|
1
|
Tran-Minh D, Poirot-Seynaeve B, Vialla T, Ohl X, Diallo S, Siboni R. Comparison of the outcomes of first metatarsophalangeal joint arthrodesis by locking plate and compression screw in patients with severe hallux valgus or hallux valgus revision. Orthop Traumatol Surg Res 2024; 110:103932. [PMID: 38987032 DOI: 10.1016/j.otsr.2024.103932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Arthrodesis of the first metatarsophalangeal joint (MTP1) is indicated for hallux rigidus, septic arthritis, severe hallux valgus (HV) or HV revision. Few studies have compared the functional and radiographic outcomes between indications. The goal of this study was to compare the results of MTP1 arthrodesis in patients with severe HV or HV revision at 6 months postoperative. The hypothesis was that there are no differences in the fusion rate, functional scores and radiological correction between the two groups. MATERIALS AND METHODS This was a retrospective, observational, single-center study conducted between January 1, 2018 and July 31, 2021. The inclusion criteria were patients treated for severe HV or HV revision by MTP1 arthrodesis with a compression screw and locking plate who were at least 18 years of age. The exclusion criteria were a history of septic arthritis of MTP1 without prior HV surgery, primary hallux rigidus, rheumatoid arthritis, incomplete medical record. The functional outcomes consisted of the Foot Function Index (FFi-f) and the European Foot and Ankle Society (EFAS) score. Radiographs were made to evaluate preoperative and postoperative deformity, the correction and the fusion rate. These outcomes were compared between two groups: severe HV and HV revision. RESULTS An analysis was done of 58 cases of MTP1 arthrodesis: 45 severe HV and 13 HV revisions. The mean patient age was 66 years, and the mean follow-up was 15.7 months. There were no significant differences between the two groups in the postoperative functional scores: EFAS (p = 0.85) and FFI-f (p = 0.14). At the final review, there were no significant differences between the two groups in the foot angle measurements (hallux valgus angle, p = 0.08 and intermetatarsal angle, p = 0.15) and fusion rate (p = 0.89) with a 93% fusion rate in patients with severe HV and 92% in patients with HV revision. CONCLUSION Given the good radiographic and functional outcomes, MTP1 arthrodesis by locking plate and compression screw is indicated as a first line surgical treatment for patients with severe HV or for patients undergoing HV revision. There is no evidence of a significant difference in the functional scores, fusion rate and radiographic correction between these two indications. LEVEL OF PROOF IV; retrospective case series.
Collapse
Affiliation(s)
- Dong Tran-Minh
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Benoit Poirot-Seynaeve
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Tristan Vialla
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Xavier Ohl
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Saidou Diallo
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France
| | - Renaud Siboni
- Université de Reims Champagne-Ardenne, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Maison Blanche, Centre Hospitalo-Universitaire de Reims, France.
| |
Collapse
|
|
2
|
Watanabe K, Kubota M, Tanaka H, Nishiyama T, Hirao M, Fukushi JI, Kakihana M, Nozawa D, Okuda R. Japanese Orthopaedic Association (JOA) Clinical Practice Guidelines on the Management of Hallux Valgus - Secondary publication. J Orthop Sci 2024; 29:1-26. [PMID: 37451976 DOI: 10.1016/j.jos.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Kota Watanabe
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Japan.
| | - Makoto Kubota
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirofumi Tanaka
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Hyakutake Orthopedic Surgery and Sports Clinic, Saga, Japan
| | - Takayuki Nishiyama
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Makoto Hirao
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jun-Ichi Fukushi
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masataka Kakihana
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Japan
| | - Daisuke Nozawa
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryuzo Okuda
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, Kyoto, Japan
| |
Collapse
|
|
3
|
Witkowski W, Kuik L, Rucka M, Daszkiewicz K, Andrzejewska A, Łuczkiewicz P. Medially positioned plate in first metatarsophalangeal joint arthrodesis. PLoS One 2021; 16:e0260572. [PMID: 34852005 PMCID: PMC8635389 DOI: 10.1371/journal.pone.0260572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
Objective The purpose of this study was to biomechanically compare the stability of first metatarsophalangeal (MTP1) joint arthrodesis with dorsally and medially positioned plates. Methods A physical model of the MTP1 joint consists of printed synthetic bones, a titanium locking plate and screws. In the experiments, samples with dorsally and medially positioned plates were subjected to loading of ground load character in a universal testing machine. Force-displacement relations and relative displacements of bones were recorded. The obtained results were used to validate the corresponding finite element models of the MTP1 joint. Nonlinear finite element simulations of the toe-off phase of gait were performed to determine the deformation and stress state in the MTP1 joint for two positions of the plate. Results In numerical simulations, the maximum displacement in the dorsal direction was noticed at the tip of the distal phalanx and was equal to 19.6 mm for the dorsal plate and 9.63 mm for the medial plate for a resultant force of 150 N. Lower relative bone displacements and smaller plastic deformation in the plate were observed in the model with the medial plate. Stress values were also smaller in the medially positioned plate and locking screws compared to fixation with the dorsal plate. Conclusions A medially positioned locking plate provides better stability of the MTP1 joint than a dorsally positioned plate due to greater vertical bending stiffness of the medial plate. Smaller relative bone displacements observed in fixation with the medial plate may be beneficial for the bone healing process. Moreover, lower stress values may decrease the risk of complications associated with hardware failure.
Collapse
Affiliation(s)
- Wojciech Witkowski
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Leszek Kuik
- II Clinic of Orthopaedics and Kinetic Organ Traumatology, Medical University of Gdansk, Gdańsk, Poland
| | - Magdalena Rucka
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Karol Daszkiewicz
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Angela Andrzejewska
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Piotr Łuczkiewicz
- II Clinic of Orthopaedics and Kinetic Organ Traumatology, Medical University of Gdansk, Gdańsk, Poland
- * E-mail:
| |
Collapse
|
|
4
|
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.
Collapse
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
| |
Collapse
|
|
5
|
Picouleau A, Orsoni N, Hardy J, Mabit C, Charissoux JL, Marcheix PS. Analysis of the effects of arthrodesis of the hallux metatarsophalangeal joint on gait cycle: results of a GAITRite ® treadmill test. INTERNATIONAL ORTHOPAEDICS 2020; 44:2167-2176. [PMID: 32683459 DOI: 10.1007/s00264-020-04716-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Approximately 80% of patients are satisfied with the outcome of arthrodesis of the hallux metatarsophalangeal (MTP) joint. The hypothesis of this study was that MTP arthrodesis does not influence the walking cycle. The aim of this study was to evaluate the effect of MTP arthrodesis on gait cycle and to measure the functional outcome of MTP arthrodesis after a minimum of two year follow-up. METHOD This was an observational prospective cohort study performed at a single centre that included 26 patients (32 ft) who underwent unilateral or bilateral MTP arthrodesis during the period 2004-2014. An X-ray assessment based on the American Orthopaedic Foot and Ankle Society score was performed pre-operatively and at the last follow-up (average follow-up duration 8.3 years). The walking cycle was analysed at the final follow-up using a GAITRite® treadmill test. RESULTS Twenty unilateral and six bilateral MTP arthrodeses were included in this study. The average age of the patients was 70 years. No significant difference was found in the walking cycle between the operated and non-operated sides for unilaterally MTP arthrodesis. However, we observed a non-significant increase in the percentage of contact time after MTP arthrodesis (65% on the operated side vs. 63% on the non-operated side). We also observed a significant decrease in the average walking rate, and a decrease in walking speed, in cases of bilateral MTP arthrodesis compared with normal walking cycle data from a laboratory study. CONCLUSIONS MTP joint arthrodesis does not appear to have any effect on the walking cycle, but reduced patient pain and increased the walking distance. The patients reported satisfaction with the surgical outcomes and would recommend it to a relative with the same pathology.
Collapse
Affiliation(s)
- Alexandre Picouleau
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Nathlaie Orsoni
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Jeremy Hardy
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Christian Mabit
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Jean-Louis Charissoux
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Pierre-Sylvain Marcheix
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France.
| |
Collapse
|
|
6
|
Paredes-Carnero X, Fernández-Cebrián AM, Villardefrancos-Gil S. Do Postoperative Hallux Angles Correlate With Outcome in MP1 Fusion? Our Experience With 71 Cases. Foot Ankle Spec 2018; 11:1938640017751186. [PMID: 29310462 DOI: 10.1177/1938640017751186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine if the postoperative alignment of the hallux influences the final clinical outcome of hallux metatarsophalangeal joint (first MTPJ) arthrodesis. METHODS A total of 71 consecutive cases (hallux rigidus) were studied in stages 3 and 4. They were operated through arthrodesis between 2008 and 2014. The follow-up mean was 7.3 years. The AOFAS (American Orthopaedic Foot and Ankle Society) test was performed preintervention and per annum. In radiology, both the hallux valgus angle and the dorsiflexion angle of the first MTPJ were studied. Furthermore, clinical outcomes were evaluated according to the type of implant used. RESULTS Preoperative AOFAS score was 27.5, rising to 91.3 after the intervention ( P < .01). The improvement test average was 63.6. There were 17 local complications (23%), 7 of them were considered to be major complications (9%), 6 of which needed reoperation (8.5%). The dorsiflexion angle postoperative mean was 21.7°. The hallux valgus angle postoperative mean was 10.9°. No correlations between both angles, and improved AOFAS score or complications ( P > .4 and P > .5, respectively), were found. Patients who had a dorsiflexion angle higher than 20° had greater improvement in the AOFAS score compared with those who had angles lower than 20° (64.5 vs 59.6 points). Nevertheless, this result was not statistically significant ( P = .059). No differences in AOFAS score improvement regarding arthrodesis plate ( P > .1) were found. CONCLUSION First MTPJ arthrodesis is a good alternative for patients in advanced hallux rigidus stages when conservative treatment fails. We could not confirm if a better postoperative alignment may influence in clinical outcomes. However, better results are obtained with dorsiflexion angle greater than 20° than with those with less than 20°. Likewise, any differences between the 2 arthrodesis plates have been able to confirm. LEVELS OF EVIDENCE Level III: Retrospective cohort study.
Collapse
Affiliation(s)
- Xavier Paredes-Carnero
- Servizo de Cirurxía Ortopédica e Traumatoloxía, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | - Silvia Villardefrancos-Gil
- Servizo de Cirurxía Ortopédica e Traumatoloxía, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| |
Collapse
|
|
7
|
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.
Collapse
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.
| |
Collapse
|
|
8
|
Dayton P. Letter Regarding: Radiographic Evaluation of Intermetatarsal Angle Correction Following First MTP Joint Arthrodesis for Severe Hallux Valgus. Foot Ankle Int 2016; 37:1187. [PMID: 27811281 DOI: 10.1177/1071100716667291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
|
9
|
Dalat F, Cottalorda F, Fessy MH, Besse JL. Does arthrodesis of the first metatarsophalangeal joint correct the intermetatarsal M1M2 angle? Analysis of a continuous series of 208 arthrodeses fixed with plates. Orthop Traumatol Surg Res 2015; 101:709-14. [PMID: 26315348 DOI: 10.1016/j.otsr.2015.06.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 04/25/2015] [Accepted: 06/08/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION First-ray metatarsophalangeal arthrodesis is a classic surgical procedure in the treatment of severe hallux valgus, hallux rigidus, revision surgery, and inflammatory arthritis. The objective of this study was to verify if metatarsophalangeal plate arthrodesis could correct the M1M2 intermetatarsal angle. MATERIAL AND METHODS This prospective and continuous series (June 2007 to March 2011) included 208 patients (48% severe and/or arthritic hallux valgus, 18% hallux rigidus, 16% rheumatoid forefoot, 13% surgical revision of the first ray, 5% hallux varus), with a mean age of 62.4±9.9 years (range, 19-87 years). All the patients were operated on by a senior surgeon with the same technique: spherical avivement of the joint surfaces using reamers, osteosynthesis with an anatomic plate (Fyxis-Biotech™) in Ti.6Al.4 V alloy prebent to 5° with a phalangeal arm to receive an oblique metatarsophalangeal screw in compression, in addition to four 2.7-mm nonlocking dorsal screws. The full-scale preoperative and intraoperative angle measurements were taken on AP and lateral X-rays of the weightbearing foot, as related to the etiology and the severity of the preoperative metatarsus varus (M1M2<15°, M1M2 15-19°, M1M2≥20°). The statistical analysis was done using the StatView software. RESULTS The mean follow-up was 18.6±12.4 months (range, 2-76 months). Nearly all of the arthrodesis patients (97%) achieved bone union, and 5% of the plates were removed. The M1P1 angle decreased from 33.8±19.7° (range, -45° to -67°) preoperatively to 13.3±5.3° (range, 0-32°) at the last follow-up, and the M1M2 angle from 14.2±5.4°(range, 0-26°) to 6.5±2.3° (range, 0-12°). The preoperative M1M2 angle was <15° in 97 patients, 15-19° for 78 patients, and ≥20° for the 33 others; at the last follow-up it was 5.8±2.1° (range, 0-10°), 6.7±2.2° (0-10°), and 8.1±2.4° (3-12°), respectively. No correction of the metatarsus varus was demonstrated in relation to etiology. The M1M2 angle was >10° in only two patients (one case of rheumatoid arthritis and one case of severe hallux valgus): 0.9%. DISCUSSION These results show that isolated metatarsophalangeal arthrodesis of the first ray can correct metatarsus varus even in substantial deformations in any etiology. LEVEL OF PROOF Level II cohort study.
Collapse
Affiliation(s)
- F Dalat
- Service de chirurgie orthopédique, traumatologique et de médecine du sport, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite cedex, France.
| | - F Cottalorda
- Service de chirurgie orthopédique et traumatologique, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - M-H Fessy
- Service de chirurgie orthopédique, traumatologique et de médecine du sport, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite cedex, France; Laboratoire de biomécanique et mécanique des chocs, université Lyon 1, IFSTTAR, LBMC UMR-T 9406, 69675 Bron cedex, France
| | - J-L Besse
- Service de chirurgie orthopédique, traumatologique et de médecine du sport, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite cedex, France; Laboratoire de biomécanique et mécanique des chocs, université Lyon 1, IFSTTAR, LBMC UMR-T 9406, 69675 Bron cedex, France
| |
Collapse
|
|
10
|
Vermersch T, Fessy MH, Besse JL. Forefoot Surgery in Elderly Compared With Younger Patient Populations: Complications and Type of Procedure. J Foot Ankle Surg 2014; 54:586-90. [PMID: 25488192 DOI: 10.1053/j.jfas.2014.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Indexed: 02/03/2023]
Abstract
In forefoot surgery, the presenting complaints and expected benefits differ between elderly and younger patients. The present study mapped forefoot procedures recommended to elderly patients compared with those recommended to the general population and assessed the complications according to age group and comorbidity. Consecutive patients were included in a single-center, continuous, retrospective case-control study. Three age groups were defined: <65 years, 65 to 74 years, and ≥ 75 years. All patients, regardless of age, underwent the same procedure; elderly-specific techniques such as the Keller procedure were not used. A total of 321 patients were included, with a mean age of 60.6 (range 16 to 86) years. A similar procedure was used in all 3 groups, but at differing frequencies, with arthrodesis and minor procedures increasing with increasing patient age. In all 3 groups, in the population as a whole, the incidence of delayed healing, deep infection, and nonunion was 9%, 1%, and 2%, respectively. These complications were independent of age group. In the <65-year-old group, just as in the study population as a whole, arthrodesis associated with resection arthroplasty resulted in greater rates of delayed healing and deep infection. The complications rates were equivalent among the 3 age groups. Major surgical procedures should be avoided in elderly patients, if possible. However, no particular procedure is contraindicated in the elderly, although the method of fixation must be robust owing to the frequency of osteoporosis. A first step would be to achieve consensus on the age threshold for "elderliness."
Collapse
Affiliation(s)
- Thibault Vermersch
- Service de Chirurgie Orthopédique et Traumatologique, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
| | - Michel Henri Fessy
- Service de Chirurgie Orthopédique et Traumatologique, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France; Université Lyon 1, IFSTTAR, LBMC UMRT-9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France
| | - Jean-Luc Besse
- Service de Chirurgie Orthopédique et Traumatologique, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France; Université Lyon 1, IFSTTAR, LBMC UMRT-9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France
| |
Collapse
|
|
11
|
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.
Collapse
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
| |
Collapse
|
|
12
|
Dayton P, Feilmeier M, Hunziker B, Nielsen T, Reimer RA. Reduction of the intermetatarsal angle after first metatarsal phalangeal joint arthrodesis: a systematic review. J Foot Ankle Surg 2014; 53:620-3. [PMID: 24656763 DOI: 10.1053/j.jfas.2014.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Indexed: 02/03/2023]
Abstract
Arthrodesis of the first metatarsophalangeal joint (MTPJ) has commonly been used for the treatment of a variety of first MTPJ disorders, including hallux valgus. We undertook a systematic review of the electronic databases and other relevant sources to identify material relating to the reduction of the first intermetatarsal angle (IMA) after first MTPJ arthrodesis. Fifteen studies with a total of 701 first MTPJ arthrodesis procedures were identified that met the inclusion criteria. Our results showed the mean preoperative IMA was 13.74° and the mean postoperative IMA was 9.38°, for a mean change in the IMA of 4.36°. The data were analyzed further in 2 subsets. The first subset included 8 studies (434 procedures) that reported a mean preoperative IMA of less than 15°. The mean change in the IMA in this group was 3.70°. The second subset included 7 studies (267 procedures) that reported a mean preoperative IMA of greater than 15°. The mean change in the IMA in this group was 5.42°. The results of the present systematic review have confirmed that a significant reduction of the first IMA can be achieved by first MTPJ arthrodesis alone and that additional procedures to correct the IMA will not be necessary.
Collapse
Affiliation(s)
- Paul Dayton
- UnityPoint Clinic Foot and Ankle, Trinity Regional Medical Center; Adjunct Professor, Des Moines University College of Podiatric Medicine and Surgery, Fort Dodge, IA.
| | - Mindi Feilmeier
- Assistant Professor, Des Moines University College of Podiatric Medicine and Surgery, Des Moines, IA
| | - Brian Hunziker
- Resident, UnityPoint Clinic Foot and Ankle, Trinity Regional Medical Center, Fort Dodge, IA
| | - Todd Nielsen
- Podiatric Medical Student, Des Moines University College of Podiatric Medicine and Surgery, Des Moines, IA
| | - Rachel A Reimer
- Assistant Professor, Des Moines University College of Health Sciences, Des Moines, IA
| |
Collapse
|
|
13
|
Desmarchelier R, Besse JL, Fessy MH. Scarf osteotomy versus metatarsophalangeal arthrodesis in forefoot first ray disorders: comparison of functional outcomes. Orthop Traumatol Surg Res 2012; 98:S77-84. [PMID: 22951054 DOI: 10.1016/j.otsr.2012.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 04/14/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Scarf osteotomies of the first metatarsal and metatarsophalangeal arthrodesis are the two most frequent surgical forefoot reconstructive procedures. HYPOTHESIS We compared functional results of isolated arthrodesis of the first metatarsophalangeal joint with an isolated Scarf osteotomy of the first metatarsal. MATERIALS AND METHODS This was a retrospective, observational, continuous study of patients operated between 1993 and 2008. After patients who had undergone a procedure on the lateral rays, extremely elderly patients, lost to follow-up patients and those with incomplete questionnaires had been excluded, there remained two comparable groups of 25 patients. Mean age was 60 in the arthrodesis group [41-70] and 59.8 in the Scarf group [47-71]. The Scarf group included 25 hallux valgus (100%) compared to 16 hallux valgus (64%) and nine hallux rigidus (36%) in the arthrodesis group. Complications were recorded. Evaluation of functional results was based on the most recent functional or quality of life scores (AOFAS, FFI, FAAM, SF 36) and a questionnaire on physical and athletic ability. RESULTS There was no significant difference in the rate of complications between the two groups. There was no difference in pain according to the AOFAS score with 35.6/40 (± 6.5) in the Scarf group and 34.5 (± 5.9) in the arthrodesis group. Global satisfaction was also similar between the Scarf and arthrodesis groups: 91.4% and 90% of very satisfied or satisfied patients, respectively. The FFI score was higher in the Scarf group than in the arthrodesis group: 8.6 (± 20.1) and 19.8 (± 17.7) respectively. Functional results were better in the Scarf group than in the arthrodesis group with a FAAM Daily Activity score of 80.2 (± 12.1) compared to 68 (± 7.2), a FAAM Sports Activity score of 29.7 (± 6.7) compared to 25.2 (± 7.6) and a FAAM Global Function score of 94% (± 10.8) compared to 87% (± 15.7), respectively. The Global SF36 score was higher in the Scarf group than in the arthrodesis group: 70.9% (± 14.1) and 62.3% (± 20.6) respectively, which was due to a higher Mental Health score in the Scarf group: 68.7% (± 14.2) and 60.4% (± 19.3) respectively. In the area of sports activities the Scarf group practiced more hiking than the arthrodesis group (74% versus 42% respectively). There was no difference for other activities. DISCUSSION AND CONCLUSION This study provides detailed information on the level of physical and sports activities that are practiced following these procedures, so that the patient can be better informed.
Collapse
Affiliation(s)
- R Desmarchelier
- Southern Lyon Hospital Center, Department of Orthopaedic Surgery and Traumatology and sports medicine, Lyon Civilian Hospitals, 69495 Pierre-Bénite Cedex, France.
| | | | | | | |
Collapse
|
|
14
|
Roukis TS. Nonunion after arthrodesis of the first metatarsal-phalangeal joint: a systematic review. J Foot Ankle Surg 2011; 50:710-3. [PMID: 21840737 DOI: 10.1053/j.jfas.2011.06.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 06/19/2011] [Indexed: 02/03/2023]
Abstract
Arthrodesis of the first metatarsal-phalangeal joint (MTPJ) has been proposed for treatment of first MTPJ pathology because of the perceived safety and efficacy. Nonunion of the arthrodesis site has been purported as a common complication. The author undertook a systematic review of the electronic databases and other relevant sources to identify material relating to the incidence of nonunion and other complications after arthrodesis of the first MTPJ. In an effort to procure the highest quality studies available, the studies were eligible for inclusion only if they involved patients undergoing arthrodesis of the first MTPJ using modern osteosynthesis techniques (1980 onward time restriction), included a minimum of 30 feet in the publication, and evaluated patients at a mean follow-up of ≥12 months' duration. The studies were also required to include details of any complications requiring surgical intervention, had not primarily involved only rheumatoid arthritis as an indication, and had not involved the use of a structural bone graft. A total of 37 studies involving a total of 2,818 first MTPJ arthrodesis procedures were identified that met the inclusion criteria. The weighted mean age of the patients was 59.3 years, the follow-up was 34.3 months, and the union time was 64.3 days. For those studies that specifically mentioned the indications for first MTPJ arthrodesis, 2,656 joints were included as follows: severe hallux valgus (47.2%), hallux rigidus (32%), rheumatoid arthritis (11.5%), and revision of failed surgery (9.3%). Osteosynthesis involved 3 main configurations: compression screws, dorsal plate and screws, or staples. The overall nonunion incidence was 5.4% (153 of 2,818), with symptomatic nonunion occurring in 32.7% (50 of 153) of all nonunions (1.8% total incidence; 50 of 2,818). The overall incidence of malunion was 6.1% (39 of 640), with dorsal malunion accounting for 87.1% (34 of 39). The overall incidence of hardware removal was 8.5% (69 of 817). The historical comment that nonunion occurs in approximately 10% of attempted first MTPJ arthrodesis procedures is inaccurate. The incidence of malunion and hardware removal is inappropriately high, and efforts to determine effective methods of decreasing their incidence should be undertaken. Additionally, there is still a need for methodologically sound prospective cohort studies focusing on the use of arthrodesis of the first MTPJ for purely severe hallux valgus and specific grades of hallux rigidus, as well as specific forms of osteosynthesis, because this has only been infrequently reported in small series.
Collapse
Affiliation(s)
- Thomas S Roukis
- Department of Orthopaedics, Podiatry, and Sports Medicine, Gundersen Lutheran Healthcare System, La Crosse, WI 54601, USA.
| |
Collapse
|
|
15
|
van Doeselaar DJ, Heesterbeek PJC, Louwerens JWK, Swierstra BA. Foot function after fusion of the first metatarsophalangeal joint. Foot Ankle Int 2010; 31:670-5. [PMID: 20727314 DOI: 10.3113/fai.2010.0670] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND We measured with a validated score the operative outcome in patients without concomitant foot surgery who underwent fusion of the first metatarsophalangeal (MTP) joint for hallux rigidus (HR) and hallux valgus (HV). We also examined whether there is a correlation between foot function and hallux position to try to formulate an optimum fusion angle. MATERIALS AND METHODS Between 2002 and 2005, a consecutive series of 62 patients underwent crossed screw fusion of the first MTP joint (27 HR and 35 HV) without concomitant surgery of the same or contralateral foot or had previous surgery of the same foot. Foot function was measured by the Dutch Foot Function Index (FFI) pre- and postoperatively. Hallux valgus and dorsiflexion angles were measured on standing radiographs before operation and at followup. RESULTS Postoperatively the median hallux valgus angle was 14 (range, -2 to 33) degrees and the median dorsiflexion angle was 23 (range, 7 to 45) degrees. The median FFI score improved from 38 (range, 0 to 80) to 8 (range, 0 to 59) (p < 0.001). The FFI score was not different between the HV and HR groups. There was no correlation between postoperative foot function, dorsiflexion angles and hallux valgus angles. CONCLUSION Fusion of the first MTP joint in HR and HV results in improved function according to the validated FFI. There was no significant correlation between foot function and hallux position. This could be due to the fact that the desired position of the hallux was most often achieved.
Collapse
|
|
16
|
Sung W, Kluesner AJ, Irrgang J, Burns P, Wukich DK. Radiographic outcomes following primary arthrodesis of the first metatarsophalangeal joint in hallux abductovalgus deformity. J Foot Ankle Surg 2010; 49:446-51. [PMID: 20637657 DOI: 10.1053/j.jfas.2010.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the radiographic outcomes of primary metatarsophalangeal joint arthrodesis for hallux abductovalgus deformities. Between January 2004 and March 2009, 56 consecutive patients (58 feet) underwent primary arthrodesis of the metatarsophalangeal joint (MTPJ) for severe hallux abductovalgus deformity and or hallux rigidus. Results were assessed by primary radiographic outcome measurements (hallux valgus and first-second intermetatarsal angle). Overall, the mean hallux valgus (HA) angle improved significantly from 31.9 degrees to 13.4 degrees (P < .01). The mean first-second intermetatarsal (IM) angle correction was also significantly reduced from 14.0 degrees to 9.7 degrees (P < .01). When separated by deformity group (mild, moderate, and severe), the mean hallux valgus and first-second intermetatarsal angles demonstrated statistically significant correction in all groups when comparing preoperative and postoperative values (P < .01). Primary arthrodesis provides predictable radiographic outcomes and effective correction for patients with differing severity of hallux abductovalgus deformity and arthritis of the first metatarsophalangeal joint. A separate proximal osteotomy for severe metatarsus primus varus correction may not be necessary because of the correction achieved at the metatarsophalangeal joint arthrodesis level. The results of this study demonstrate that as the severity of the preoperative deformity increases, the amount of postoperative radiographic (HA and IM angle measurement) correction after MTPJ arthrodesis will improve correspondingly.
Collapse
Affiliation(s)
- Wenjay Sung
- University of Pittsburgh Medical Center, Podiatric Residency Program, Pittsburgh, PA, USA
| | | | | | | | | |
Collapse
|
|
17
|
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.
Collapse
|
|
18
|
Abstract
Selecting the appropriate surgical procedure for the treatment of hallux valgus not always is clear. Every procedure has its merits depending on the individual and circumstances. Correcting pain and deformity, avoiding recurrence, and preserving or re-establishing normal foot function should be the goals of bunion surgery. Although radiographic measurements can be helpful, their weight is not as important as understanding the function of the first ray in each patient. This article attempts to guide procedure selection based on re-establishing normal foot function as much as possible while meeting patients' goals and expectations.
Collapse
|
|
19
|
Mah CD, Banks AS. Immediate weight bearing following first metatarsophalangeal joint fusion with Kirschner wire fixation. J Foot Ankle Surg 2008; 48:3-8. [PMID: 19110153 DOI: 10.1053/j.jfas.2008.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Indexed: 02/03/2023]
Abstract
UNLABELLED The general consensus regarding the postoperative management of patients who have undergone first metatarsophalangeal joint arthrodesis is to maintain non-weight bearing for 4 to 6 weeks. However, a number of studies indicate that immediate postoperative weight bearing does not result in a higher rate of nonunion. A retrospective case series investigation was performed to evaluate the fusion rate of first metatarsophalangeal joint arthrodesis using various forms of pin and wire fixation, and a postoperative protocol that involved immediate weight bearing with a padded surgical shoe. The impetus behind allowing immediate postoperative weight bearing stems from the desire to avoid difficult non-weight-bearing forms of ambulation in patients at risk for falling, and to enhance postoperative rehabilitation in patients at risk for other joint maladies, as in those suffering with rheumatoid and other polyarticular forms of arthritis. A total of 22 fusions (20 patients) were reviewed. Nonunion developed in 2 feet (9.1%), and a delayed union occurred in 1 additional foot (4.55%), for a total complication rate of 13.64% (3/22 cases) and a fusion rate of 86.36%. The remaining patients demonstrated radiographic consolidation of the arthrodesis. A crude rough comparison to previously published reports, wherein weight bearing was initiated anywhere from immediately to up to 2 weeks postoperative, showed that the rate of fusion observed in the patients described in this report was similar. This study demonstrated that immediate ambulation following first metatarsophalangeal joint fusion with wire fixation was safe and effective. LEVEL OF CLINICAL EVIDENCE 4.
Collapse
|
|
20
|
Pinney SJ, Song KR, Chou LB. Surgical treatment of severe hallux valgus: the state of practice among academic foot and ankle surgeons. Foot Ankle Int 2006; 27:1024-9. [PMID: 17207427 DOI: 10.1177/107110070602701205] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the operative procedures used for treatment of severe hallux valgus by academic foot and ankle surgeons practicing in the United States. METHODS A patient with severe hallux valgus deformity was developed as a hypothetical case: a 50-year-old woman with a severe deformity (intermetatarsal angle = 20 degrees; hallux valgus angle = 42 degrees). The patient was symptomatic with pain, did not improve with conservative measures, and wanted the deformity corrected. This case was sent to academic foot and ankle surgeons in a survey to determine their preferred operative treatment for this case. The overall response rate was 84% (128 of 153). To be included in the study group each surgeon had to have 1) foot and ankle patients comprising 50% or more of his clinical practice and 2) direct responsibility for teaching orthopaedic residents. One hundred and five respondents met the inclusion criteria and formed the study group; however, three surveys with invalid responses were deleted. RESULTS Fifty-two percent (54 of 102) of the respondents chose a metatarsal osteotomy, 26% (26 of 102) a first metatarsophalangeal (MTP) joint arthrodesis, and 24% (24 of 102) a Lapidus procedure. Two respondents chose both an arthrodesis and a metatarsal osteotomy. Among the 54 respondents who chose metatarsal osteotomies, 24 used a Ludloff, 16 a proximal crescentic, eight a proximal chevron, two a scarf, two a distal chevron, and two other. In addition, secondary procedures to enhance the correction included a Weil osteotomy in 46% (47 of 102) and an Akin osteotomy in 30% (31 of 102). CONCLUSIONS There was a wide variation in the type of procedure used to correct this severe hallux valgus deformity; approximately 50% of the respondents chose a metatarsal osteotomy, 25% chose a first MTP joint arthrodesis, and 25% a Lapidus procedure.
Collapse
Affiliation(s)
- Stephen J Pinney
- Department of Orthopaedic Surgery, Stanford University Medical Center, CA 94305-5341, USA
| | | | | |
Collapse
|
|
21
|
Coughlin MJ, Grebing BR, Jones CP. Arthrodesis of the first metatarsophalangeal joint for idiopathic hallux valgus: intermediate results. Foot Ankle Int 2005; 26:783-92. [PMID: 16221449 DOI: 10.1177/107110070502601001] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Followup studies documenting the outcome of primary metatarsophalangeal (MTP) joint arthrodesis for treatment of hallux valgus deformities are rare. The purpose of this report was to evaluate the results of first MTP joint arthrodesis as treatment for moderate and severe hallux valgus deformities over a 22-year period in a single surgeon's practice. METHODS All living patients treated between 1979 and 2001, for moderate and severe idiopathic hallux valgus deformities with first MTP joint arthrodesis were contacted and asked to return for a followup examination. Outcomes were assessed by comparing preoperative and postoperative pain, function, and radiographic appearance. First ray mobility and ligamentous laxity also were assessed postoperatively. RESULTS Eighteen of 21 of the first MTP joints had successfully fused with the primary procedure at an average followup of 8.2 years (range 24 to 271 months). The time to union averaged 10 (range 7 to 15) weeks. Two of the three nonunions, both in the same patient, were asymptomatic and were not revised. One required a revision to achieve fusion. The average corrections in the hallux valgus angle and 1-2 intermetatarsal (IM) angle were 21 degrees and 6 degrees, respectively, and the average postoperative dorsiflexion angle was 22 degrees. Subjective satisfaction was rated as excellent in seventeen of 21 cases (80%) and good in the remaining four (20%). There was significant reduction in postoperative pain (p < 0.001), complete resolution of lateral metatarsalgia, and the postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores averaged 84 (range 72 to 90) at final followup. Major activity restrictions after surgery were uncommon, and all patients were able to wear conventional or comfort shoes. Interphalangeal (IP) joint arthritis progressed in seven of 21 feet (33%), but all of these changes were mild. CONCLUSIONS In the present study, arthrodesis of the first MTP joint for idiopathic hallux valgus resulted in a high percentage of successful results at an average followup of over 8 years.
Collapse
|
|
22
|
Nicholas C, Silhanek AD, Connolly FG, Lombardi CM. The effect of first metatarsophalangeal arthrodesis on transverse plane deviation of the second toe: a retrospective radiographic study. J Foot Ankle Surg 2005; 44:365-76. [PMID: 16210157 DOI: 10.1053/j.jfas.2005.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this retrospective, radiographic study was to examine the effect of first metatarsophalangeal arthrodesis on the transverse plane deviation of the second metatarsophalangeal joint. Sixty-nine patients (76 feet) were separated into 3 groups based on preoperative diagnosis: group 1, hallux valgus; group 2, hallux rigidus; and group 3, rheumatoid forefoot deformity with concomitant lesser metatarsal head resection. Intermetatarsal, hallux abduction, and second metatarsophalangeal angles were measured on preoperative and follow-up anteroposterior radiographs. Multivariate analysis found a significant postoperative change (P < .001) in both the intermetatarsal and hallux abduction angles for all groups, but no significant change in the second metatarsophalangeal angle for any group. There was also no significant difference in the number of patients with medial versus lateral second toe deviation in each group. The addition of a second ray procedure, such as a digital arthrodesis or second metatarsal decompression osteotomy, in groups 1 and 2 did not correlate to the amount of change in second metatarsophalangeal deviation. However, there was a significant correlation (r = .330; P = .004) between the amount of change in the hallux abduction angle and the amount of change in the second metatarsophalangeal angle. A lack of change in the second metatarsophalangeal angle in patients with hallux valgus and hallux rigidus suggests that the creation of a stable medial buttress may protect the lesser digits. However, in patients with rheumatoid, this lack of change denotes a postoperative recurrence of lateral deviation of the second toe despite lesser metatarsal head resection and stabilization of the hallux.
Collapse
|
|
23
|
Brodsky JW, Passmore RN, Pollo FE, Shabat S. Functional outcome of arthrodesis of the first metatarsophalangeal joint using parallel screw fixation. Foot Ankle Int 2005; 26:140-6. [PMID: 15737256 DOI: 10.1177/107110070502600205] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [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 first metatarsophalangeal (MTP) joint is a reliable procedure for a painful hallux. Most studies focus on the surgical results rather than the functional outcome for the patient. Therefore, we examined the effects of first MTP joint arthrodesis on activities of daily living and recreational activities. METHODS Fifty-three patients (60 feet) who had isolated arthrodesis of the first (MTP) joint using a parallel screw fixation technique were evaluated for the functional outcome after the surgery to determine the effect of the arthrodesis on the activities of daily living and on recreational sports and exercise. RESULTS Fusion was achieved in all patients; all but three stated that they would have the surgery again. Postoperative pain scores evaluated using the Visual Analogue Scale indicated effective pain relief. High levels of function were demonstrated in this group of patients. CONCLUSION Arthrodesis of the first MTP joint is not only a successful surgical technique for relief of pain and correction of deformity but also allows a high level of function in everyday life and in recreational activities.
Collapse
Affiliation(s)
- James W Brodsky
- The Department of Orthopaedic Surgery, Baylor University Medical Center, Dallas, Texas 75246, USA
| | | | | | | |
Collapse
|
|
24
|
Flavin R, Stephens MM. Arthrodesis of the first metatarsophalangeal joint using a dorsal titanium contoured plate. Foot Ankle Int 2004; 25:783-7. [PMID: 15574236 DOI: 10.1177/107110070402501105] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [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 first metatarsophalangeal joint (MTPJ) is used to treat a variety of foot pathologies. Numerous methods of internal fixation and bone end preparation have been reported. In an effort to bring together the best features of the various internal fixation devices, a low-profile contoured titanium plate (LPCT) using a compression screw was designed to be used with a ball-and-socket bone end preparation. A prospective study was carried out to determine the efficacy of this technique. METHODS First MTPJ arthrodesis using an LPCT was done in 12 patients (10 women and two men) either as an isolated procedure (seven patients) or in conjunction with other forefoot procedures (five patients). The changes in the level of pain and activities of daily living were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux score and the Short-Form 36 (SF-36) score. Time to bone union also was assessed. Mean followup was 18 months (+/-6 months). RESULTS Statistically significant increases in the AOFAS hallux score and the SF-36 score were noted (p = .002 and .001, respectively). All radiographs showed bone union at 6 weeks and an appropriate degree of hallux dorsiflexion in relation to the first metatarsal (20 to 25 degrees). CONCLUSION The combination of the LPCT plate and a ball-and-socket bone-end preparation has both operative and biomechanical advantages over other fixation techniques. This combination ensures that the anatomical length of the first ray is only minimally shortened and the angle of plantarflexion of the first metatarsal is maintained, resulting in preservation of medial column stability and a better functional result.
Collapse
Affiliation(s)
- Robert Flavin
- Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland
| | | |
Collapse
|
|
25
|
Dayton P, Lopiccolo J, Kiley J. Reduction of the intermetatarsal angle after first metatarsophalangeal joint arthrodesis in patients with moderate and severe metatarsus primus adductus. J Foot Ankle Surg 2002; 41:316-9. [PMID: 12400715 DOI: 10.1016/s1067-2516(02)80050-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A radiographic review of first metatarsophalangeal joint (MPJ) arthrodesis in patients who had preoperative intermetatarsal angles greater than 15 degrees is presented. The average reduction of the intermetatarsal angle was measured. Twenty-one patients with 22 fusions, with ages ranging from 43 to 79 years old, underwent first MPJ arthrodesis with screw or pin fixation as determined appropriate by their age and bone quality. Preoperative intermetatarsalangles averaged 17.27 degrees with a range of 15 degrees - 21 degrees. An overall reduction in the intermetatarsal angle of 6.41 degrees was noted. Mechanical factors affecting the reduction of the intermetatarsal angle following first MPJ arthrodesis are discussed.
Collapse
Affiliation(s)
- Paul Dayton
- Trinity Regional Hospital, Fort Dodge, IA 50501, USA
| | | | | |
Collapse
|
|
26
|
Abstract
Twelve patients (12 feet) underwent salvage first metatarsalphalangeal (MTP) arthrodesis with structural, interposition autologous iliac crest bone graft (ICBG). Eight patients had a bony defect secondary to failed first MTP joint implant arthroplasties, two had avascular necrosis (AVN) after failed bunion surgery, one had a nonunion of an attempted arthrodesis for failed bunion surgery, and one had been treated for osteomyelitis after cheilectomy. Eleven of the cases had a single dorsal plate secured by screws and one case had two plates, one dorsal and one medial. A plate, crossed screw(s) and/or K-wire combination were chosen in four cases. Indications included first MTP joint pain, metatarsalgia, intractable plantar keratoses (IPK), as well as a functionally and cosmetically short first ray refractory to non surgical management. Average preoperative shortening was 8.5 mm (range 5-17). Clinical arthrodesis was achieved after an average of 12 weeks (range 4-20). Radiographic arthrodesis was achieved in eleven of twelve feet at an average of 15 weeks (range 8-28), with one pseudoarthrosis. AOFAS forefoot clinical rating score averaged 70 points (max 90 after first MTP arthrodesis) at an average follow-up of 22 months (range 5-70). Sesamoiditis, prominent hardware and scar sensitivity were prevalent complaints in four patients postoperatively. Two cases required flap coverage for skin necrosis. Relief of metatarsalgia, good hallux alignment as well as improved patient satisfaction and function were achieved in all cases. There was no symptomatic progression of interphalangeal degenerative change postoperatively.
Collapse
Affiliation(s)
- J W Brodsky
- Baylor University Medical Center, Orthopaedic Associates of Dallas, Texas 75246, USA
| | | | | |
Collapse
|
|
27
|
Abstract
Resection arthroplasty was performed in 62 feet, with follow-up at an average of 36 months (range, 17-68 months). All cases were performed using a combined cerclage fibreux. The mean age at operation was 61 years (range, 49-77 years). The mean score according to the hallux metatarsophalangeal-interphalangeal scale of the American Orthopaedic Foot and Ankle Society was 81 points (range, 25-100 points). Correction of the hallux valgus angle at follow-up averaged 23 degrees (range, 0-45 degrees). The first intermetatarsal angle had been corrected an average of 3 degrees (range, 0-14 degrees). Transfer metatarsalgia was encountered in eight patients. No hallux varus or cock-up deformity was detected.
Collapse
Affiliation(s)
- M Franzreb
- Department of Orthopedic Surgery, University of Innsbruck, Austria
| | | | | |
Collapse
|