 vs 61.5 years old, P = .01). Average PF t scores were higher in the SCI cohort at baseline (47.1 and 43.9, respectively, P = .01) and at final follow-up (51.4 vs 45.9, respectively, P < .01). A main effect of superior improvement in PF was noted in the SCI group (+4.3) vs the AD group (+2) across time intervals (P < .01). PI t scores were similar between the 2 procedures across time points. CONCLUSION The SCI cohort reported slightly superior PF t scores preoperatively and at most follow-up time points compared with the arthrodesis group. No differences were found for PI or complication rates between the 2 treatment groups during this study time frame. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Peter Y Joo
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Judith F Baumhauer
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Olivia Waldman
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Samantha Hoffman
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey Houck
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Jessica M Kohring
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - A Samuel Flemister
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - John P Ketz
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Benedict F DiGiovanni
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Irvin Oh
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
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23
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Smyth NA, Murawski CD, Hannon CP, Kaplan JR, Aiyer AA. The Use of a Synthetic Cartilage Implant for Hallux Rigidus: A Systematic Review. Foot Ankle Spec 2021; 14:366-371. [PMID: 32618201 DOI: 10.1177/1938640020937160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background. Hallux rigidus is a common pathology afflicting the foot, for which various joint salvage techniques have been described with a multitude of different implants. Recently, a synthetic cartilage implant composed of polyvinyl alcohol (PVA) received FDA premarket approval for the treatment of arthritis of the great toe. The purpose of this study was to (1) systematically review the clinical evidence supporting the use of a PVA implant in hallux rigidus and (2) determine the strength of the recommendation that can be made supporting the use of a PVA implant by evaluating the quality of evidence available. Methods. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Using the terms "cartiva OR polyvinyl alcohol OR synthetic cartilage OR hemiarthroplasty AND hallux rigidus OR great toe arthritis OR first toe arthritis" we searched the PubMed/Medline database. The quality of the included studies was evaluated using the American Academy of Orthopaedic Surgeons Clinical Practice Guideline and Systematic Review Methodology. Results. Seven studies met the inclusion criteria, 6 of these were derived from a single randomized controlled trial. A moderate recommendation can be given for the use of a PVA implant for hallux rigidus based on short-term outcomes. A limited recommendation can be given for the use of a PVA implant for hallux rigidus based on mid-term outcomes. Conclusion. There are limited studies available detailing the outcomes of a PVA implant for hallux rigidus; however, the results that are available demonstrate a high level of evidence.Levels of Evidence: Level I: Systematic review.
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Affiliation(s)
- Niall A Smyth
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
| | - Christopher D Murawski
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
| | - Jonathan R Kaplan
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
| | - Amiethab A Aiyer
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
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Analysis of the main soft tissue stress associated with flexible flatfoot deformity: a finite element study. Biomech Model Mechanobiol 2021; 20:2169-2177. [PMID: 34331169 DOI: 10.1007/s10237-021-01500-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 07/25/2021] [Indexed: 01/01/2023]
Abstract
A better understanding of soft tissue stress and its role in supporting the medial longitudinal arch in flexible flatfoot could help to guide the clinical treatment. In this study, a 3-Dimensional finite element (FE) foot model was reconstructed to measure the stress of the soft tissue, and its variation in different scenarios related to flexible flatfoot. All bones, cartilages, ligaments and related tendons around the ankle, and fat pad were included in the finite element model. The equivalent stress on the articular surface of the joints in the medial longitudinal arch and the maximum principal stress of the ligaments around the ankle were obtained. The results show that the plantar fascia (PF) is the main tissue in maintaining the medial longitudinal arch. The equivalent stress of all the joints in the medial longitudinal arch increases when the PF attenuation and the talonavicular joint increases, while other joints decreases when all the three tissue attenuation. Moreover, the maximum principal stress variation of calcaneofibular ligament is largest when the PF attenuation and the tibionavicular ligament and posterior tibiotalar ligament are largest when the posterior tibial tendon (PTT) attenuation. The maximum principal stress variation of tibionavicular ligament and posterior tibiotalar ligament are even larger when all the three tissue attenuation. These findings support that the PF is the main factor in maintaining the medial longitudinal arch. The medial longitudinal arch collapse mainly affects the talonavicular joint and the calcaneofibular ligament, the tibionavicular ligament and the posterior tibiotalar ligament. This approach could help to improve the understanding of adult-acquired flatfoot deformity (AAFD).
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25
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Yoshida T, Tanino Y, Nakao T, Yamazaki W, Suzuki T. Examination of gait characteristics and related factors in elderly subjects with and without hallux valgus. Prog Rehabil Med 2021; 6:20210028. [PMID: 34307956 PMCID: PMC8277597 DOI: 10.2490/prm.20210028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/29/2021] [Indexed: 12/28/2022] Open
Abstract
Objective: Elderly people with hallux valgus have decreased gait speed, which can result in
reduced capacity to perform the activities of daily living. Therefore, this study
examined the gait ability and related factors of patients with hallux valgus. Methods: The study participants were 10 patients with hallux valgus and 10 without. Ground
reaction forces were measured as front–rear (X), lateral (Y), and vertical (Z)
components from the early to late stance phases. Three-dimensional motion analysis was
used to measure gait speed; touchdown distance; release distance; the angles of the limb
joints and trunk at heel contact, toe-off, and peak ground reaction force; and the
center of mass (COM) displacement in the sagittal plane. The height of the COM was
calculated as a percentage of the body height. The hallux valgus and control groups were
compared using the Mann–Whitney U-test. Results: In the hallux valgus group, the ground reaction force showed a significant increase in
the Y component in each stance phase and in the Z component in the late stance phase.
The lowest COM position in the hallux valgus group was significantly higher than that in
the control group, resulting in a smaller difference in COM height over a gait
cycle. Conclusions: The hallux valgus group was found to have reduced gait speed because of a shortened
touchdown distance. Moreover, the continued high COM position in the hallux valgus group
meant that potential energy could not efficiently be converted to kinetic energy.
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Affiliation(s)
- Takaki Yoshida
- Clinical Physical Therapy Laboratory, Kansai University of Health Sciences, Osaka, Japan
| | - Yoshitsugu Tanino
- Clinical Physical Therapy Laboratory, Kansai University of Health Sciences, Osaka, Japan
| | - Tetsuya Nakao
- Clinical Physical Therapy Laboratory, Kansai University of Health Sciences, Osaka, Japan
| | - Wataru Yamazaki
- Clinical Physical Therapy Laboratory, Kansai University of Health Sciences, Osaka, Japan
| | - Toshiaki Suzuki
- Clinical Physical Therapy Laboratory, Kansai University of Health Sciences, Osaka, Japan
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26
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Boffeli T, Duelfer K. Predicting Postoperative Sagittal Plane Alignment of the Foot Using Intraoperative Simulated Weightbearing Lateral Imaging During Flatfoot Reconstructive Surgery: A Short-Term Retrospective Analysis. J Foot Ankle Surg 2021; 60:718-723. [PMID: 33893017 DOI: 10.1053/j.jfas.2021.01.007] [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: 09/24/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 02/03/2023]
Abstract
The sagittal plane relationship of the hindfoot and midfoot joints is a primary determinant of proper alignment in flatfoot reconstructive surgery as assessed both clinically and on postoperative weightbearing (WB) lateral radiographs. The traditional approach to intraoperative radiographic imaging allows for accurate assessment of fixation placement but only a crude evaluation of final sagittal plane alignment. Surgeons employ various methods in an attempt to load the foot during lateral imaging. Skepticism exists regarding the ability of simulated WB fluoroscopy to predict the final outcome, and evidence is lacking to support this practice. A retrospective investigation was performed assessing the correlation of Meary's angle, calcaneal inclination angle, and calcaneal-1st metatarsal angle as demonstrated on intraoperative simulated WB lateral foot imaging to 10- week postoperative full WB lateral radiographs. A consistent simulated WB imaging protocol was used with 46 consecutive cases of flatfoot reconstruction in this analysis of secular trends. The average change in Meary's angle between intraoperative simulated WB and postoperative full WB was -1.09° with 89% of cases within ±5°. The average change in calcaneal-1st metatarsal angle between intraoperative simulated WB and full WB was -2.61° with 85% of cases within ±5°. The average change in calcaneal inclination angle between intraoperative simulated WB and full WB was -2.62° with 88% of cases within ±5°. These findings confirm the clinical utility of intraoperative simulated WB lateral imaging as a useful tool in predicting the postoperative sagittal plane alignment of the midfoot and rearfoot in patients undergoing flatfoot reconstructive surgery.
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Affiliation(s)
- Troy Boffeli
- Director, Foot and Ankle Surgical Residency Program, Regions Hospital, HealthPartners Institute for Education and Research, St. Paul, MN
| | - Keegan Duelfer
- Resident, Foot and Ankle Surgical Residency Program, Regions Hospital, HealthPartners Institute for Education and Research, St. Paul, MN.
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27
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Lunati M, Mahmoud K, Kadakia R, Coleman M, Bariteau J. Complications Associated with the Surgical Management of Hallux Rigidus. Orthop Clin North Am 2021; 52:291-296. [PMID: 34053574 DOI: 10.1016/j.ocl.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hallux rigidus is the most common arthritic pathology of the foot. This review article discusses the pathophysiology and common clinical presentation of hallux rigidus. Furthermore, we discuss multiple classification systems that categorize the arthritic process and guide management. Surgical interventions include cheilectomy, Moberg osteotomy, synthetic cartilage implants, interpositional arthroplasty, and arthrodesis. The common complications are reviewed, and the rates of these complications highlighted. Surgical options for hallux rigidus globally have successful outcomes with low rates of complications when done on appropriate patients.
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Affiliation(s)
- Matthew Lunati
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Karim Mahmoud
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Rishin Kadakia
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Michelle Coleman
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Jason Bariteau
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA.
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28
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Bejarano-Pineda L, Cody EA, Nunley JA. Prevalence of Hallux Rigidus in Patients With End-Stage Ankle Arthritis. J Foot Ankle Surg 2021; 60:21-24. [PMID: 33160837 DOI: 10.1053/j.jfas.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/19/2019] [Accepted: 04/07/2020] [Indexed: 02/03/2023]
Abstract
Arthritis of the foot is a significant cause of pain and disability. The prevalence of foot arthritis in adults aged ≥50 has been reported to be 17%. Of those, 25% are estimated to be radiographic arthritis of the first metatarsophalangeal joint. The purposes of this study were to (1) identify the prevalence of radiographic hallux rigidus (HR) in a population of patients with end-stage ankle arthritis relative to that reported in the general population and (2) identify associations between the presence of HR and demographic and clinical factors. A total of 870 feet in 809 subjects with end-stage ankle arthritis who underwent primary total ankle arthroplasty between November 2006 and November 2017 were included. Feet were stratified by patient age: <40, 40 to 59, 60 to 79, and ≥80 years. Etiology of ankle arthritis was classified as inflammatory, post-traumatic, primary, and other. The prevalence of HR in the study group was 72.9%. The prevalence of HR was slightly higher in patients with inflammatory arthritis (odds ratio 1.31, 95% confidence interval 0.73 to 2.32) and primary arthritis (odds ratio 1.18, 95% confidence interval 0.86 to 1.63). The prevalence of HR increased with age (p = .01). In conclusion, the prevalence of radiographic HR in a population with end-stage ankle arthritis was significantly higher relative to patients without documented comorbidities in the foot and ankle. Increasing age was associated with a higher prevalence of the disease.
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Affiliation(s)
- Lorena Bejarano-Pineda
- Fellow, Division of Sports Medicine, Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL.
| | - Elizabeth A Cody
- Assistant Attending, Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - James A Nunley
- Professor, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
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29
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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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30
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Akoh CC, Chen J, Kadakia R, Park YU, Kim H, Adams SB. Adverse events involving hallux metatarsophalangeal joint implants: Analysis of the United States Food and Drug Administration data from 2010 to 2018. Foot Ankle Surg 2021; 27:381-388. [PMID: 32505511 DOI: 10.1016/j.fas.2020.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/27/2020] [Accepted: 05/08/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prevalence of osteoarthritis of the hallux metatarsophalangeal joint (MTPJ) is 1 in 40 people over the age of 50. Surgical treatment options for MTPJ arthritis include joint preservation, joint resurfacing, and arthrodesis. Hallux MTPJ implants have evolved over the past several decades, but are associated with various complications. The aim of this study was to examine the MAUDE database to determine reported adverse events for hallux MTPJ implants. MATERIALS AND METHODS The US Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was reviewed from 2010 to 2018 to review voluntary reported adverse event reports for approved implants within the United States. We recorded the type of adverse event and excluded duplicate reports and those extracted from already published literature. RESULTS Among 64 reported hallux MTPJ implant adverse events, the most common modes of adverse events were component loosening (34%), infection (14.1%), component fracture (9.4%), inflammation (9.4%), and allergic reaction (7.8%). Regarding implant type, Cartiva SCI had the highest percentage of adverse events (23.4%), followed by Arthrosurface ToeMotion (20.3%), Ascension MGT (12.5%), Arthrosurface HemiCAP® (10.9%), Futura primus (9.4%), and Osteomed Reflexion (6.3%). There was an increase in reported adverse events after 2016. The MAUDE database does not report the total incidence of implant insertion. CONCLUSION Our study of the MAUDE database demonstrated that component loosening and infection are the most common modes of adverse events for hallux MTPJ implants. Cartiva accounted for one-fourth of the implant-related adverse events during our study period, followed by ToeMotion, and Ascension MGT implants. Continued reporting of adverse events will improve our understanding on short and long-term complications of various hallux MTPJ implants. LEVEL OF EVIDENCE Level IV; Case Series from Large Database Analysis; Treatment Study.
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Affiliation(s)
- Craig C Akoh
- Duke University Medical Center, Box 2887, Durham, NC 27710, United States.
| | - Jie Chen
- Duke University Medical Center, Box 2887, Durham, NC 27710, United States
| | - Rishin Kadakia
- Duke University Medical Center, Box 2887, Durham, NC 27710, United States
| | - Young Uk Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggido, Republic of Korea
| | - Hyongnyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Samuel B Adams
- Duke University Medical Center, Box 2887, Durham, NC 27710, United States
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31
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Yildiz K, Medetalibeyoglu F, Kaymaz I, Ulusoy GR. Triad of foot deformities and its conservative treatment: With a 3D customized insole. Proc Inst Mech Eng H 2021; 235:780-791. [PMID: 33845665 DOI: 10.1177/09544119211006528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The coexisting of three deformities as hallux valgus, flatfoot, and the calcaneal spur is an undefined medical condition, and it may be called triad of foot deformities (TFD) as a definition for a new disease entity. A customized 3D insole prototype was created by postprocessing of MRI data, and printed by 3D printer technology for the purpose of providing effective and innovative treatment for TFD. A 42 years-old female was clinically examined for TFD findings. All radiological measurements were made on the weightbearing anteroposterior and lateral X-rays. The patient underwent the pedogram (RSscan International, footscan©). MRI images were taken for the purpose of 3D scanning that was used for producing the 3D splint for TFD. AOFAS (American Orthopedic Foot and Ankle Society scores) and FHSQ (Foot Health Status Questionnaire) were used for clinical follow-up. MRI images of the patient were imported to Mimics software in order to create a 3D model using image processing. Thus, Patient-Specific 3D customized silicone orthotic insole that was based on 3D printing technology was produced. The one-simple test was used to compare the results of AOFAS and FHSQ scores. The measurements of radiological measurements were given. On the clinical follow-up, AOFAS was FHSQ scores were obtained. There was a significant difference in terms of AOFAS and FHSQ scores (p ≤ 0.05). As a result of our study; our 3D customized insole was produced at the price of approximately 1/3 of the total cost of three standard medical products. The coexisting of these three deformities may be called triad of foot deformities (TFD). The 3D printer technology enables us to access a customized, personalized conservative treatment option for TFD. The conservative treatment of TFD is possible by a single orthotic insole.
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Affiliation(s)
- Kadri Yildiz
- Medical School Orthopaedia and Traumatology Department, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Fatih Medetalibeyoglu
- Mechanical Engineering Department, Engineering Faculty, Kafkas University, Kars, Turkey
| | - Irfan Kaymaz
- Mechanical Engineering Department, Engineering Faculty, Erzurum Technical University, Erzurum, Turkey
| | - Gokhan Ragip Ulusoy
- Medical School Orthopaedia and Traumatology Department, Faculty of Medicine, Kafkas University, Kars, Turkey
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32
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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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Shimozono Y, Hurley ET, Kennedy JG. Early Failures of Polyvinyl Alcohol Hydrogel Implant for the Treatment of Hallux Rigidus. Foot Ankle Int 2021; 42:340-346. [PMID: 33040611 DOI: 10.1177/1071100720962482] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the clinical and radiological outcomes following a polyvinyl alcohol hydrogel implant in the treatment of hallux rigidus. METHODS A retrospective cohort study investigating patients treated with a polyvinyl alcohol hydrogel implant for hallux rigidus was performed. Clinical outcomes were evaluated with the Foot and Ankle Outcomes Score (FAOS) and visual analog scale (VAS) score at the final follow-up. Plain radiographs were assessed postoperatively. Eleven patients (11 feet) with a mean follow-up of 20.9 months (range, 14-27 months) were included. The mean age was 60.3 years. RESULTS All FAOS subscales showed pre- to postoperative improvements, but there was no statistical significance in all subscales. The mean VAS score showed improvement from 4.1 to 3.0 (P = .012). On postoperative plain radiographs, implant subsidence was observed 60% (6/10) at 4 weeks after surgery and 90% (9/10) at the final follow-up. Fifty percent (5/10) showed radiologic lucency around the implant. Forty percent (4/10) had erosion of the proximal phalanx of the great toe. Four patients (36%) reported no improvement following surgery at the final follow-up, which were considered as failures. Three patients required additional surgery related to the implants. An additional patient is waiting to revise the implant. CONCLUSION Our current cohort study demonstrated a high failure rate with the polyvinyl alcohol hydrogel implant in patients with hallux rigidus. Significant radiologic subsidence with lysis around the implant, erosion of the proximal phalanx countersurface, and implant wear are harbingers for concern in the long term. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - John G Kennedy
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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34
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Glenn RL, Gonzalez TA, Peterson AB, Kaplan J. Minimally Invasive Dorsal Cheilectomy and Hallux Metatarsal Phalangeal Joint Arthroscopy for the Treatment of Hallux Rigidus. FOOT & ANKLE ORTHOPAEDICS 2021; 6:2473011421993103. [PMID: 35097431 PMCID: PMC8702932 DOI: 10.1177/2473011421993103] [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: Hallux rigidus (HR) is a common source of forefoot pain and disability. For those who fail nonoperative treatment, minimally invasive dorsal cheilectomy (MIDC) is an increasingly popular alternative to the open approach with early positive results. Early failures may be due to lose bone debris from the MIDC as well as other intra-articular pathology that cannot be addressed with MIDC alone. Metatarsophalangeal (MTP) arthroscopy can be used in addition to MIDC to assess the joint after MIDC and address any intra-articular pathology while still maintaining the benefits of minimally invasive surgery. We report our clinical outcomes following MIDC combined with MTP arthroscopy. Methods: From November 2017 to July 2020, a retrospective analysis of all MIDC cheilectomies with MTP arthroscopy performed by the 2 senior authors was done. Wound complications, infections, revision rates, need for future surgery, conversion to fusion rates, pre- and postoperative range of motion, visual analog scale (VAS) scores, time to return to normal shoe, intraoperative arthroscopic findings, and operative time were collected. Follow-up average was 16.5 months (range 3-33 months). Results: A total of 20 patients were included with an average follow-up of 16.5 months. The average VAS score improved from 7.05 preoperatively to 0.75 postoperatively ( P < .05). Average range of motion in dorsiflexion increased from 32 to 48 degrees ( P < .05) and plantarflexion increased from 15 to 19 degrees plantarflexion ( P < .05). All patients were weightbearing as tolerated immediately after surgery in a postoperative shoe and transitioned to a regular shoe at average of 2.1 weeks. We had no wound infections, wound complications, revision surgeries, tendon injuries or nerve damage. One patient required conversion to a fusion 3 years after the index procedure. Average tourniquet time was 30.39 minutes (range 17-60 minutes) and total average operating room time was 59.7 minutes (range 40-87 minutes). On arthroscopic evaluation of the MTP joint after MIDC, 100% of patients had bone debris, 100% had synovitis, 10% had loose bodies, and 30% had large cartilage flaps within the joint. Conclusion: MIDC and first MTP joint arthroscopy for treatment of hallux rigidus provide improved pain relief with minimal complications while still maintaining the benefits touted for minimally invasive operative procedures. Additionally, we have shown a high rate of intra-articular debris along with intra-articular pathology such as synovitis, loose chondral flaps, and loose bodies that exist after MIDC. This combined procedure has the potential for improving patient outcomes and may minimize risk of future revision surgeries compared with MIDC alone. Level of Evidence: Level IV, case series study.
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Affiliation(s)
- Rachel L. Glenn
- Department of Orthopaedic Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Tyler A. Gonzalez
- Department of Orthopaedic Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Alexander B. Peterson
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jonathan Kaplan
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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Drobnič M, Vannini F, Kon E, Dulić O, Kecojević V, Andor B, Altschuler N, Robinson D. Treatment of hallux rigidus by a novel bi-phasic aragonite-based implant: results of a two year multi-centre clinical trial. INTERNATIONAL ORTHOPAEDICS 2020; 45:1033-1041. [PMID: 33184685 DOI: 10.1007/s00264-020-04872-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE The two year results of a multi-centre clinical trial were examined to evaluate surgical treatment of hallux rigidus using a novel, bi-phasic, biodegradable, and cell-free aragonite-based scaffold (Agili-C™, CartiHeal Ltd, Israel). METHODS Twenty patients with moderate-to-severe hallux rigidus were recruited. After thorough metatarsophalangeal joint (MTPJ-1) debridement, the scaffolds were implanted into the defect centre. Eight patients received concomitant osteotomy. Treatment outcome was followed clinically (Pain VAS, FAAM-ADL, FAAM-Sport, AOFAS-HMIS, maximum active range of extension ROM-EXT, and flexion ROM-FLEX), and by medical imaging, at six month intervals for two years. Adverse events were recorded throughout the study follow-up period. RESULTS Significant clinical improvement over time was observed in all evaluated parameters (screening to final evaluation averages: Pain VAS 59 to 26, FAAM-ADL 57 to 77, FAAM-Sport 39 to 66, AOFAS-HMIS 51 to 81, ROM-EXT 18° to 36°), except for ROM-FLEX. Radiographs showed stable MTPJ-1 width over the two years in 17/18 cases (94%). MRI demonstrated progressive implant biodegradation, coupled with articular cartilage and subchondral bone regeneration, with a repair tissue defect fill of 75-100% in 14/17 (82%) subjects at their final visit. Revision surgery with implant removal was performed in two patients. CONCLUSION Bi-phasic, osteochondral, biodegradable, aragonite-based scaffold demonstrated positive clinical outcome and a good safety profile in the treatment of medium-to-advanced hallux rigidus. According to the medical imaging, this implant has the potential to restore the entire osteochondral unit of metatarsal head.
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Affiliation(s)
- Matej Drobnič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Zaloška ulica 9, SI-1000, Ljubljana, EU, Slovenia. .,Chair of Orthopedics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - Francesca Vannini
- Clinic 1, Orthopedic Institute Rizzoli, Bologna University, Bologna, Italy
| | - Elizaveta Kon
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Oliver Dulić
- Department for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, Novi Sad, Serbia.,Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Vaso Kecojević
- Department for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Bogdan Andor
- Department of Orthopedics, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Dror Robinson
- Faculty of Medicine, Hasharon Hospital Affiliated to Tel Aviv University, Petah Tikwa, Israel
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Lunati MP, Manz WJ, Maidman SD, Kukowski NR, Mignemi D, Bariteau JT. Effect of Age on Complication Rates and Outcomes Following First Metatarsophalangeal Arthrodesis for Hallux Rigidus. Foot Ankle Int 2020; 41:1347-1354. [PMID: 32791854 DOI: 10.1177/1071100720942140] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux rigidus is one of the most common toe pathologies in patients greater than 50 years old. Although metatarsophalangeal (MTP) arthrodesis is used to improve pain and function, older patients are often considered to be higher-risk operative candidates. There are minimal data on outcomes of MTP fusion and no studies comparing outcomes between geriatric and younger patients. METHODS This is a single-center, prospective study of all patients who underwent MTP fusion between August 1, 2015, and July 1, 2018. Patient-reported outcomes were assessed using the Short Form Health Survey (SF-36), Life-Space Assessment survey (LSA), and visual analog scale (VAS) for pain administered preoperatively as well as 6 months and 1 year postoperatively. Baseline characteristics and operative outcomes were collected from the electronic medical record. Clinical and patient-reported outcomes were compared between patients <65 years old and ≥65 years old. Of 143 included patients, 79 were in the younger group (mean of 56.5 years) and 64 were in the older group (mean of 72.0 years). RESULTS Compared with the younger group, the older group was more predominantly female (95.3% older group, 77.2% younger group, P = .002). More patients in the older group had hypertension (73.4% older group, 50.6% younger group, P = .005) and coronary artery disease (9.4% older group, 0.0% younger group, P = .005). Both age groups had similar rates of postoperative wound complications requiring operative irrigation and debridement, deep vein thrombosis, deformity recurrence, and revision surgery. No differences were detected in SF-36, LSA, and VAS surveys administered at baseline, 6 months postoperation, or 1 year postoperation between younger and older patients. CONCLUSION Despite more comorbidities, older patients had similar rates of postoperative complications and reported similar outcomes for pain, function, and mobility following MTP fusion. These findings support increased implementation of MTP fusion surgery for older patients with hallux rigidus. LEVEL OF EVIDENCE Level II, prospective cohort.
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Affiliation(s)
- Matthew P Lunati
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Wesley J Manz
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Nathan R Kukowski
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Jason T Bariteau
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Brandao B, Hall A, Aljawadi A, Fox A, Pillai A. Joint sparing management of hallux rigidus: Cartiva SCI vs cheilectomy a comparative review. J Orthop 2020; 21:401-405. [PMID: 32943827 PMCID: PMC7479491 DOI: 10.1016/j.jor.2020.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/10/2020] [Accepted: 07/21/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Hallux rigidus, or first metatarsophalangeal joing arthritis, is a very common condition which causes pain and loss of motion in the joing which can be debilitating. METHODS Patient reported outcome measures were utilised to study the difference in day to day functionality between two common surgical management options for hallux rigidus. RESULTS 55 Cartiva and 23 Cheilectomy patients were included in this study. The Manchester Oxford Foot and Ankle Questionnaire revealed statistically significant improvements in the cheilectomy patients when compared to Cartiva SCI.Foot and Ankle Ability Measure found no statistical difference was found between the two surgical treatments. CONCLUSION Cheilectomy offers good post-operative functional and sporting outcomes after surgery for the management of hallux rigidus at 5 years.
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Affiliation(s)
- Bernardo Brandao
- Foundation Doctor, Sandwell and West Birmingham Hospitals NHS Trust, UK
| | - Angus Hall
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Ahmed Aljawadi
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Anna Fox
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Anand Pillai
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
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38
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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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Rothermel SD, King JL, Tupinio M, Walley KC, Juliano PJ, Aynardi MC. Cost Comparison of Synthetic Hydrogel Implant and First Metatarsophalangeal Joint Arthrodesis. Foot Ankle Spec 2020; 13:281-285. [PMID: 31179731 DOI: 10.1177/1938640019850617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. First metatarsophalangeal (MTP) arthrodesis is the "gold standard" treatment for hallux rigidus. Recently, there has been increased interest in new synthetic cartilage implants to preserve joint motion while eradicating pain. With current health care economics, the cost of a treatment is gaining particular importance. This study set out to perform a cost comparison between MTP arthrodesis and synthetic hydrogel implant to determine which treatment modality is more cost-effective based on direct aggregate costs. Study design. Economic and decision analysis. Methods. Studies in the available literature were analyzed to estimate hardware removal rates for MTP fusion and failure rates for a synthetic hydrogel implant and MTP fusion. Costs were determined by examining direct costs at a single institution for implants and data reported in the literature for operating room time. Sensitivity analysis and Monte Carlo simulation were performed to examine cost and measurement uncertainty. Results. Assuming a 4.76% MTP arthrodesis revision rate and 7.06% hardware removal rate, the total direct cost of MTP joint arthrodesis was $3632. Using a 9.2% failure rate with subsequent conversion to MTP arthrodesis, the total cost of synthetic hydrogel implant was $4565. Sensitivity analysis revealed that MTP fusion was more cost-effective even if the failure rate increased to 15% and synthetic hydrogel implant failure rate was 0%. The synthetic cartilage implant cost would have to be reduced 28% or approximately 200% the cost of MTP fusion implants to be comparable to MTP arthrodesis. Conclusion. Hallux rigidus treatment with a synthetic hydrogel implant resulted in a higher direct aggregate cost than MTP arthrodesis.Level of Evidence: Level II: Cost analysis.
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Affiliation(s)
- Shane D Rothermel
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Jesse L King
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Maegan Tupinio
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Kempland C Walley
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Paul J Juliano
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Michael C Aynardi
- Department of Orthopaedic Surgery, Penn State Hershey Bone and Joint Institute, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania
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40
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Smyth NA, Krishnan V, McCormick JR, Kaplan JR, Aiyer AA. Consumer Prices for Surgical Management of End-Stage Hallux Rigidus. Foot Ankle Spec 2020; 13:276-280. [PMID: 31167549 DOI: 10.1177/1938640019846966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Hallux rigidus is the most prevalent arthritic condition of the foot. Treatment of end-stage disease traditionally consists of a first metatarsophalangeal joint (MTPJ) arthrodesis; however, the use of a synthetic cartilage implant is becoming more common. With the high prevalence of disease and implementation of new treatment modalities, health care consumers should be aware of the costs associated with management. The purpose of this study was to determine access to the cost and variability in price of first MTPJ arthrodesis and synthetic cartilage implantation. Methods. Forty academic centers were contacted using a standardized patient script. The patient was a 59-year-old female who had failed conservative treatment of hallux rigidus. Each institution was contacted up to 3 times in an attempt to obtain a full bundled operative quote for a first MTPJ arthrodesis and synthetic cartilage implantation. Results. Twenty centers (50%) provided a quote for first MTPJ arthrodesis and 15 centers (38%) provided a quote for synthetic cartilage implantation. Only 14 centers (35%) were able to provide a quote for both procedures. The mean bundled price for MTPJ arthrodesis was $21 767 (range $8417 to $39 265). The mean bundled price for synthetic cartilage implantation was $21 546 (range $4903 to $74 145). There was no statistically significant difference between the bundled price for first MTPJ arthrodesis and synthetic cartilage implantation. Conclusions. There was limited availability of consumer prices for first MTPJ arthrodesis and synthetic implantation, thus impeding health care consumers' decision making. There was a wide range of quotes for both procedures, indicating potential cost savings.Levels of Evidence: IV, basic science.
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Affiliation(s)
- Niall A Smyth
- Department of Orthopaedic Surgery, Medstar Union Memorial, Baltimore, Maryland (NAS)
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (VK, JRM, AAA)
- Orthopaedic Specialty Institute, Orange, California (JRK)
| | - Vaishnavi Krishnan
- Department of Orthopaedic Surgery, Medstar Union Memorial, Baltimore, Maryland (NAS)
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (VK, JRM, AAA)
- Orthopaedic Specialty Institute, Orange, California (JRK)
| | - Johnathon R McCormick
- Department of Orthopaedic Surgery, Medstar Union Memorial, Baltimore, Maryland (NAS)
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (VK, JRM, AAA)
- Orthopaedic Specialty Institute, Orange, California (JRK)
| | - Jonathan R Kaplan
- Department of Orthopaedic Surgery, Medstar Union Memorial, Baltimore, Maryland (NAS)
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (VK, JRM, AAA)
- Orthopaedic Specialty Institute, Orange, California (JRK)
| | - Amiethab A Aiyer
- Department of Orthopaedic Surgery, Medstar Union Memorial, Baltimore, Maryland (NAS)
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (VK, JRM, AAA)
- Orthopaedic Specialty Institute, Orange, California (JRK)
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41
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Edwards SR, Kingsford AC. Radical Cheilectomy as an Alternative to Arthrodesis for Hallux Rigidus. Cureus 2020; 12:e9453. [PMID: 32874787 PMCID: PMC7455381 DOI: 10.7759/cureus.9453] [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: 12/03/2022] Open
Abstract
Hallux rigidus (HR) is a painful condition involving osteoarthrosis and reduced range of motion of the first metatarsophalangeal joint (MTPJ). It is associated with significant morbidity and reduced quality of life. We report a case of a 42-year-old female who had been referred to our surgical clinic regarding the progressively worsening chronic pain, stiffness and long-term shoe-fitting difficulties associated with her right HR pathology. Her vocational duties within the fashion industry necessitated the use of high heeled court-style shoes, and thus she maintained a preference for a procedure that would facilitate normal joint range of motion so that she could continue to wear this type of footwear. We performed a variation to a traditional cheilectomy procedure involving radical remodelling of the first metatarsal head to allow for up to 90 degrees of intraoperative dorsiflexion. The patient reported reduced pain and increased function up until her discharge at 12 weeks postoperatively. A radical cheilectomy may provide acceptable pain relief and improved joint function in patients with end-stage HR who decline the option of arthrodesis.
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Affiliation(s)
- Steven R Edwards
- Surgery, Australasian College of Podiatric Surgeons, Melbourne, AUS.,Podiatry, La Trobe University, Bundoora, AUS
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42
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Carpenter B, Klemeyer L. Motion Preservation in Hallux Rigidus After Failure of Hydrogel Implantation: Treatment Considerations and a Report of 2 Cases. J Foot Ankle Surg 2020; 59:162-168. [PMID: 31882138 DOI: 10.1053/j.jfas.2019.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/03/2019] [Accepted: 03/12/2019] [Indexed: 02/03/2023]
Abstract
Hallux rigidus is a common condition treated daily by surgeons worldwide. During the past decade, the standard treatment algorithm has been questioned by both patients and surgeons seeking alternatives to arthrodesis, which was previously considered the gold standard for advanced disease. Patients are living longer, and many have a more active lifestyle; thus, recreating and improving range of motion and achieving pain relief are increasingly desirable. The treatment spectrum and implant options for motion-preserving techniques in the metatarsophalangeal joint has been widened with the recent US Food and Drug Administration approval of a polyvinyl-alcohol hydrogel implant. In the controlled US Food and Drug Administration trial, the 2-year revision rate was 9.2% and all failures were revised to a first metatarsophalangeal arthrodesis. Outcomes comparison of these revisions to primary fusions showed less predictable pain relief and may warrant alternative treatment considerations, preferably those that allow for continuation of motion preservation. Revision of failed hydrogel implants to arthrodesis can be performed through various first metatarsophalangeal fusion techniques or, as introduced in this review, with a fourth-generation threaded hemiarthroplasty. Excellent 10-year results with primary hemiarthroplasty supported its use as revision procedure in 2 failed polyvinyl-alcohol implantations, preserving arthrodesis for future salvage if necessary. The purpose of this report was to outline a motion-preserving technique after failed hydrogel implants and describe preoperative, intraoperative, and postoperative considerations for optimized outcomes.
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Affiliation(s)
- Brian Carpenter
- Professor, Department of Orthopaedics, The University of North Texas Health Science Center, Fort Worth, TX.
| | - Lisa Klemeyer
- Physician, Private Practice, Aesthetic & Family Podiatry Center, Sarasota, FL
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Engasser WM, Coetzee JC, Ebeling PB, Den Hartog BD, Seybold JD, Holthusen SM, McGaver RS, Seiffert KJ, Giveans MR. Patient-Reported Outcomes and Early Complications After Synthetic Cartilage Device Implantation. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420930691. [PMID: 35097387 PMCID: PMC8697263 DOI: 10.1177/2473011420930691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Previous Level I studies show promising results for the use of a hydrogel synthetic cartilage implant (SCI) for the treatment of hallux rigidus. A recent independent retrospective review has put those results into question, however. The purpose of this article is to report patient-reported outcomes and early complications using this implant so as to add to the paucity of data in the literature regarding this implant. Methods: This was a retrospective chart review of patients undergoing hydrogel synthetic cartilage implant for the treatment of hallux rigidus from July 2017 to November 2018. Data collected included patient demographics, radiographic grading, and outcomes: Veterans Rand 12 Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), patient satisfaction, and complications. Fifty-four patients (59 feet) with an average age of 57.6 (range, 39-78) years were analyzed. The average latest follow-up was 18.9 (range, 3-31.3) months. Body mass index was 26.7 (range, 18.7-35.2). None were diabetic and 5 were smokers. Results: The mean outcome improvements were 6.5 points (VR-12 Physical), 17.2 points (FAAM ADL), 27.4 points (FAAM Sport), and 18.4 points (VAS) (P < .01 for each). Scores were significantly improved from preoperatively to most recent follow-up for FAAM ADL (71.0 vs 88.2 points), FAAM Sports (44.6 vs 72.0 points), and VAS (49.4 vs 31.0) (P < .01). Overall, 72.5% patients would definitely or probably have the operation again. Ten patients (18.5%) went on to have revision surgery. Of these, 7 patients were revised to an arthrodesis, and 1 metal hemiarthroplasty and 2 implants were removed because of infection. Conclusion: Synthetic cartilage implantation for the treatment of hallux rigidus demonstrated improved pain and outcome scores at short-term follow-up. Reoperation and conversion to fusion rates were comparable to prior studies. Level of Evidence: Level IV, case series.
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44
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Gilheany M, Edwards SR, Cotchett M. Capsular Interposition Arthroplasty With Percutaneous Suture Anchoring: A Pragmatic and Novel Surgical Technique for Hallux Rigidus. Cureus 2020; 12:e8556. [PMID: 32670693 PMCID: PMC7357305 DOI: 10.7759/cureus.8556] [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] [Received: 05/27/2020] [Accepted: 06/10/2020] [Indexed: 11/05/2022] Open
Abstract
There is support for the use of capsular interposition arthroplasty (CIA) as an alternative to arthrodesis in the surgical treatment of hallux rigidus. In this technical report, the authors describe novel technical variations to the traditional capsular interposition arthroplasty that are anatomically rational, reproducible, and efficient. This technique was developed by the primary author and has been the preferred approach to CIA for over 10 years. The key technical differences of the procedure are metatarsal head preparation, the use of a proximally based capsular graft, and anchoring by utilizing a simple percutaneous anchoring technique. This approach maintains anatomic joint morphology, preserves vascular supply, and bone stock to facilitate future procedures if required.
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Affiliation(s)
- Mark Gilheany
- Surgery, Australasian College of Podiatric Surgeons, Melbourne, AUS
| | - Steven R Edwards
- Surgery, Australasian College of Podiatric Surgeons, Melbourne, AUS
- Podiatry, La Trobe University, Bundoora, AUS
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45
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Tan CY, Bin Mohd Fadil MF. Biomechanical consequences of first metatarsaophalangeal joint arthrodesis on flexor digitorum longus function: A cadaveric study. J Orthop Surg (Hong Kong) 2020; 27:2309499019826325. [PMID: 30798770 DOI: 10.1177/2309499019826325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND First metatarsophalangeal joint (MTPJ) arthrodesis is a common treatment modality for hallux rigidus with successful outcomes. However, the effect of arthrodesis on flexor digitorum longus (FDL) is poorly understood. The purpose of this study was to investigate this effect in a biomechanical model. METHODS Ten cadaveric trans-knee amputated specimens were studied. Lesser toe range of motion (ROM) and FDL excursion on simulated FDL contraction were measured in the following three scenarios: (1) before 1st MTPJ arthrodesis, (2) after 1st MTPJ arthrodesis, and (3) after the knot of Henry release. RESULTS 1st MTPJ arthrodesis reduced both mean lesser toe ROM and FDL excursion. However, there was improvement in these parameters after the knot of Henry release. CONCLUSIONS FDL function was reduced following 1st MTPJ arthrodesis. This effect was contributed by soft tissue connections at the knot of Henry, where FDL crosses flexor hallucis longus (FHL). Therefore, with restriction of FHL movement after 1st MTPJ arthrodesis, FDL movement was also restricted. CLINICAL RELEVANCE This result improved our understanding of 1st MTPJ arthrodesis biomechanics and suggested potential benefits of the knot of Henry release in 1st MTPJ arthrodesis to improve FDL function, thereby decreasing the rate of metatarsalgia and other associated problems.
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Brandao B, Aljawadi A, Poh ZE, Fox A, Pillai A. Comparative study assessing sporting ability after Arthrodesis and Cartiva hemiarthroplasty for treatment of hallux rigidus. J Orthop 2020; 18:50-52. [PMID: 32189883 PMCID: PMC7067982 DOI: 10.1016/j.jor.2019.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - Ahmed Aljawadi
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | | | - Anna Fox
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Anand Pillai
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
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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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Shi E, Todd N, Rush S, Jennings M, Yurgelon J, Sue A, Bourke C, Baravarian B, Allen J, Shofler D. First Metatarsophalangeal Joint Space Area Decreases Within 1 Month After Implantation of a Polyvinyl Alcohol Hydrogel Implant: A Retrospective Radiographic Case Series. J Foot Ankle Surg 2019; 58:1288-1292. [PMID: 31679683 DOI: 10.1053/j.jfas.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 03/10/2019] [Accepted: 04/04/2019] [Indexed: 02/03/2023]
Abstract
In 2016, the U.S. Food and Drug Administration approved the first and only polyvinyl alcohol hydrogel implant for the treatment of hallux rigidus. The implant functions as a bumper to maintain first metatarsophalangeal joint space to prevent contact of the phalangeal base with the first metatarsal head. Short-term and intermediate outcomes with this implant have reported positive outcomes with no radiographic outcomes of implant wear or subsidence. We performed a retrospective radiographic review of 27 consecutive patients who received the implant and measured preoperative and postoperative joint space area (JSA). We found a significant improvement in JSA (p < .001) between the preoperative JSA and JSA at the first postoperative visit at 1 to 2 weeks. We also found a significant decrease in JSA (p < .001) between the first postoperative visit and the second postoperative visit at 5 to 12 weeks. This information could have further implications for implant design as well as how we can better achieve functional improvements in the first metatarsophalangeal joint in patients with hallux rigidus.
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Affiliation(s)
- Eric Shi
- Fellow, Sutter Health Palo Alto Medical Foundation, Mountain View, CA.
| | - Nicholas Todd
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | - Shannon Rush
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | - Meagan Jennings
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | - Jesse Yurgelon
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | - Alan Sue
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | | | - Bob Baravarian
- Assistant Clinical Professor UCLA School of Medicine, Los Angeles, CA
| | - Jamey Allen
- Fellow, University Foot and Ankle Institute, Santa Monica, CA
| | - David Shofler
- Assistant Professor, Department of Podiatric Medicine, Surgery, and Biomechanics, Western University College of Podiatric Medicine, Pomona, CA
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Sidon E, Rogero R, Bell T, McDonald E, Shakked RJ, Fuchs D, Daniel JN, Pedowitz DI, Raikin SM. Long-term Follow-up of Cheilectomy for Treatment of Hallux Rigidus. Foot Ankle Int 2019; 40:1114-1121. [PMID: 31307212 DOI: 10.1177/1071100719859236] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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 most common arthritic condition in the foot. First metatarsophalangeal joint cheilectomy produces satisfactory results in retrospective studies with reported good to excellent results in up to 97% and pain relief and function in 92%. The results of cheilectomy for higher grades of hallux rigidus are less favorable. The purpose of this study was to evaluate the long-term functional results and survivorship of cheilectomy for treatment of hallux rigidus. METHODS This was a retrospective, questionnaire-based study investigating the long-term results of cheilectomy for treatment of hallux rigidus. The preoperative arthritic grade was graded retrospectively according to the Hattrup and Johnson (H&J) grading system. A questionnaire was administered via email or telephone that included questions regarding pain recurrence following surgery, current functional status, and satisfaction with the operation. Kaplan-Meier survival analysis was performed to estimate survival time between arthritic grades. We reviewed 165 patients (169 feet) with an average follow-up of 6.6 (5.0-10.9) years. RESULTS The overall survival rate (painless at the time of last follow-up) was 70.4% (119 feet), with no significant difference between the 3 H&J arthritic grades. Most of the recurrences (28 feet, 75%) were at the first 2 years following the surgery. Nine feet (5.3%) had a second procedure at a mean postoperative time of 3.6 (range, 1.6-7.4) years. Of the 169 feet, 117 (69.3%) reported being satisfied or very satisfied and 127 (75.1%) indicated they would repeat the operation under the same circumstances. CONCLUSION Our study supports the use of cheilectomy for treatment of hallux rigidus (grade 1-3 Coughlin and Shurnas) as a reliable procedure with favorable results. At long-term follow-up, patients who underwent cheilectomy had a low revision rate and a moderately low rate of pain recurrence. LEVEL OF EVIDENCE Level IV, retrospective case-series.
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Affiliation(s)
- Eliezer Sidon
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Ryan Rogero
- Rothman Orthopaedic Institute, Philadelphia, PA, USA.,Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Timothy Bell
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Elizabeth McDonald
- Rothman Orthopaedic Institute, Philadelphia, PA, USA.,Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Daniel Fuchs
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Abstract
Evidence-based medicine continues to guide our treatment of patients. Owing to the unique characteristics of the first metatarsophalangeal joint (1st MTPJ) with its small surface area and the significant amount of multiplanar force that affects it, finding the perfect implant to allow motion and alleviate pain is still the ultimate goal. While some of the older metallic implants and silastic spacers may still be providing pain relief and function to patients, the majority have failed and caused significant bone loss along the way. The HemiCap implants have shown some promise in select patients and may still be a viable option in patients desiring maintenance of 1st MTPJ motion.
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Affiliation(s)
- Michelle L Butterworth
- Williamsburg Regional Hospital, 500 Thurgood Marshall Hwy, Suite B, Kingstree, SC 29556, USA.
| | - Maria Ugrinich
- Penn Presbyterian Medical Center, 1317 Lombard Street, Philadelphia, PA 19147, USA
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