Treatment of aseptic loosened MTPI prosthesis by one-stage revision with ToeFit Plus prosthesis

PRINCIPLES OF SURGICAL TREATMENT IN PATIENTS WITH OSTEOARTHRITIS OF THE FIRST METATARSOPHALANGEAL JOINT

At present, there is no general approach to choosing surgical tactics for hallux rigidus. Many surgical procedures are used to treat osteoarthritis (OA) of the first metatarsophalangeal joint (FMPJ), which are relevant at different stages of the disease. Nevertheless, this fact also suggests that all proposed methods have one or other disadvantages. At the same time, FMPJ arthrodesis that relieves pain and is functionally inferior to joint-sparing surgery remains the gold standard. However, due to the fact that not only persons over the age of 50 years, but also younger patients often suffer from FMPJ OA, the most non-damaging option of joint-sparing surgery is cheilectomy with chondroplasty of the FMPJ, which allows restoration of painless joint motions, thus sparing the anatomy of the foot. Chondroplasty using the authologous matrix-induced chondrogenesis (AMIC®) technique for knee, hip, and ankle cartilage defects is described. There are no reports on FMPJ chondroplasty with the AMIC method in either Russian or foreign literature.

A prospective 24 months follow-up of a three component press-fit prosthesis for hallux rigidus

BACKGROUND

The aim of this study was to evaluate the results following total first metatarsophalangeal (FMTP) joint replacement arthroplasty using a modular three component press fit prosthesis at two year follow up.

METHODS

All patient data was collected in a prospective way in four study centres. Both preoperative and postoperative evaluation consisted of an assessment using the AOFAS-HMI score, visual analogue scale for pain, evaluation of the range of motion and patient satisfaction scores. Postoperative X-rays were reviewed for loosening and radiolucency up to two years.

RESULTS

Fifty-five feet were available for analysis at 24 months. Two implants were removed during the study. Six more feet had additional surgery due to stiffness or malalignment. Postoperative AOFAS-HMI scores improved significantly by 32.4 points at two year follow-up (p<0.001). The visual analogue scale for pain improved significantly from 6.8 (std 1,6) preoperatively to 1.6 (std 1,9) postoperatively (p<0.0001). Mean dorsiflexion improved from 12.6 (std 10,1) degrees preoperatively to 31.2 (std 16,8) degrees postoperatively. Eighty-seven percent of patients were moderately to well satisfied with the end result. Eighteen prostheses showed radiolucency at 24 months.

CONCLUSION

Implantation of a Metis^® modular three component press fit prosthesis for the metatarsophalangeal joint in hallux rigidus shows significant improvement in AOFAS-HMI scores and a decrease in pain. Concerns remain with regard to early reoperation rate (14.5%) and long term survival of the implant. Future studies will have to address these aspects.

Reduced Postoperative Functional Length Ratio Influences Patient Satisfaction in First Metatarsophalangeal Joint Replacement

Complications of first metatarsophalangeal joint metallic arthroplasty are well known. However, the resulting shortening of the metatarsals can lead to transverse metatarsalgia or medial column pain at the metatarsophalangeal joints by creating Morton's toe/foot, which increases pressure on the second metatarsal head. The effect of the functional length ratio of the first and second metatarsals on pain and patient satisfaction has not been rigorously evaluated. We evaluated the effect of the first/second metatarsal ratio on patient satisfaction with first metatarsophalangeal joint metallic arthroplasty. From October 2008 to February 2010, 34 patients (median age 66.2, range 55 to 70 years) with hallux rigidus were treated surgically using the Toefit-Plus(™) prosthesis. At a mean follow-up period of 27.5 (range 17 to 35) months, 30 patients (88.24%) underwent re-evaluation. The functional length of the first and second metatarsals and the lucency around the prosthesis were evaluated. Statistically significant (p ≤ .05) improvements were found for the mean modified American Orthopaedic Foot and Ankle Society score (from 44 to 80), pain (from 7 to 3 on a 10-cm visual analog scale), and mean total range of motion (from 42.2° to 59.4°). Also, 20 patients (58.82%) were fully satisfied with the procedure (scores of 8 to 10 on a 3-point Likert scale). Shortening the first metatarsal reduced the functional length ratio (r = 0.95; p < .001) and was associated with lower patient satisfaction (r = 0.66, p = .007). Preoperative consideration of the first/second metatarsal functional length ratio could be useful in preventing medial column pain due to a relatively short first metatarsal to a long second metatarsal axis in the transverse plane.