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Ismail A, Hannant G, Ashour A, Broadhurst D. The Outcome of the Use of Continuous Action Compression Device for the First Metatarsophalangeal Joint Fusion. Cureus 2024; 16:e74168. [PMID: 39712823 PMCID: PMC11662993 DOI: 10.7759/cureus.74168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2024] [Indexed: 12/24/2024] Open
Abstract
INTRODUCTION First metatarsophalangeal (MTP) joint fusion is a widely accepted surgical intervention for treating severe arthritis, deformities, and instability of the first MTP joint. This paper provides a review of a single surgeon's experience with continuous compression implants (CCI), which offer a notable advantage by providing uniform compression across a larger surface area of the fusion site compared to plate and screw constructs. This design potentially reduces soft tissue irritation and, consequently, the need for subsequent implant removal. It also saves on cost and has the potential to reduce the length of surgery. METHODS A retrospective review was conducted on 27 patients (n=36 feet) who underwent primary first metatarsophalangeal joint (MTPJ) fusion using continuous compression implants (CCI) between March 2020 and April 2024 at Bradford Royal Infirmary. Patient data were collected from the surgeon's logbook and medical records. The outcomes analyzed included the fusion rate and complications. Statistical analysis was performed using SPSS version 22.0, with p<0.05 considered significant. RESULTS The mean age of the cohort was 60.24 years (range 41-90), with 88.88% female. The ratio of left to right was 70%. The mean follow-up duration was 27 months (range 6-48 months). Complete fusion of the first MTPJ was achieved in 34 out of 36 feet (94.4%). Nonunion occurred in one patient, while delayed union was observed in another. Clinically, 35 out of 36 patients (97.3%) reported satisfaction with the procedure, with one patient requiring metalwork removal and revision due to loosening. CONCLUSION Early results show that the rate of fusion achieved by using the CCI for the first MTPJ arthrodesis in our series was comparable to that of other devices quoted in the literature.
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Affiliation(s)
- Ahmed Ismail
- Orthopaedics, Bradford Royal Infirmary, Bradford, GBR
| | - Gary Hannant
- Orthopaedics and Trauma, Bradford Royal Infirmity, Bradford, GBR
| | - Ahmed Ashour
- Trauma and Orthopaedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
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Abar B, Vail E, Mathey E, Park E, Allen NB, Adams SB, Gall K. A bending model for assessing relative stiffness and strength of orthopaedic fixation constructs. Clin Biomech (Bristol, Avon) 2024; 111:106135. [PMID: 37948989 DOI: 10.1016/j.clinbiomech.2023.106135] [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: 07/25/2023] [Revised: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The purpose of this study is to develop a simple and reproducible bending model that is compatible with a wide range of orthopaedic fixation devices and 3D printed spacers. METHODS A robust 4-point bending model was constructed by securing sawbones blocks with different orthopaedic fixation device constructs. Stress strain curves derived from a fundamental mechanics model were used to assess the effect of bone density, type of hardware (staple vs intramedullary beam), the use of dynamic compression, orientation of staples (dorsal vs plantar), and the use of 3D printed titanium spacers. FINDINGS The high throughput 4-point bending model is simple enough that the methods can be easily repeated to assess a wide range of fixation methods, while complex enough to provide clinically relevant information. INTERPRETATIONS It is recommended that this model is used to assess a large initial set of fixation methods in direct and straightforward comparisons.
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Affiliation(s)
- Bijan Abar
- Duke University, Department of Mechanical Engineering and Material Sciences, USA; Duke University, Department of Orthopaedic Surgery, USA
| | - Elijah Vail
- Duke University, Department of Mechanical Engineering and Material Sciences, USA
| | - Elizabeth Mathey
- University of Colorado Denver, Department of Mechanical Engineering, USA
| | - Ella Park
- Duke University, Department of Mechanical Engineering and Material Sciences, USA
| | | | | | - Ken Gall
- Duke University, Department of Mechanical Engineering and Material Sciences, USA.
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Ravenell RA, Doh K. Immediate Weightbearing Following First Metatarsal Phalangeal Joint Arthrodesis With 2 Nickel Titanium Alloy Staples. J Foot Ankle Surg 2024; 63:42-46. [PMID: 37625778 DOI: 10.1053/j.jfas.2023.08.009] [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: 01/31/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
The use of staples has been shown to be a reasonable fixation technique to achieve stability of a first MTPJ arthrodesis. Although it has been shown to be a weaker construct than crossed screws or plate and screw combinations, their ease of insertion, low profile, and stability make them a desirable choice for first MTPJ arthrodesis fixation. However, because of this relative weakness, the question remains whether immediate weightbearing when using staples is advisable. The aim of this study is to determine whether the use of 2 nickel-titanium alloy (NITINOL) staples, placed at 90 degrees to one another is a stable enough construct to support full, immediate weightbearing following first MTPJ arthrodesis. We performed a retrospective chart review of patients undergoing first MTPJ arthrodesis by a single surgeon utilizing 2 NITINOL staples placed at 90 degrees to one another. Patients were allowed to be fully weightbearing immediately postoperatively. Forty-seven of 50 (94%) patients achieved complete radiologic consolidation of fusion at 12 weeks, with only 3 requiring revision surgery for nonunion. All of the patients requiring revision surgery for nonunion, had preoperative diagnosis of hallux abducto valgus. We concluded that the use of 2 NITINOL staples placed at 90 degrees to one another is a viable option for first MTPJ arthrodesis, and immediate weightbearing does not increase rate of nonunion or incidence of revision surgery when compared to other fixation techniques.
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Affiliation(s)
- Rahn A Ravenell
- Assistant Professor, Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC.
| | - Kwame Doh
- Chief Resident, Emory University School of Medicine Podiatry Medicine and Surgery Residency, Decatur, GA
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Balu AR, Baumann AN, Tsang T, Talaski GM, Anastasio AT, Walley KC, Adams SB. Evaluating the Biomechanical Integrity of Various Constructs Utilized for First Metatarsophalangeal Joint Arthrodesis: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6562. [PMID: 37834699 PMCID: PMC10573906 DOI: 10.3390/ma16196562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
The first metatarsophalangeal (MTP) joint is a frequently loaded joint, handling loads up to 90% of bodyweight. First MTP arthrodesis is a frequently performed procedure designed to improve pain in patients with degenerative MTP joint disease. There are a wide variety of fixation constructs for this procedure without consensus on the most effective method. The purpose of this study was to compare the biomechanical integrity of various constructs utilized for first MTP arthrodesis. A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, MEDLINE, and Web of Science databases were searched from inception to 18 June 2023. Articles discussing the biomechanics of first MTP arthrodesis constructs were included. A total of 168 articles were retrieved. A total of 20 articles involving 446 cadaveric and synthetic bone constructs were included in the final review. Of the six articles comparing dorsal plating with compression screws to crossed interfragmentary screws, five found that dorsal plating had significantly higher stiffness. All three studies assessing shape-memory staples found them to be significantly less stable than crossed screws or dorsal plates alone. Both studies evaluating fully threaded screws found them to be stronger than crossed cancellous screws. Wedge resections have been shown to be 10 times stronger than standard planar or conical excision. Dorsal plating with compression screws is the gold standard for MTP arthrodesis. However, more research into newer methods such as fully threaded screws and wedge resections with an increased focus on translation to clinical outcomes is needed.
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Affiliation(s)
- Abhinav R. Balu
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60208, USA
| | - Anthony N. Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA;
| | - Terence Tsang
- Campbell University School of Osteopathic Medicine, Lillington, NC 27546, USA;
| | - Grayson M. Talaski
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA;
| | - Albert T. Anastasio
- Department of Orthopaedic Surgery, Duke University, Durham, NC 27708, USA; (A.T.A.); (S.B.A.)
| | - Kempland C. Walley
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Samuel B. Adams
- Department of Orthopaedic Surgery, Duke University, Durham, NC 27708, USA; (A.T.A.); (S.B.A.)
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von Deimling C, Tondelli T, Brunner S, Andronic O, Graf AD. Achieving high union rates after first metatarsophalangeal joint arthrodesis: Radiographic outcomes and technical pitfalls. World J Orthop 2023; 14:436-442. [PMID: 37377987 PMCID: PMC10292060 DOI: 10.5312/wjo.v14.i6.436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/14/2023] [Accepted: 05/15/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Fusion of the first metatarsophalangeal (MTP1) joint is a common surgery performed to correct hallux rigidus, hallux rigidus et valgus and other painful degenerative diseases of the MTP1.
AIM To assess outcomes of our surgical technique including non-union rates, accuracy and aims of correction.
METHODS Between September 2011 and November 2020 a total 72 of MTP1 fusions were performed using a low profile, pre-contoured dorsal locking plate and a plantar compression screw. Union and revision rates were analyzed with a minimum clinical and radiological follow up of at least 3 mo (range 3-18 mo). The following parameters were evaluated on pre- and postoperative conventional radiographs: Intermetatarsal angle, Hallux-valgus angle, dorsal extension of the proximal phalanx (P1) in relation to the floor and the angle between the Metatarsal 1 and the P1 (MT1-P1 angle). Descriptive statistical analysis was performed. Pearson analysis was used to assess for correlations between radiographic parameters and achievement of fusion.
RESULTS An overall union rate of 98.6% (71/72) was achieved. Two out of 72 patients did not primarily fuse with one patient suffering from a non-union, whilst the other demonstrating a radiological delayed union without clinical symptoms, with eventually complete fusion after 18 mo. There was no correlation between the measured radiographic parameters and the achievement of fusion. We believe the reason for the non-union was mainly attributed to the patient’s incompliance without wearing the therapeutic shoe leading to a fracture of the P1. Furthermore, we didn`t find any correlation between fusion and the degree of correction.
CONCLUSION With our surgical technique, high union rates (98%) can be achieved using a compression screw and a dorsal variable-angle locking plate to treat degenerative diseases of the MTP1.
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Affiliation(s)
- Christian von Deimling
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
| | - Timo Tondelli
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
| | - Samuel Brunner
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
| | - Octavian Andronic
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
| | - Alexander David Graf
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
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Tytgat HE, Wuite S, Matricali GA. Arthrodesis of the first metatarsophalangeal joint using an intraosseous fixation device. Acta Orthop Belg 2022; 88:135-142. [PMID: 35512164 DOI: 10.52628/88.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The complication rate for an arthrodesis of the first metatarsophalangeal joint remains high. To improve results, we used a complete intraosseous fixation device (IOFIX) with proposed biomechanical advantages. Our hypothesis is that this technique has at least an equal union rate and less hardware irritation compared to other techniques. Seventy procedures were performed in 55 patients. Average follow-up was 24.5 months. All patients returned to follow-up after 6 weeks and were evaluated for union. Fifty-nine feet (84%) completed full follow- up. Union occurred in 62 of 70 feet (88.5%). Eight feet had nonunion at 1 year follow-up. Average time to fusion was 51 days. Three of 59 feet had malunion. No hardware removal was necessary. In conclusion, an MTP1 arthrodesis using IOFIX provides consistent and good functional outcomes. Due to the low-profile design, no hardware removal was necessary. However, union rates seem slightly lower compared to other techniques.
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Gould AER, Logan K, Lin Z, Marsland D, Elliot RR. A Prospective Evaluation of First Metatarsophalangeal Fusion Using an Innovative Dorsal Compression Plating System. J Foot Ankle Surg 2021; 60:891-896. [PMID: 33785240 DOI: 10.1053/j.jfas.2021.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 09/08/2020] [Accepted: 02/24/2021] [Indexed: 02/03/2023]
Abstract
Numerous techniques have been described for first metatarsophalangeal joint (MTPJ) fusion. The aim of this study was to prospectively evaluate an innovative plating system which uses a cross plate compression screw. Thirty consecutive first MTPJ fusions in 28 patients were evaluated. All procedures were performed by a single fellowship trained consultant foot and ankle surgeon. Patient function was evaluated preoperatively at 6 and at 12 months using the Manchester-Oxford Foot Questionnaire (MOXFQ). Union rates and complications were recorded. Postoperative MOXFQ scores demonstrated significant improvement in all domains, with mean improvement at 12 months of 35, 27, 17 and 106 points for pain, walking/standing, social interactions and combined scores respectively (p value ≤.0001). In all 30 cases, clinical and radiological evidence of union was achieved by 6 months. Superficial infection occurred in 1 (3%) case. One (3%) case required plate removal due to soft tissue irritation. There were no plate failures. This evaluation study demonstrates that this cross-plate compression plating system is safe, provides high patient satisfaction and reliable union, with low complication rates. Prospective comparative research is now required to determine the optimal technique for first MTPJ fusion.
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Affiliation(s)
| | - Karl Logan
- Orthopaedic Registrar, Basingstoke and North Hampshire Hospital, England, UK.
| | - Zoe Lin
- Orthopaedic Registrar, Basingstoke and North Hampshire Hospital, England, UK
| | - Daniel Marsland
- Consultant Orthopaedic Surgeon, Royal Hampshire County Hospital, England, UK
| | - Robin R Elliot
- Consultant Orthopaedic Surgeon, Basingstoke and North Hampshire Hospital, England, UK
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Koutsouradis P, Savvidou OD, Stamatis ED. Arthrodesis of the first metatarsophalangeal joint: The “when and how”. World J Orthop 2021; 12:485-494. [PMID: 34354936 PMCID: PMC8316842 DOI: 10.5312/wjo.v12.i7.485] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/18/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
Arthrodesis of the first metatarsophalangeal (MTP) joint has been established as the “gold standard” for the treatment of several first ray disorders, due to its perceived efficacy and the consistently reported good results in the literature. Arthrodesis is a commonly performed procedure for the treatment of end stage arthritis, rheumatoid arthritis with severe deformity, selected cases of severe hallux valgus (with or without signs of degenerative joint disease), as well as a salvage procedure after failed previous operation of the first ray. The goals of a successful 1st MTP arthrodesis are pain alleviation and deformity correction in order to restore a comfortable gait pattern and to improve shoe wear. Several techniques have been reported with several proposals regarding the preparation of the articular surfaces and the method of definitive fixation. As with any given surgical procedure, various complications may occur after arthrodesis of the 1st MTP joint, namely delayed union, nonunion, malunion, irritating hardware, etc.
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Affiliation(s)
- Panagiotis Koutsouradis
- Department of Foot and Ankle Reconstructive Surgery, Mediterraneo Hospital, Athens 16675, Greece
| | - Olga D Savvidou
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, “ATTIKON” Hospital, Athens 12462, Greece
| | - Emmanouil D Stamatis
- Department of Foot and Ankle Reconstructive Surgery, Mediterraneo Hospital, Athens 16675, Greece
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9
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Kunovsky R, Kocis J, Navrat T, Vosynek P, Pink T, Joukal M, Cizmar I. Lapidus arthrodesis in combination with arthrodesis of the first metatarsophalangeal joint-biomechanical cadaver study comparing two methods of fixation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:334-342. [PMID: 33976433 DOI: 10.5507/bp.2021.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
AIMS To assess the results of a biomechanical test of cadaveric specimens, comparing 2 methods of fixation of modified Lapidus arthrodesis in combination with arthrodesis of the first metatarsophalangeal joint. METHODS A total of 12 cadaveric specimens were used in the test. Arthrodesis of the first MTP joint was in all patients fixed with a Variable Angle LCP 1st MTP Fusion Plate 2.4/2.7. Two methods of fixation of the Lapidus arthrodesis were compared, i.e. fixation with two screws in the PS (plate-screw) version versus fixation with X-Locking Plate 2.4/2.7 in the PP (plate-plate) version. Measurements were obtained with the use of a testing machine ZWICK Z 020-TND with an optical device Mercury RT for measuring deformities. Each specimen was subjected to 3 loading options, a. displacement 5 mm, the support is placed under the proximal phalanx, b. displacement 5 mm, the support is placed under the first metatarsal head and c. load to failure, the support is placed under the first metatarsal head. RESULTS In all specimens the PS construct showed a statistically considerably higher stiffness than the PP construct. In all specimens treated with the PP construct the load to failure was lower than in the PS construct. For loading mode a., at a significance level of 0.05 (P<0.05), the P-value was 0.036, for mode b. the P-value was 0.007 and for loading mode c. the P-value was 0.006. In addition, age-related decrease in stiffness of the specimen was proved at a significance level of 5% (P=0.004). CONCLUSION In all the three loading modes, the PS (plate-screw) construct showed a statistically higher stiffness than the PP (plate-plate) construct.
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Affiliation(s)
- Radek Kunovsky
- Department of Clinical Orthopedics, Trauma Hospital, Brno, Czech Republic
| | - Jan Kocis
- Department of Trauma Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Navrat
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, Technical University, Brno, Czech Republic
| | - Petr Vosynek
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, Technical University, Brno, Czech Republic
| | - Tomas Pink
- Department of Clinical Orthopedics, Trauma Hospital, Brno, Czech Republic.,Department of Trauma Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marek Joukal
- Institute of Anatomy, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Igor Cizmar
- Educational Center for Practical Anatomy, Brno, Czech Republic
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10
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LaCoste KL, Andrews NA, Ray J, Harrelson WM, Shah A. First Metatarsophalangeal Joint Arthrodesis: A Narrative Review of Fixation Constructs and Their Evolution. Cureus 2021; 13:e14458. [PMID: 33996318 PMCID: PMC8117946 DOI: 10.7759/cureus.14458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
First metatarsophalangeal (MTP) joint arthrodesis is a surgical procedure in which the first metatarsal head is fused to the proximal phalanx of the great toe in order to permanently stiffen the first MTP joint. It was originally proposed as a treatment for severe cases of hallux valgus deformity, but the procedure's indications and utilization have expanded since its initial development. Despite a wide variety of indications, first MTP arthrodesis has been shown to have reliable, satisfactory outcomes. As a result, the development of a wide array of surgical approaches, joint preparation techniques, and fixation devices used in the procedure has occurred. In this narrative review, we highlight the evolution of fixation constructs used in first MTP arthrodesis in order to provide a frame of reference for the various types of fixation constructs available.
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Affiliation(s)
- Ketrick L LaCoste
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Nicholas A Andrews
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Jessyca Ray
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Whitt M Harrelson
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Ashish Shah
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
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Dureja K, Bhardwaj SH. The Functional Outcome of Hallux Metatarsophalangeal Joint Arthrodesis Using Hallux Intramedullary Fusion Device. Indian J Orthop 2020; 55:103-109. [PMID: 34122762 PMCID: PMC8149532 DOI: 10.1007/s43465-020-00194-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/04/2020] [Indexed: 02/04/2023]
Abstract
Functional outcome of first metatarsophalangeal joint (MTPJ) arthrodesis using intramedullary implant was reviewed in retrospective series of 12 patients who had MTPJ arthritis. The outcome measures were improvements seen in VAS for pain and AOFAS scores recorded pre-operatively and post-operatively at the time of achieving complete union. VAS for pain improved from mean of 7.5 pre-operative to 1.8 post-operative (p < 0.001). AOFAS Score improved from mean of 35.58 pre-operative to 80.91 post-operative (p < 0.001). The fusion rate was 100 percent and mean time needed for fusion was 9.6 weeks. Only one patient had malunion which was acceptable to patient and was not revised. The fusion using intramedullary intra-osseous Hallux Fusion implant is a promising technique with good functional outcome and low complications.
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Affiliation(s)
- Kamal Dureja
- Foot and Ankle Unit, Max Smart Super-Specialty Hospital, Saket, New Delhi, 110017 India
| | - Shantanu H. Bhardwaj
- Foot and Ankle Surgery, Max Smart Super-Specialty Hospital, Saket, Delhi, 110017 India ,Maharashtra Jalgaon, India
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12
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Latif A, Dhinsa BS, Lau B, Abbasian A. First metatarsophalangeal fusion using joint specific dorsal plate with interfragmentary screw augmentation: Clinical and radiological outcomes. Foot Ankle Surg 2019; 25:132-136. [PMID: 29409296 DOI: 10.1016/j.fas.2017.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/18/2017] [Accepted: 09/24/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study reports the outcome of a plating system for arthrodesis of the first metatarsophalangeal joint (1st MTPJ) that incorporates a lag compression screw within a low profile titanium plate with a predetermined contour. This is the first report of the outcomes of this implant from a non-affiliated centre. PATIENT AND METHODS This is a prospective cohort study of 40 consecutive primary 1st MTPJ arthrodesis procedures. The mean age of the cohort was 56 years (range, 20-74 years). The diagnosis was hallux rigidus in 31 patients and inflammatory arthropathy in 7 patients. RESULTS All patients achieved clinical union at 6 weeks and radiological union was confirmed on plain radiographs between 6-16 weeks. One case of hardware removal was reported. CONCLUSION The cohort achieved consistently satisfactory results with a reliable and reproducible MTPJ position and a 100% union rate. There was a low rate of hardware removal. LEVEL OF EVIDENCE Level IV evidence. Prospective cohort study.
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Affiliation(s)
- Ahmed Latif
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Baljinder S Dhinsa
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom.
| | - Benjamin Lau
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Ali Abbasian
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
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13
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Maleki F, Ramesh A, Cassar-Gheiti AJ, Fox C, Kelly P, Stephens MM, McKenna JV. Comparison of 4 different techniques in first metatarsophalangeal joint arthrodesis. Ir J Med Sci 2019; 188:885-891. [PMID: 30617457 DOI: 10.1007/s11845-018-01961-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/29/2018] [Indexed: 12/11/2022]
Abstract
AIMS The aim of this study was to evaluate outcomes and fusion rates of 4 different methods of first metatarsophalangeal joint (MTPJ) arthrodesis. METHODS We performed a retrospective analysis of first MTPJ fusion using Bold® and Acutrak® compression screws, universal 1/3 tubular plate and Hallu®-S non-locking plate in 6 hospitals in Dublin over 4 years. A cohort of 300 patients (351 feet) was operated on by 3 feet and ankle fellowship trained orthopaedic surgeons (PK, MMS, JVMcK) over 4 years. Mean age was 62.4 years. There were 261 females and 39 males. One hundred three patients had a fusion of first MTPJ using two Acutrak® screws and 90 with two Bold® screws. Sixty-five were fused with the Hallu-S® plate and 42 with the universal 1/3 tubular plate. Patients were evaluated clinically and radiographically at 6 weeks, 3 months and 12 months. RESULTS Functional outcome scores performed using Manchester-Oxford Foot Questionnaire (MOXFQ). Failure rate in those fused with the Hallu®-S plate was 0%, Acutrak® screws 2.4%, Bold® screws 9.5% and universal 1/3 tubular plate 12.5% (p > 0.12). All treatment groups demonstrated significantly reduced MOXFQ scores (p value < 0.05). CONCLUSION In this retrospective study for first MTPJ fusion, a low profile, pre-contoured plate in combination with a screw mode had the best results with no failure rates and improved MOXFQ scores. LEVEL OF CLINICAL EVIDENCE IV, retrospective study.
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Affiliation(s)
- Farshid Maleki
- Orthopaedic Department, St. James's Hospital, James's Street, Dublin, D08 NHY1, Ireland
| | - Ashwanth Ramesh
- Orthopaedic Department, St. James's Hospital, James's Street, Dublin, D08 NHY1, Ireland
| | - Adrian J Cassar-Gheiti
- Orthopaedic Department, St. James's Hospital, James's Street, Dublin, D08 NHY1, Ireland.
| | - Ciara Fox
- Orthopaedic Department, St. James's Hospital, James's Street, Dublin, D08 NHY1, Ireland
| | - Paula Kelly
- Orthopaedic Department, Tallaght University Hospital, Tallaght, Dublin, D24 NR0A, Ireland
| | - Michael M Stephens
- Orthopaedic Department, Cappagh National Orthopaedic Hospital, Finglas, Dublin, D11 EV29, Ireland
| | - Johnny V McKenna
- Orthopaedic Department, St. James's Hospital, James's Street, Dublin, D08 NHY1, Ireland
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Willmott H, Al-Wattar Z, Halewood C, Dunning M, Amis A. Evaluation of different shape-memory staple configurations against crossed screws for first metatarsophalangeal joint arthrodesis: A biomechanical study. Foot Ankle Surg 2018; 24:259-263. [PMID: 29409249 DOI: 10.1016/j.fas.2017.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 03/02/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The first metatarsophalangeal joint may be fused in order to treat arthritis or instability. The use of shape-memory staples for fixation is well recognised, but little work has been done into the optimal configuration of staples. METHODS The structural behaviour of first metatarsophalangeal joint (MTPJ) arthrodeses using shape-memory staples or crossed screws was studied using cadaveric porcine joints. Five fixation configurations were tested: single vertical or horizontal staple, paired staples in dorsal-medial configuration (0-90° to the sagittal plane), paired staples in oblique orthogonal configuration (45-135°); or two crossed screws. Specimens were loaded in cyclical dorsiflexion for 1000 cycles. Plantar gapping and shearing were measured. Specimens were then loaded to failure. RESULTS Cyclic testing caused more shear in the 45-135° staples than the crossed screws (1.0mm±0.5mm compared to 0.14mm±0.4mm, p<0.01). No significant difference was found in plantar gap formation. Single vertical and horizontal single staples failed at 15N and 19. CONCLUSIONS N, respectively. Paired 0-90° staples failed at 43N±9N, significantly lower than the 45-135° staples (141N±25N; p<0.001) and crossed screws (180N±67N; p<0.001). There was no significant difference between the 45-135° staples and crossed screws. Screws failed by sudden cortical fracture; staples displayed gradual pull-out and shearing. First MTPJ arthrodeses fixed with single staples are not recommended. Arthrodeses fixed with staples at 0-90° to the sagittal plane were significantly less strong than two crossed screws. However, positioning oblique staples at 45-135° significantly improved stability, creating a construct as strong as, crossed screws. None of the constructs was strong enough for immediate weight bearing.
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Affiliation(s)
- H Willmott
- Department of Orthopaedics, Conquest Hospital, East Sussex Hospitals NHS Trust, United Kingdom.
| | - Z Al-Wattar
- Department of Orthopaedics, Conquest Hospital, East Sussex Hospitals NHS Trust, United Kingdom
| | - C Halewood
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, United Kingdom
| | - M Dunning
- Department of Orthopaedics, Conquest Hospital, East Sussex Hospitals NHS Trust, United Kingdom
| | - A Amis
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, United Kingdom; The Musculoskeletal Surgery Lab, Department of Surgery & Cancer, Imperial College London, United Kingdom
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Harris E, Moroney P, Tourné Y. Arthrodesis of the first metatarsophalangeal joint-A biomechanical comparison of four fixation techniques. Foot Ankle Surg 2017; 23:268-274. [PMID: 29202986 DOI: 10.1016/j.fas.2016.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/17/2016] [Accepted: 07/11/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthrodesis of the first metatarsophalangeal joint is a commonly performed orthopaedic procedure. The optimum method of fixation and joint surface preparation has yet to be determined. METHODS This study compared four fixation techniques: Biomechanical grade sawbones were used. The dorsal plate used was a titanium, anatomically contoured locked plate. Testing was performed using an Instron machine applying force from the plantar aspect of the fused joint. Each fused sample was tested to failure. Stiffness, as calculated from the force-displacement curve, and ultimate load tolerated were recorded for each sample. The method of failure of each sample was also documented. RESULTS Constructs arthrodesed using dorsal plate with separate screw groups, regardless of method of joint preparation, were the stiffest (p<0.001). The weakest construct was dorsal plate alone without interfragmenary screw. There was no difference in stiffness between planar and cup-cone joint preparation (p=0.99). Maximum load tolerated was similar when comparing Crossed Screws with dorsal plate with screw with either cup-cone or planar reaming (p=0.93, p=0.89 respectively). Dorsal plating alone tolerated a significantly lower maximum load than Plate with Screw Groups or Crossed Screws (p<0.001). CONCLUSION This study confirms that an IFS combined with a dorsally positioned locked-plate is the ideal construct, with the joint preparation technique of little consequence.
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Affiliation(s)
- Ella Harris
- Biomedical Sciences Institute, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland.
| | - Paul Moroney
- Department of Orthopaedic Surgery, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland.
| | - Yves Tourné
- Clinique des Cedres, 38130 Echirolles, France.
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Bauer T. Percutaneous First Metatarsophalangeal Joint Fusion. Open Orthop J 2017; 11:724-731. [PMID: 28979586 PMCID: PMC5620410 DOI: 10.2174/1874325001711010724] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 07/21/2016] [Accepted: 07/23/2016] [Indexed: 12/26/2022] Open
Abstract
The first metatarsophalangeal (MTP1) joint fusion is a very useful procedure in forefoot surgery and is still the gold standard for the treatment of severe and painful hallux rigidus. Normal walking and running are possible after MTP1 fusion, the first ray mobility being essentially in the interphalangeal (IP) joint with a compensatory hypermobility in dorsal flexion. Percutaneous MTP1 fusion is a simple procedure providing comparable results to fusions performed with open techniques. Postoperative cares are simplified with an immediate full weight bearing on rigid flat shoes and quick return to normal walking. Bone preparation is an important step and requires an experience in percutaneous forefoot surgery. Arthrodesis positioning and fixation with this percutaneous procedure are simple with possibility of clinical and radiological control. The indications for percutaneous MTP1 fusion are very large and only severe bone loss or osteoporosis represent the limits for this technique.
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Affiliation(s)
- Thomas Bauer
- Department of Orthopedic Surgery, Ambroise Paré University Hospital, West Paris University, 9 avenue Charles de Gaulle, 92100 Boulogne Billancourt, France
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Wanivenhaus F, Espinosa N, Tscholl PM, Krause F, Wirth SH. Quality of Early Union After First Metatarsophalangeal Joint Arthrodesis. J Foot Ankle Surg 2016; 56:50-53. [PMID: 27866887 DOI: 10.1053/j.jfas.2016.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Indexed: 02/03/2023]
Abstract
The aim of the present retrospective cohort study was to assess the quality of union and the clinical outcomes in patients who had undergone first metatarsophalangeal joint (MTPJ) fusion using a dorsal plate and plantar lag screw. From March 2011 to December 2012, the clinical and radiographic data of 39 patients (41 feet) who had undergone first MTPJ fusion using a compressive locking plate were retrospectively reviewed. All patients had undergone postoperative computed tomography at 6 weeks postoperatively to assess union. The average metatarsophalangeal angles improved from 23° ± 16° preoperatively to 14° ± 5° postoperatively. The dorsiflexion of the hallux at the preoperative assessment averaged 17° ± 11° and 23° ± 5° postoperatively. At 6 weeks postoperatively, the computed tomography scans demonstrated 3 complete fusions (7.3 %) and 38 partial unions (92.7%). Also at 6 weeks, the mean ± standard deviation joint bridging was 54% ± 14.6%. The forefoot American Orthopaedic Foot and Ankle Society scale score had improved significantly from 50 ± 13 preoperatively to 80 ± 7 at >1 year of follow-up (p = .001). Hardware removal was performed in 8 cases because of pain in 7 and infection in 1. Revision arthrodesis was required in 2 cases because of nonunion. At 6 weeks postoperatively, partial bony joint bridging could be observed in most cases after arthrodesis of the first MTPJ with the dorsal fusion plate.
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Affiliation(s)
- Florian Wanivenhaus
- Surgeon, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland.
| | - Norman Espinosa
- Surgeon, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Philippe M Tscholl
- Surgeon, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Fabian Krause
- Surgeon, Department of Orthopaedics, University Hospital Bern, Bern, Switzerland
| | - Stephan H Wirth
- Surgeon, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
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Abstract
First metatarsophalangeal joint arthrodesis plays a significant role in the management of symptomatic hallux rigidus/osteoarthritis of the 1st metatarsophalangeal joint. Several open and few percutaneous techniques have been described in the literature. This article describes and discusses a percutaneous technique that has been successfully used to achieve a pain-free stable and functional 1st metatarsophalangeal joint. All aspects of surgical indication and operative technique and details of patient-reported outcomes are presented with a referenced discussion.
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Affiliation(s)
- A H Sott
- Foot & Ankle Unit, Trauma & Orthopaedics, Epsom & St Helier University Hospitals NHS Trust, Wrythe Lane, London SM5 1AA, UK.
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Rashid MA, Parnell M, Khan WS, Khan A. First Metatarsalphalangeal Joint Arthrodesis: A Retrospective Comparison of Two Methods of Fixation. Open Orthop J 2015; 9:480-2. [PMID: 26587065 PMCID: PMC4645895 DOI: 10.2174/1874325001509010480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/03/2015] [Accepted: 05/22/2015] [Indexed: 12/02/2022] Open
Abstract
First metatarsalphalangeal joint arthrodesis is a well established and successful treatment; however there still remains controversy over the best choice of construct. We performed a retrospective study of patients undergoing first metatarsalphalangeal fusion over eighteen months (n=52) using either dorsal non-locking plate with additional compression lag screw fixation or dorsal non-locking plate alone. We found when assessing clinical criteria, patients with dorsal non-locking plates and additional compression lag screw fixation had a significantly higher rate of fusion (100% vs 77.8%), significantly higher rate of fusion within the first two months (55.6% vs 83.3%), significantly earlier time to fusion (52.2 days vs 75.6 days), and significantly lower rate of non-union (0% vs 22.2%). When blindly assessing radiographic criteria, the patients treated with the plate and compression screw had a significantly higher rate of fusion and lower rate of non-union (0% vs 33%). There was no statistically significant difference between the frequencies of complications in the groups. We believe that the interfragmentary compression is a crucial factor in achieving good union rates and recommend the use of non-locking pre-contoured plating with additional interfragmentary compression screw as the fixation method of choice for these procedures.
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Affiliation(s)
- M A Rashid
- Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK
| | - M Parnell
- Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK
| | - W S Khan
- Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK
| | - A Khan
- Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK
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20
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Luk PC, Johnson JE, McCormick JJ, Klein SE. First Metatarsophalangeal Joint Arthrodesis Technique With Interposition Allograft Bone Block. Foot Ankle Int 2015; 36:936-43. [PMID: 25848133 DOI: 10.1177/1071100715577953] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We present a technique of first metatarsophalangeal joint arthrodesis utilizing an interposition allograft bone block with a bipolar reaming technique that creates congruent fusion surfaces on both ends of the graft-host bone interface. In addition, we examined the union rates, fusion position, patient satisfaction, and functional outcome of this technique. METHODS Fifteen patients underwent first metatarsophalangeal joint arthrodesis with an interposition allograft bone block between September 2004 and October 2013. Charts and radiographs were reviewed. Six measures were compared on preoperative and postoperative radiographs. Clinical outcomes were measured using a telephone questionnaire, pre- and postoperative visual analog scale pain scale, and Foot and Ankle Ability Measure. Average follow-up was 46 weeks (range, 19 to 97). RESULTS Thirteen of 15 (87%) patients achieved bony union at an average of 21 weeks. One patient underwent revision arthrodesis for their nonunion. Symptomatic hardware was removed in 3 cases. Improvement was noted in visual analog scale pain scores (6 to 2) and functional scores as measured by the Foot and Ankle Ability Measure. There were no postoperative wound complications or infections. Average length of the first ray on anteroposterior radiograph increased from 10.7 to 11.3 cm and from 10.0 to 10.7 cm on the lateral radiograph. Thirteen of 14 patients were very satisfied or satisfied. One patient expressed dissatisfaction with the procedure. One patient was not available for clinical follow-up. CONCLUSION First metatarsophalangeal joint allograft bone block arthrodesis using the bipolar reaming technique achieved high bony union rates and satisfactory radiographic and clinical outcomes. This procedure was an effective salvage option for managing bone loss on 1 or both sides of the joint. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Pamela C Luk
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA Congress Medical Associates, Arcadia, CA, USA
| | - Jeffrey E Johnson
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Jeremy J McCormick
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Sandra E Klein
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO, USA
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21
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Fanous RN, Ridgers S, Sott AH. Minimally invasive arthrodesis of the first metatarsophalangeal joint for hallux rigidus. Foot Ankle Surg 2014; 20:170-3. [PMID: 25103703 DOI: 10.1016/j.fas.2014.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 02/17/2014] [Accepted: 03/11/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND First metatarsophalangeal joint arthrodesis plays a significant role in the management of symptomatic hallux rigidus. Several open and one percutaneous technique have been described in the literature. The authors present a minimally invasive technique, not previously published in the UK with patient-reported outcomes. METHODS A total of 26 cases of are presented in this prospective, continuous series. Clinical outcome and patient satisfaction were assessed by the Manchester-Oxford Foot Questionnaire (MOXFQ) preoperatively and at most recent follow up (maximum 20 months). Radiographic and clinical evaluation of fusion was also assessed with a fusion rate of 93%. RESULTS The MOXFQ score for cases where fusion was achieved improved from a mean of 42 points to 18 points at last follow up (p<0.05). Patient satisfaction was overall very good. CONCLUSIONS This minimally invasive technique is simple and can achieve results similar or better than open techniques in experienced hands. Postoperative care requirements are minimal and both clinical and patient-reported outcome show significant improvement in this series.
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Affiliation(s)
- Rafik Nabil Fanous
- Foot & Ankle Unit, Epsom & St Helier University Hospital NHS Trust, Wrythe Lane, Carshalton SM5 1AA, United Kingdom.
| | - Sophia Ridgers
- Foot & Ankle Unit, Epsom & St Helier University Hospital NHS Trust, Wrythe Lane, Carshalton SM5 1AA, United Kingdom
| | - Andrea H Sott
- Foot & Ankle Unit, Epsom & St Helier University Hospital NHS Trust, Wrythe Lane, Carshalton SM5 1AA, United Kingdom
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22
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Abstract
Arthrodesis of the first metatarsophalangeal joint is a reliable operation in the treatment of selected cases of hallux valgus. It corrects deformity of hallux valgus and metatarsus primus varus, leading to good functional results with a low complication rate. It is a technique well suited to patients with hallux valgus associated with degenerative changes or severe deformity, and those for whom primary hallux valgus surgery has failed.
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Affiliation(s)
- Edward V Wood
- Department of Orthopaedics, Countess of Chester Hospital NHS Trust, Liverpool Road, Chester CH2 1UL, UK.
| | - Christopher R Walker
- Department of Orthopaedics, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - Michael S Hennessy
- Department of Orthopaedics, Wirral University Hospitals NHS Trust, Arrowe Park Road, Upton, Wirral CH49 5PE, UK
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Abstract
INTRODUCTION Although the gold standard to address hallux rigidus that fails conservative treatment is an arthrodesis, some surgeons have attempted to use arthroplasty to improve range of motion and to simulate a normal joint. When these implants do fail, a salvage MTP arthrodesis is the only surgical option for these patients. This research aims to outline various methods to arthrodese the MTP joint in salvage situations. METHODS We retrospectively looked at patients who underwent a first-MTP fusion after failure of an implant arthroplasty. All fusions involved either bone allograft or autograft and internal fixation. The patients were assessed clinically, radiographically, and with the Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS MTP-IP) clinical questionnaire preoperatively and postoperatively. RESULTS In all, 11 patients met the inclusion criteria. The average age of patients at the time of the salvage MTP arthrodesis was 57 years. The interval time between primary surgery and revision arthrodesis was on average 84.2 months. There was a high reoperation rate, with 7 operative procedures occurring per 12 arthrodeses (58%). The average time to radiographic fusion was 6.9 ± 4.8 months; 41.7% of patients had a delayed union (>6 months to fusion). Two patients had symptomatic nonunions (16.7%). All the patients had an improvement in their AOFAS MTP-IP score. CONCLUSION Although salvage arthrodeses for failed arthroplasties generally have favorable satisfaction rates and are a powerful tool in treating this painful condition, they are fraught with complications. They unite slower, have a significantly higher reoperation rate, and have lower AOFAS scores than primary fusions.
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Affiliation(s)
- Christopher E Gross
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Migues A, Calvi J, Sotelano P, Carrasco M, Slullitel G, Conti L. Endomedullary screw fixation for first metatarsophalangeal arthrodesis. Foot Ankle Int 2013; 34:1152-7. [PMID: 23524860 DOI: 10.1177/1071100713483113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the clinical and radiological results in a group of patients who underwent first metatarsophalangeal joint arthrodesis with an endomedullary screw fixation technique (MPA-E). METHODS Between 2003 and 2009, 101 metatarsophalangeal arthrodesis were performed in 76 patients. There were 64 women and 12 men with an average age of 68 years. The indication for surgery was osteoarthritis with severe pain and functional limitation. Patients were evaluated radiologically and with the American Orthopaedic Foot & Ankle Society scoring system (AOFAS) at an average follow-up of 32 months (range, 24-92 months). RESULTS The success rate was 93%, with an increase of the average preoperative AOFAS from 38.5 points to 85.5 points postoperatively (P < .0001). The consolidation rate after radiological evaluation was 90.1%; there were 5 cases (5.0%) with asymptomatic nonunion and 5 cases (5.0%) with poor results because of symptomatic nonunion. Screw removal was needed in 4 feet (4.0%), and 2 feet (2.0%) had acute postoperative superficial infection. No implant cutout was observed. CONCLUSION The MPA-E technique provided consistent and high functional outcomes. This valid and effective alternative should be considered as an option for hallux metatarsophalangeal arthrodesis. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Atilio Migues
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Treadwell JR. First metatarsophalangeal joint arthrodesis; what is the best fixation option? A critical review of the literature. Clin Podiatr Med Surg 2013; 30:327-49. [PMID: 23827491 DOI: 10.1016/j.cpm.2013.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
First metatarsophalangeal joint arthrodesis can be accomplished using many forms of fixation. Distinguishing the best fixation construct requires evaluation of many variables. A review of the literature provides a starting point for what needs to be assessed and what questions need to be asked. In vivo and in vitro studies attempt to provide answers but frequently reveal shortcomings in the evidence to date. In the end, there is always 1 best fixation technique.
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Eleftheriou KI, Rosenfeld PF, Calder JDF. Lisfranc injuries: an update. Knee Surg Sports Traumatol Arthrosc 2013; 21:1434-46. [PMID: 23563815 DOI: 10.1007/s00167-013-2491-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 03/26/2013] [Indexed: 12/19/2022]
Abstract
Lisfranc injuries are a spectrum of injuries to the tarsometatarsal joint complex of the midfoot. These range from subtle ligamentous sprains, often seen in athletes, to fracture dislocations seen in high-energy injuries. Accurate and early diagnosis is important to optimise treatment and minimise long-term disability, but unfortunately, this is a frequently missed injury. Undisplaced injuries have excellent outcomes with non-operative treatment. Displaced injuries have worse outcomes and require anatomical reduction and internal fixation for the best outcome. Although evidence to date supports the use of screw fixation, plate fixation may avoid further articular joint damage and may have benefits. Recent evidence supports the use of limited arthrodesis in more complex injuries.
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Mann JJ, Moon JL, Brosky TA. Low-profile titanium plate construct for early weightbearing with first metatarsophalangeal joint arthrodesis. J Foot Ankle Surg 2013; 52:460-4. [PMID: 23632068 DOI: 10.1053/j.jfas.2013.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Indexed: 02/03/2023]
Abstract
First metatarsophalangeal joint arthrodesis is a useful procedure for various first ray pathologic entities. Multiple constructs for fixation have provided successful fusion. A retrospective study of 21 feet (18 patients) was performed after first metatarsophalangeal joint fusion using crossed Kirschner wires or compression fixation with cannulated screws followed by the application of a 2-hole low-profile partially locking titanium plate. The median age was 59 (range 41 to 76) years, and we had 4 smokers and 3 patients with diabetes in our series. Postoperatively, a compression dressing with a posterior splint was applied. The patients then transitioned to a controlled ankle motion walker, and all patients reported full weightbearing by 2 weeks postoperatively. The mean follow-up duration was 11.43 (range 6 to 27) months. The overall primary fusion rate was 95.24% (20 of 21). Two nonunions occurred; one was asymptomatic and successfully consolidated at 12 months. The second nonunion required revisional surgery with an autogenous bone graft to heal successfully. This patient was noncompliant with the postoperative regimen and had a 48-pack year history of tobacco usage. Our results have shown early weightbearing after first metatarsophalangeal joint arthrodesis can be successfully initiated with splintage or lag screw fixation and a 2-hole, low-profile, partially locking titanium plate.
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Shah K, Augustine A, Carter R, McFadyen A. Arthrodesis of the first metatarsophalangeal joint: comparison of three techniques. J Am Podiatr Med Assoc 2013; 102:13-7. [PMID: 22232316 DOI: 10.7547/1020013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND There are cadaveric and biomechanical studies comparing different methods of fixation for achieving arthrodesis in hallux rigidus. However, there are no comparative clinical studies. We compared the clinical and radiologic outcomes of first metatarsophalangeal joint fusion using three different techniques: lag screw, lag screw and circlage wire, and Memory staples. METHODS This was a retrospective study of 46 patients who underwent first metatarsophalangeal joint fusion. All of the operations were performed by experienced surgeons. Each patient had clinical and radiologic assessments postoperatively. RESULTS The three groups were matching in terms of demographic features and comorbidity. Intraobserver and interobserver reliability for radiographic metatarsophalangeal joint fusion was excellent. The mean time to clinical and radiologic union in the Memory staples group was earlier (7.6 weeks) than that of the other two techniques (8.0 and 8.1 weeks). The Memory staples group also had the lowest incidence of nonunion (1 of 15 compared with 4 of 15 in the single lag screw fixation group and 3 of 16 in the lag screw and circlage wire fixation group) and no hardware-related problems. CONCLUSIONS Our experience corroborates the advantages of Memory staples as described in the literature, including good approximation of bone fragments, technically easy application with fewer steps than an AO-applied screw, and an adequate source of internal fixation to achieve metatarsophalangeal joint fusion. There is also a suggestion that the time to achieve fusion is shorter.
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Affiliation(s)
- Kalpesh Shah
- Southern General Hospital, Glasgow, Glasgow, Scotland, United Kingdom.
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Hunt KJ, Barr CR, Lindsey DP, Chou LB. Locked versus nonlocked plate fixation for first metatarsophalangeal arthrodesis: a biomechanical investigation. Foot Ankle Int 2012; 33:984-90. [PMID: 23131445 DOI: 10.3113/fai.2012.0984] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND First metatarsophalangeal (MTP) arthrodesis using dorsal plate fixation is a common procedure for painful conditions of the great toe. Locked plates have become increasingly common for arthrodesis procedures in the foot, including the hallux MTP joint. The biomechanical advantages and disadvantages of these plates are currently unknown. The purpose of this study was to compare locked and nonlocked plates used for first MTP fusion for strength and stiffness. MATERIALS AND METHODS The first ray of nine matched pairs of fresh-frozen cadaveric feet underwent dissection, preparation with cup-and-cone reamers, and fixation of the MTP joint with a compression screw and either a nonlocked or locked stainless steel dorsal plate. Each specimen was loaded in a cantilever fashion to 90 N at a rate of 3 Hz for a total of 250,000 cycles. The amount of plantar MTP gap was recorded using a calibrated extensometer. Load-to-failure testing was performed for all specimens that endured the entire cyclical loading. Stiffness was calculated from the final load-to-failure test. RESULTS The locked plate group demonstrated significantly less plantar gapping during fatigue endurance testing from cycle 10,000 through 250,000 (p < .05). Mean stiffness was significantly greater in the locked plate group compared with the nonlocked plate group (p = .02). There was no significant difference in load to failure between the two groups (p = .27). CONCLUSION Compared with nonlocked plates, locked hallux MTP arthrodesis plates exhibited significantly less plantar gapping after 10,000 cycles of fatigue endurance testing and significantly greater stiffness in load-to-failure testing. CLINICAL RELEVANCE As the use of locked plate technology is becoming increasingly common for applications in the foot, a thorough understanding of the biomechanical characteristics of these implants may help optimize their indications and clinical use.
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Affiliation(s)
- Kenneth J Hunt
- Department of Orthopaedics, Stanford University, Redwood City, CA 94063, USA.
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Hyer CF, Scott RT, Swiatek M. A retrospective comparison of first metatarsophalangeal joint arthrodesis using a locked plate and compression screw technique. Foot Ankle Spec 2012; 5:289-92. [PMID: 22935413 DOI: 10.1177/1938640012457936] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The historic primary treatment for end-stage first metatarsophalangeal (MTP) joint arthritis has been fusion. Traditionally, this has been accomplished by metaphyseal apposition between the proximal phalanx and metatarsal using crossed compression screws. Recently, locked plates have been introduced that help support this technique by offering added stability. We present our experience with 45 first MTP fusions in 45 feet using a locked plate and compression screw. METHODS A retrospective review of 45 patients who met the study criteria with a hallux rigidus correction using a locked plate with a compression screw was performed. Charts and radiographs were independently reviewed by 2 authors not involved in the index procedures to assess outcomes. RESULTS There was a 93% fusion rate (42/45 feet) with 3 nonunions. The mean time to union was 51.1 days (range = 29-116 days, SD = 24.4). The mean patient age was 58.1 years (range = 29-80 years, SD = 10.1). The mean time to partial weight bearing was 7.0 days (range = 0-53 days, SD = 13.8) and the mean time to full weight bearing was 62.0 days (range = 29-57 days, SD = 17.9). DISCUSSION We report on the results of first MTP fusion using a compression screw and locked plate technique. The results show that this is an effective means of creating a first MTP joint arthrodesis.
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Dening J, van Erve RHGP. Arthrodesis of the first metatarsophalangeal joint: a retrospective analysis of plate versus screw fixation. J Foot Ankle Surg 2011; 51:172-5. [PMID: 22178200 DOI: 10.1053/j.jfas.2011.10.044] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Indexed: 02/03/2023]
Abstract
Arthrodesis of the first metatarsophalangeal joint is a commonly accepted technique to treat various afflictions of the hallux. Many techniques have been described to fixate the arthrodesis. However, no superior fixation technique has been identified in regard to nonunion. We performed a retrospective analysis of first metatarsophalangeal joint arthrodeses in our clinic from January 2000 to April 2010, focusing on plate and screw fixation. Our aim was to identify the best fixation construct in regard to fusion rates and radiologic nonunion. We identified 72 arthrodeses performed using 1 oblique (n = 24) or 2 crossed (n = 21) lag screws or a plate (n = 13) or a plate augmented with plantar lag screw fixation (n = 14). Our analysis showed that plate fixation alone results in significantly fewer nonunions than single screw fixation. A comparison of the other fixation types showed no significant differences with regard to nonunion. Although our analysis showed that plate fixation alone is superior to single screw fixation, no definitive conclusion can be drawn owing to methodologic shortcomings. We believe a randomized controlled trial with larger sample sizes is necessary to find the clinically superior fixation technique.
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Affiliation(s)
- Jan Dening
- Resident, Emergency Department, Scheper Hospital, Emmen, The Netherlands.
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Abstract
This article is a review of the history, etiology, and clinical and radiographic presentations of hallux rigidus. The focus is on current treatment options being offered for the treatment of hallux rigidus.
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Moon JL, McGlamry MC. First metatarsophalangeal joint arthrodesis: current fixation options. Clin Podiatr Med Surg 2011; 28:405-19, ix. [PMID: 21669346 DOI: 10.1016/j.cpm.2011.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This article reviews the current literature on first metatarsophalangeal joint arthrodesis rates using various forms of fixation, as well as reviewing biomechanical studies comparing the strengths of the different fixation options that are available.
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Das besondere Instrument – Cup & Cone-Fräsen zur Arthrodese des Großzehengrundgelenks. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2010; 22:431-9. [DOI: 10.1007/s00064-010-9015-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kumar S, Pradhan R, Rosenfeld PF. First metatarsophalangeal arthrodesis using a dorsal plate and a compression screw. Foot Ankle Int 2010; 31:797-801. [PMID: 20880483 DOI: 10.3113/fai.2010.0797] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fusion of the first metatarsophalangeal joint is considered a `gold standard' procedure for arthritis and as a salvage procedure for previous failed surgeries. Recent biomechanical studies have shown that a combination of a plate and screw is the most stable construct. Only a few studies have evaluated this combination and they have small cohorts so we are presenting our larger series of patients. MATERIALS AND METHODS Forty-six consecutive cases of first metatarsophalangeal joint fusion performed between April 2006 and April 2008 were performed using a dorsal plate and a compression screw. We analyzed the outcome in terms of fusion rate, patient satisfaction and complication rates. The average followup period was 23 (range, 14 to 37) months. The most common indications were hallux rigidus and severe hallux valgus. RESULTS Ninety-eight percent of the cases fused uneventfully by four months. The average time to fusion was 3.1 months. There was one non-union, which remained asymptomatic after metal removal which was the only case requiring removal of metal. There was no hardware failure. The patient satisfaction was 100%. The average AOFAS score was 82.1 (maximum, 90). CONCLUSION These results show that arthrodesis of the first MTP joint with spherical reamers and a low-profile contoured dorsal titanium plate and compression screw is highly successful, with excellent patient satisfaction and functional outcomes. We recommend the use of specially designed plates against improvised plates as bending leads to poor control over dorsiflexion and may increase the incidence of plate failure.
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Affiliation(s)
- Sujit Kumar
- Registrar, Trauma & Orthopaedics, St Mary's Hospital, Paddington, London, UK.
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Bauer T, Lortat-Jacob A, Hardy P. First metatarsophalangeal joint percutaneous arthrodesis. Orthop Traumatol Surg Res 2010; 96:567-73. [PMID: 20627766 DOI: 10.1016/j.otsr.2010.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 11/22/2009] [Accepted: 01/28/2010] [Indexed: 02/02/2023]
Abstract
UNLABELLED The aim of this work is to describe a percutaneous technique of first metatarsophalangeal (MTP1) joint fusion and to assess its preliminary results. Thirty-two percutaneous MTP1 joint arthrodeses were analysed in a prospective continuous series including 30 patients of mean age 66 years old. The indications for arthrodesis of the MTP1 joint were symptomatic hallux rigidus or hallux rigido-valgus in most of the cases. All patients underwent the same percutaneous procedure, as a one-day surgery for 26 cases. Clinical results were assessed using the functional AOFAS forefoot scoring system both preoperatively and at last follow-up. Radiographical analysis was focused on positioning and quality of the arthrodesis. No patient was lost to follow-up and the mean follow-up was 18 months. The functional AOFAS score improved in all cases from a mean 36/100 preoperatively to a mean 80/100 postoperatively (p=0.02). In 30 cases, patients were satisfied or very satisfied with their final outcome, one patient was disappointed and one was dissatisfied. Satisfied or very satisfied patients could wear normal shoes after a mean 50-day period. Fusion was radiographically obtained in 31 cases out of 32. The mean postoperative dorsi flexion of the MTP1 joint arthrodesis was 21° (min: 15°, max: 35°). One patient developed a deep surgical site infection, 3 weeks after the procedure. Percutaneous MTP1 joint fusion is a simple surgical technique that can achieve similar results to open techniques for MTP1 fusions, with very simple postoperative care requirements. Indications for percutaneous MTP1 joint arthrodesis are large and only major bone defects or severe osteoporosis can be considered as contraindications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- T Bauer
- Department of Orthopaedics and Trauma Surgery, Ambroise-Paré Hospital, West Paris District University, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France.
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Bayomy AF, Aubin PM, Sangeorzan BJ, Ledoux WR. Arthrodesis of the first metatarsophalangeal joint: a robotic cadaver study of the dorsiflexion angle. J Bone Joint Surg Am 2010; 92:1754-64. [PMID: 20660239 DOI: 10.2106/jbjs.i.00984] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthrodesis of the first metatarsophalangeal joint is indicated for severe osteoarthritis or as a revision of failed treatment for hallux valgus. The literature suggests that an optimum fused dorsiflexion angle is between 20 degrees and 25 degrees from the axis of the first metatarsal. The purpose of this study was to investigate the relationship between dorsiflexion angle and plantar pressure in the postoperative gait. We assumed that there is a fused dorsiflexion angle at which pressures are minimized under the hallux and the first metatarsal head. METHODS Six cadaver foot specimens underwent incremental changes in simulated fused metatarsophalangeal joint dorsiflexion angle followed by dynamic gait simulation. A robotic gait simulator performed at 50% of body weight and one-fifteenth of physiologic velocity. In vitro tibial kinematics and tendon forces were based on normative in vivo gait and electromyographic data and were manually tuned to match the in vitro ground reaction force and tendon force behavior. Regression lines were calculated for peak pressure and pressure-time integral under the hallux and the metatarsal head by dorsiflexion angle. RESULTS Peak pressure and pressure-time integral under the hallux were negatively correlated with dorsiflexion angle (p < 0.004), while peak pressure and pressure-time integral under the metatarsal head were positively correlated with dorsiflexion angle (p < 0.004). The intersection of the regression lines that represented the angle at which peak pressure and pressure-time integral were minimized was 24.7 degrees for peak pressure and 21.3 degrees for pressure-time integral. CONCLUSIONS Our findings support the hypothesis that an angle-pressure relationship exists following arthrodesis of the first metatarsophalangeal joint and that it is inversely related for the hallux and the metatarsal head. Our results encompass the suggested range of 20 degrees to 25 degrees.
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Affiliation(s)
- Ahmad F Bayomy
- Department of Veterans Affairs Rehabilitation Research and Development Service Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, VA Puget Sound Health Care System, MS 151, 1660 South Columbian Way, Seattle, WA 98108, USA
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Besse JL, Chouteau J, Laptoiu D. Arthrodesis of the first metatarsophalangeal joint with ball and cup reamers and osteosynthesis with pure titanium staples Radiological evaluation of a continuous series of 54 cases. Foot Ankle Surg 2010; 16:32-7. [PMID: 20152753 DOI: 10.1016/j.fas.2009.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 01/26/2009] [Accepted: 03/31/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND In a continuous series of 54 MTP-1 arthrodeses using ball and cup reamers, fusion and great toe position were analyzed. MATERIALS AND METHODS The population was mainly female (46 versus 8). Mean age at operation was 61 years. Arthrodesis was for four conditions of symptomatic degenerative disease: 36 severe hallux valgus (>35 degrees ), 7 recurrences of hallux valgus, 9 hallux rigidus and 2 hallux varus. Arthrodesis used a medial approach, articular surface preparation by ball and cup reamers (plus perforation by Kirschner wire), and osteosynthesis with three titanium staples. Pre- and postoperative big toe positions were analysed with the Footlog semi-automated X-ray assessment software. RESULTS All patients were followed up for a mean 38.6 months (22-56). Overall fusion rate was 94.4%, and 99% for primary arthrodesis. Mean time to union was 56 days (74% in 6 weeks), with 3 non-unions (5.6%), including 2 after hallux valgus recurrence. Mean pre-operative toe valgus was 40 degrees and 14.1 degrees at revision for all groups. 95% of arthrodeses fused at a mean lateral metatarsophalangeal angle of 22.6 (18-26 degrees ). Metatarsus varus exceeded 20 degrees in 8 cases, mainly in the severe hallux valgus group; at revision, the mean first intermetatarsal angle was 10.6 degrees (9-12 degrees ). CONCLUSION Arthrodesis of the first metatarsophalangeal joint with ball and cup reamers is a reliable and reproducible technique, giving total correction of big toe valgus. The first intermetatarsal angle was corrected without supplementary osteotomy. Using three pure titanium staples for fixation, rate and time of fusion were in line with reference techniques.
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Bennett GL, Sabetta J. First metatarsalphalangeal joint arthrodesis: evaluation of plate and screw fixation. Foot Ankle Int 2009; 30:752-7. [PMID: 19735631 DOI: 10.3113/fai.2009.0752] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND First metatarsalphalangeal joint (MTPJ) arthrodesis is a commonly performed procedure for the treatment of a variety of conditions affecting the hallux. There are several different methods to accomplish the fusion. We utilized a method incorporating a ball and cup preparation of the joint, followed by stabilization of the arthrodesis site utilizing the Accutrak congruent first MTPJ fusion set. MATERIALS AND METHODS We prospectively evaluated two hundred consecutive patients who underwent first MTPJ arthrodeses utilizing the Accutrak congruent first MTPJ fusion set. Patients were evaluated preoperatively, postoperatively, and at a final followup, utilizing the AOFAS forefoot scoring system. RESULTS Two hundred consecutive patients underwent first MTPJ arthrodeses by the same surgeon. All but three feet (230/233) (98.7%) went on to solidly fuse. Three of the patients did not fuse solidly. One patient broke two of the screws, and the other two patients did not have hardware failure. All patients dramatically improved their AOFAS scores compared with pre-surgical values. There were three minor hardware problems in the group of patients who solidly fused their joint. CONCLUSION We concluded that a solid first MTPJ fusion results in excellent function and pain relief. The Accutrak first MTPJ fusion system would appear to be an ideal implant system to accomplish a fusion because of its low profile, strength, and ease of use. Compared to other methods we have used, this procedure results in a very high rate of fusion, with minimal complications and excellent patient satisfaction.
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Affiliation(s)
- Gordon L Bennett
- Crystal Clinic, Inc., 3975 Embassy Parkway, Akron, OH 44333, USA.
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Wassink S, van den Oever M. Arthrodesis of the first metatarsophalangeal joint using a single screw: retrospective analysis of 109 feet. J Foot Ankle Surg 2009; 48:653-61. [PMID: 19857821 DOI: 10.1053/j.jfas.2009.05.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Indexed: 02/03/2023]
Abstract
UNLABELLED Arthrodesis of the first metatarsophalangeal joint is a recommended technique for hallux rigidus. The preparation of the joint surfaces and the way in which fixation is achieved might be relevant in success or failure of the arthrodesis. All patients were selected from archived records of operations performed at the 'Groene Hart' Hospital in Gouda, the Netherlands, from 1996 until 2005. Patients were operated following a fixed protocol using flat surfaces and a single compression screw bridging the arthrodesis from proximal medial to distal lateral. Their charts were reviewed retrospectively. Answers to questions regarding their current pain, shoe wear, and walking ability were recorded using the criteria of the AOFAS foot score as a template in a questionnaire. Of a total of 109 arthrodesis, 104 (95.4 %) united within 8 weeks without problems. Four feet were re-operated for pseudoarthrosis and one was re-operated for malunion with too much dorsiflexion. Removal of the intramedullary screw was necessary in 85 feet (78%). Of the 79 patients who returned their questionnaire, 58 patients (73.4%) considered their problems solved and 57 patients (72%) were completely satisfied with the result. Our study shows that a single screw fixation method is an effective technique in treating hallux rigidus, with high satisfaction in patients between 40 and 80 years of age. LEVEL OF CLINICAL EVIDENCE 4.
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Affiliation(s)
- Sander Wassink
- Orthopaedic Surgery, Spaarne Hospital, Bloemhofstraat 9 zwart, Haarlem, The Netherlands.
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Hamilton GA, Ford LA, Patel S. First metatarsophalangeal joint arthrodesis and revision arthrodesis. Clin Podiatr Med Surg 2009; 26:459-73, Table of Contents. [PMID: 19505644 DOI: 10.1016/j.cpm.2009.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Arthrodesis of the first metatarsophalangeal joint is a powerful procedure that can improve the load-bearing capabilities of the forefoot and assist in medial arch stability. It is the mainstay of treatment for patients with severe arthritic deformity of the great toe joint, because it addresses the importance first ray weight-bearing has on the rest of the foot. In select individuals, fusion can also be effective as a primary procedure in the treatment of hallux valgus. Rather than cause detrimental effects to the function of the foot, this article suggests that first metatarsophalangeal arthrodesis can actually improve faulty mechanics secondary to a dysfunctional joint.
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Affiliation(s)
- Graham A Hamilton
- Department of Orthopedics and Podiatric Surgery, Kaiser Permanente Medical Center, Antioch, CA 94801, USA.
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Abstract
Arthrodesis of the first metatarsophalangeal joint is a highly successful treatment for patients with symptomatic hallux rigidus who have failed conservative management. Before arthrodesis, the importance of host factors, such as use of nicotine, local blood supply, medical comorbidites, and use of systemic immunosuppressive agents, must be considered. Arthrodesis is currently considered the gold standard treatment for end-stage arthritis of the metatarsophalangeal joint. Careful attention to surgical detail is critical to achieving optimal outcomes.
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Affiliation(s)
- John W Womack
- Piedmont Orthopaedic Associates, 35 International Drive, Greenville, SC 29615, USA
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Great toe metatarsophalangeal arthrodesis for hallux valgus deformity in ambulatory adolescents with spastic cerebral palsy. J Child Orthop 2009; 3:47-52. [PMID: 19308612 PMCID: PMC2656842 DOI: 10.1007/s11832-008-0147-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 10/25/2008] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hallux valgus deformity is a common sequel of spastic cerebral palsy. METHODS Twenty ambulatory patients (24 feet) suffering hallux valgus deformity, with painful forefoot and restricted footwear, secondary to spastic cerebral palsy acquired perinatally, were treated with great toe metatarsophalangeal (MTP) arthrodesis using percutaneous K-wires for fixation. The mean age at the time of surgery was 16.2 years (range 14-18 years). They were retrospectively evaluated for the results after arthrodesis at a mean interval of 3 years and 4 months (range 3-4 years) by physical examination and radiographs. RESULTS All patients had a stable painless aligned great toe, with <10 degrees valgus, <20 degrees dorsiflexion and neutral rotation after arthrodesis, evidenced by improvement in pain, cosmesis, functional activity, footwear, callosities and hygiene, as well as by significant improvement in the measures of the MTP and the intermetatarsal angles (IMA) by postoperative radiographs. Neither non-union (pseudoarthrosis) nor recurrence of the deformity developed. Complications included superficial wound slough in a single case. Using the modified American Orthopaedic Foot Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale, 18 feet (75%) were classified as excellent and six feet (25%) as good. Neither fair nor poor cases were recorded. CONCLUSION Hallux valgus deformity in adolescents with spastic cerebral palsy is best treated by great toe MTP arthrodesis to improve segmental foot malalignment and dynamic foot deviation.
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Berlet GC, Hyer CF, Glover JP. A retrospective review of immediate weightbearing after first metatarsophalangeal joint arthrodesis. Foot Ankle Spec 2008; 1:24-8. [PMID: 19825688 DOI: 10.1177/1938640007311920] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
First metatarsophalangeal (MTP) joint arthrodesis is a proven technique as a salvage procedure for many foot pathologies. Many studies have looked at joint preparation techniques, position of the fusion, and construct stability. In this retrospective study, the authors report the overall fusion rate after first MTP joint fusion with full immediate postoperative weightbearing. Forty-five first MTP arthrodeses were performed during the study period. Eight fusions were excluded, leaving 37 fusions for review. The overall fusion rate was 91.1%. The mean time to fusion was 69.0 +/- 37.6 days. Complications included 2 delayed unions (1 screw, 1 plate), 3 nonunions (1 screw, 2 plates), and 2 hardware removals (1 screw, 1 plate). Fixation stability is important to allow immediate postoperative weightbearing. A fusion rate of 91.1% was seen in a diversity of patients after first MTP fusion with immediate weightbearing.
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Sharma H, Bhagat S, Deleeuw J, Denolf F. In vivo comparison of screw versus plate and screw fixation for first metatarsophalangeal arthrodesis: does augmentation of internal compression screw fixation using a semi-tubular plate shorten time to clinical and radiologic fusion of the first metatarsophalangeal joint (MTPJ)? J Foot Ankle Surg 2008; 47:2-7. [PMID: 18156057 DOI: 10.1053/j.jfas.2007.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Indexed: 02/03/2023]
Abstract
A retrospective analysis of first metatarsophalangeal joint fusion in 26 consecutive patients (34 feet), treated between April 1998 and February 2002, comparing single compression screw versus a compression screw supplemented with a dorsal quarter tubular plate, was undertaken. The study aimed to assess whether or not plate augmentation of the single interfragmental compression screw lead to an earlier fusion. There were 18 women and 8 men with a mean age of 54.6 +/- 11.02 years and a mean follow-up of 2.9 +/- 1.1 years. Successful fusion was determined clinically and radiologically by means of identifying transarticular trabeculation. The overall incidence of fusion was 97.06% (33/34 fusions). Observed complications included 4 cases of superficial wound infection, each of which resolved with antibiotic therapy; 3 cases of paraesthesia involving the dorsomedial aspect of the big toe; and 2 cases of transfer metatarsalgia. Statistical analyses did not reveal any significant associations between the type of fixation and time to fusion, patient satisfaction, and complications. In regard to the methods of osteosynthesis compared in this investigation, the choice of first metatarsophalangeal fusion fixation can be determined based on surgeon's preference. ACFAS Level of Clinical Evidence: 2c.
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Abstract
Forefoot problems in patients who have rheumatoid arthritis are common. The progressive joint destruction causes a redistribution of weight about the forefoot, with a diminished weightbearing capacity of the first metatarsophalangeal (MTP) joint. Changes around the first MTP joint include synovitis, joint instability with subluxation, and arthritic change. Hallux MTP fusion in patients who have rheumatoid arthritis acts to permanently restore alignment and restore the medial column support of the foot, while at the same time enabling the first MTP to resume its original weightbearing role. Rheumatoid hallux MTP fusion and its rationale are reviewed.
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Affiliation(s)
- Benjamin W Stevens
- Grand Rapids Medical Education and Research Center/Michigan State University Orthopaedic Surgery Residency Program, 300 Lafayette, Suite 3400, Grand Rapids, MI 49503, USA.
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Faraj AA, Naraen A, Twigg P. A comparative study of wire fixation and screw fixation in arthrodesis for the correction of hallux rigidus using an in vitro biomechanical model. Foot Ankle Int 2007; 28:89-91. [PMID: 17257545 DOI: 10.3113/fai.2007.0016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthrodesis of the great toe metatarsophalangeal joint for osteoarthritis usually involves internal fixation. Ideally, the fixation method should be reproducible, leading to a high rate of fusion and minimal complications. METHODS This biomechanical study compares circumferential wire and screw fixation methods of arthrodesis. RESULTS The two arthrodesis models have remarkably similar limits of elastic and plastic deformation. However, in the screw, failure by permanent deformation occurs at a load six times higher than the wire. CONCLUSIONS The use of circumferential wire fixation for osteoporotic bones in which screw purchase is poor is reasonable and for quality bone, screw fixation may be preferable.
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Affiliation(s)
- Adnan A Faraj
- Airedale General Hospital, Department of Orthopaedics, Skipton Road, Keighley, West Yorkshire BD20 6TD, and Medical Engineering Department, Biomechanical Laboratory, University of Bradford, United Kingdom.
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Abstract
BACKGROUND First metatarsophalangeal joint (MTPJ) arthrodesis is commonly used for the treatment of a variety of conditions affecting the hallux. We used a method incorporating a ball-and-cup preparation of the first metatarsal and proximal phalanx, followed by fixation of the arthrodesis with a lag screw and a dorsal plate (Synthes Modular Hand Set). METHODS Ninety-five consecutive patients had first MTPJ arthrodesis using fixation with the Synthes Modular Hand Set. All patients were evaluated preoperatively, at regular intervals postoperatively, and at final followup. The American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scoring system was used preoperatively and at final followup. RESULTS Solid fusion occurred in 93 of 107 feet (86.9%). In the 14 that did not fuse, either the screws or plate, or both, broke. Ten of the 14 feet were symptomatic, but only three required further operative treatment. There were no hardware problems or failures in patients who had solid fusions. Preoperative AOFAS scores were improved after surgery in all patients. CONCLUSIONS A solid first MTPJ fusion results in excellent function and pain relief, but the Synthes Modular Hand Set implants do not appear to be strong enough in all patients for this application; nonunion at the arthrodesis site and failure of hardware occurred in 13% of arthrodeses. We no longer recommend this implant for this application.
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Affiliation(s)
- Gordon L Bennett
- Crystal Clinic, Inc., 3975 Embassy Parkway, Suite 102, Akron, OH 44333, USA.
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First Metatarsophalangeal Joint Arthrodesis With Conical Reaming and Crossed Dual Compression Screw Fixation. TECHNIQUES IN FOOT AND ANKLE SURGERY 2005. [DOI: 10.1097/01.btf.0000160716.64812.68] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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