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Anastasio AT, Shaffrey I, Easley ME. Surgical Management of Failed First Metatarsophalangeal Joint Arthroplasty. Foot Ankle Clin 2024; 29:541-556. [PMID: 39068028 DOI: 10.1016/j.fcl.2023.12.009] [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] [Indexed: 07/30/2024]
Abstract
This article describes the etiology, clinical presentation, surgical management, and outcomes for treatment of the failed first metatarsophalangeal (MTP) joint arthroplasty. Failure following implant arthroplasty typically creates large osseous deficits and surgical management can be difficult. Salvage arthrodesis provides reliable joint stability while maintaining hallux length. Outcomes following conversion of a failed MTP joint arthroplasty to MTP joint arthrodesis have demonstrated consistent pain relief and high satisfaction: however, high rates of complication and nonunion have been reported. Bone graft may be necessary to fill large voids in the joint. Other revision options for failed arthroplasty have been described, but outcomes remain inconsistent and varied. Ultimately, conversion to MTP joint arthrodesis is the recommended intervention for treatment of the failed MTP arthroplasty implant, providing sufficient stability and pain relief.
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Affiliation(s)
| | - Isabel Shaffrey
- Duke University School of Medicine, 2927 40 Duke Medicine Circle 124 Davison Building, Durham, NC 27710, USA
| | - Mark E Easley
- Department of Orthopaedics, Duke University Hospital, Durham, NC, USA
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Lee W, Wang C, Prat D, Wapner KL, Chao W, Farber DC. Patient Satisfaction Following Hallux Rigidus Treatment With a Synthetic Cartilage Implant. Foot Ankle Spec 2023; 16:527-536. [PMID: 33769110 DOI: 10.1177/19386400211001993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There remains no clear consensus on patient satisfaction and functional outcomes following synthetic cartilage implant (SCI) implantation for hallux rigidus. The purpose of this study was to review our experience at a single academic institution using an SCI for treatment of hallux rigidus. METHODS A retrospective review was performed of patients who underwent the SCI procedure for treatment of hallux rigidus between January 2017 and May 2019. Functional outcomes were evaluated using Patient-Reported Outcome Measures Informational System (PROMIS)-10 scores as well as a survey investigating patient satisfaction, self-reported clinical improvement, and changes in sporting ability. Patients were divided into satisfied versus unsatisfied subgroups, and between-group differences in preoperative variables and complications were reviewed. A total of 90 patients (96 implants) were included in this study. The mean follow-up time was 26.4 months. RESULTS In all, 81.2% of patients reported that their foot was "much improved" (55.2%) or "improved" (26.0%) since undergoing the SCI procedure, whereas a slightly lower percentage, 74.0%, stated that they were "extremely satisfied" (41.7%) or "satisfied" (32.3%) at final follow-up. Patients were able to tolerate higher impact sporting activities after the procedure, and 75.0% of patients stated they would have the same surgery again. PROMIS-10 T-scores averaged 54.2 points for physical health and 57.4 points for mental health. Only 2.1% of patients required conversion to arthrodesis. Significant differences between the satisfied versus unsatisfied subgroups were found in preoperative corticosteroid injection use (21.1% vs 41.1%, respectively; P = .029) and preoperative VAS pain score (8.2 vs 7.1, respectively; P = .036). CONCLUSION The SCI procedure can be a viable option for treating hallux rigidus with high satisfaction overall, increased sport activity levels, and a very low revision rate. However, maximizing patient satisfaction may require more careful consideration of preoperative prognosticators and extensive patient counseling to ensure realistic expectations for recovery time and individual outcome. LEVEL OF EVIDENCE Level IV: Retrospective case series.
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Affiliation(s)
- Wonyong Lee
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Carol Wang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dan Prat
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Keith L Wapner
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Wen Chao
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Daniel C Farber
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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Pellegrini MJ, Mombello F, Cortes A, Chaparro F, Ortiz C, Carcuro G. Short-term Results of Hemiarthroplasty of the Ankle Joint for Talar-Sided Cartilage Loss. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114221148172. [PMID: 36741679 PMCID: PMC9893082 DOI: 10.1177/24730114221148172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Ankle hemiarthroplasty is a 1-piece implant system replacing the talar side of the tibiotalar joint. Hemiarthroplasty offers limited bone resection and may provide easier revision options than joint-ablating procedures. Methods Prospective, multicenter, noncomparative, nonrandomized clinical study with short term follow-up on patients undergoing hemiarthroplasty of the ankle. Radiologic and functional outcomes (Foot and Ankle Outcome Score FAOS, Foot and Ankle Ability Measure [FAAM], Short Form-36 Health Survey [SF-36], Short Musculoskeletal Functional Assessment [SMFA], and visual analog scale [VAS] pain scores) were obtained at 3 and 12 months and the last follow-up (mean 31.9 months). Results Ten patients met the inclusion criteria. Three were converted to total ankle replacement at 14, 16, and 18 months. Pain VAS scores improved on average from 6.8 to 4.8 (P = .044) of the remaining 7 at a mean of 31.9 months' follow-up. For these 7 in the Survival Group, we found that SF-36 physical health component improved from 25.03 to 42.25 (P = .030), SMFA dysfunction and bother indexes improved from 46.36 to 32.28 (P = .001), and from 55.21 to 30.14 (P = .002) in the Survival Group, and FAAM sports improved from 12.5 to 34.5 (P = .023). Conclusion Patients undergoing hemiarthroplasty of the ankle joint for talar-sided lesions had a 30% failure rate by 18 months. Those who did not have an early failure exhibited modest pain reduction, functional improvements, and better quality of life in short-term follow-up. This procedure offers a possible alternative for isolated talar ankle cartilage cases. Level of Evidence Level IV, prospective case series.
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Affiliation(s)
- Manuel J. Pellegrini
- Hospital Clinico Universidad de Chile, Santiago, Chile,Clinica Universidad de Los Andes, Santiago, Chile,Manuel J. Pellegrini, MD, Facultad de Medicina, Departamento de Traumatología, Clinica Universidad de los Andes, Av. Plaza 2501, Santiago 7620157, Chile.
| | | | - Aaron Cortes
- Clinica Universidad de Los Andes, Santiago, Chile
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Hallux rigidus - Osteoarthritis of the first MTP-joint. Surgical and patient-reported results from Swefoot. Foot Ankle Surg 2021; 27:555-558. [PMID: 32859495 DOI: 10.1016/j.fas.2020.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/14/2020] [Accepted: 07/17/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Swefoot is a Swedish national registry, that covers surgery in the foot and ankle. Surgical treatment of hallux rigidus (HR) vary within and between countries. The aim of this study was to report baseline variables for patients with HR. METHODS We extracted baseline characteristics, surgical procedures and patient-reported data for patients with HR entered in the registry during the period January 2014 to August 2019. RESULTS By August 2019, 1818 patients were reported in the registry. 68.9% of the patients were women, the average age was 58 years, the mean BMI was 26.4kg/m2. 41.9% of the patients underwent a cheilectomy,19.8% a metatarsal osteotomy, 34.3% a fusion, 0.2% an arthroplasty, 0.3% Keller's procedure and 3.5% other methods. The preoperative summary score for SEFAS (Self-reported Foot and Ankle Score) was 26 and for EQ-5D (Euroqol-5 Dimension) 0.60. CONCLUSION This study is the first report from Swefoot regarding HR.
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Abstract
Evidence-based medicine continues to guide our treatment of patients. Owing to the unique characteristics of the first metatarsophalangeal joint (1st MTPJ) with its small surface area and the significant amount of multiplanar force that affects it, finding the perfect implant to allow motion and alleviate pain is still the ultimate goal. While some of the older metallic implants and silastic spacers may still be providing pain relief and function to patients, the majority have failed and caused significant bone loss along the way. The HemiCap implants have shown some promise in select patients and may still be a viable option in patients desiring maintenance of 1st MTPJ motion.
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Affiliation(s)
- Michelle L Butterworth
- Williamsburg Regional Hospital, 500 Thurgood Marshall Hwy, Suite B, Kingstree, SC 29556, USA.
| | - Maria Ugrinich
- Penn Presbyterian Medical Center, 1317 Lombard Street, Philadelphia, PA 19147, USA
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Siclari A, Krueger JP, Endres M, Boux E. A 24-month follow-up after treatment of hallux rigidus with resection arthroplasty in combination with a resorbable polymer-based implant and platelet-rich plasma. Foot Ankle Surg 2018; 24:389-393. [PMID: 29409233 DOI: 10.1016/j.fas.2017.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Aim of this study was to analyze the clinical outcome after treatment of hallux rigidus with implantation of a resorbable polymer-based implant immersed with autologous platelet-rich plasma (PRP). METHODS Forty-five patients with hallux rigidus were treated with three-stage resection arthroplasty and subsequent covering of the metatarsal head with a polyglycolic acid-hyaluronan implant immersed with autologous PRP. Patients were clinically assessed using the AOFAS rating scale preoperatively and at 12 and 24 month follow-up. Alignment and range of motion in the metatarsophalangeal joint was measured using a goniometer. RESULTS The AOFAS rating scale and ROM showed significant (p<.01) improvement in all subcategories one and two years after surgery compared to the preoperative situation. CONCLUSIONS Covering of the metatarsal head after resection arthroplasty with the PGA-hyaluronan implant immersed with autologous PRP is safe and leads to a notable improvement of the symptoms in patients with hallux rigidus.
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Affiliation(s)
- A Siclari
- Struttura Complessa di Ortopedia e Traumatologia, Ospedale degli Infermi di Biella ASLBI, Str. Cantone Rondolina 50, 13900 Biella, Piemonte, Italy.
| | - J P Krueger
- TransTissue Technologies GmbH, Charitéplatz 1, 10117 Berlin, Germany
| | - M Endres
- TransTissue Technologies GmbH, Charitéplatz 1, 10117 Berlin, Germany
| | - E Boux
- Struttura Complessa di Ortopedia e Traumatologia, Ospedale degli Infermi di Biella ASLBI, Str. Cantone Rondolina 50, 13900 Biella, Piemonte, Italy
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Hilario H, Garrett A, Motley T, Suzuki S, Carpenter B. Ten-Year Follow-Up of Metatarsal Head Resurfacing Implants for Treatment of Hallux Rigidus. J Foot Ankle Surg 2018; 56:1052-1057. [PMID: 28842091 DOI: 10.1053/j.jfas.2017.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Indexed: 02/03/2023]
Abstract
Controversy remains regarding the use of arthroplasty versus arthrodesis in the surgical treatment of late-stage hallux rigidus. The purpose of our retrospective study was to report the long-term follow-up results of the metatarsal head resurfacing implant used for hemiarthroplasty. The patient assessments were conducted using the American Orthopaedic Foot and Ankle Society (AOFAS) metatarsophalangeal clinical rating system and a satisfaction questionnaire. A total of 59 consecutive implantations were performed from January 2005 to December 2009 at our institution. Of the 59 patients, 2 had died and 12 were lost to follow-up, for a 76.3% follow-up rate (45 of 59 procedures) at a mean of 117.67 (range 96 to 143) months. The mean overall AOFAS scale score was 90.6 ± 7.6. The AOFAS pain scale score was 37.78 ± 4.71. One implant was removed, and all remaining patients were happy with their outcome and would repeat the procedure on their other foot, if needed. A subset of patients from a previous mid-term study at our institution showed no significant change in the AOFAS scale scores. Of these 32 patients, 30 (93.75%) were available for follow-up examination at a mean of 122.62 (range 96 to 143) months. We were able to obtain long-term results for 32 implants (30 patients), resulting in a 10-year follow-up rate of 93.7%. With the minimal resection required for this implant, salvage arthrodesis remains a viable option if revision is needed. The surgical treatment of late-stage hallux rigidus with metatarsal head resurfacing allows for low-risk and excellent outcomes at long-term follow-up point.
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Affiliation(s)
- Henry Hilario
- Chief Resident, Foot and Ankle Surgery Division, Department of Orthopaedics, John Peter Smith Hospital, Fort Worth, TX.
| | - Alan Garrett
- Assistant Professor, Department of Orthopaedics, John Peter Smith Hospital, University of North Texas Health Science Center, Fort Worth, TX
| | - Travis Motley
- Assistant Professor, Department of Orthopaedics, John Peter Smith Hospital, University of North Texas Health Science Center, Fort Worth, TX
| | - Sumihiro Suzuki
- Associate Professor and Chair, Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX
| | - Brian Carpenter
- Professor, Department of Orthopaedics, John Peter Smith Hospital, University of North Texas Health Science Center, Fort Worth, TX
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Vuurberg G, Reilingh ML, van Bergen CJ, van Eekeren IC, Gerards RM, van Dijk CN. Metal Resurfacing Inlay Implant for Osteochondral Talar Defects After Failed Previous Surgery: A Midterm Prospective Follow-up Study. Am J Sports Med 2018; 46:1685-1692. [PMID: 29624081 PMCID: PMC5985591 DOI: 10.1177/0363546518764916] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of osteochondral talar defects (OCDs) after failed previous surgery is challenging. Promising short-term results have been reported with use of a metal resurfacing inlay implant. PURPOSE To evaluate the midterm clinical effectiveness of the metal implant for OCDs of the medial talar dome after failed previous surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS We prospectively studied all patients who met the inclusion criteria and received a metal resurfacing inlay implant between 2007 and 2014. The primary outcome measure was implant survival, as measured by reoperation rate. Secondary outcome measures were numeric rating scales for pain at rest and during walking, running, and stair climbing; the Foot and Ankle Outcome Score (FAOS); the American Orthopaedic Foot and Ankle Society Ankle Hindfoot Scale; the 36-Item Short Form Health Survey (SF-36); return to work and sports; and radiographic evaluation. RESULTS This study included 38 patients with a mean age of 39 years (SD, ±13 years) and a mean follow-up of 5.1 years (SD, ±1.5 years). Two patients (5%) underwent revision surgery by means of an ankle arthrodesis (2 and 6 years postoperatively). In 8 patients, computed tomography scanning was conducted to assess postoperative complaints. These scans showed impression of the tibial plafond (n = 4), a small tibial cyst (<2.5 mm; n = 1), and cyst formation around the implant screw (n = 4). A total of 21 reoperations were performed, including medial malleolar screw removal (n = 12), arthroscopic removal of bony anterior impingement (n = 7), and calcaneal realignment osteotomy (n = 2). All secondary outcome measures improved significantly, apart from pain at rest, the FAOS symptoms subscale, and the SF-36 mental component scale. The mean time for return to sport was 4.1 months (SD, ±3 months), and 77% of patients resumed sporting activities postoperatively. Only 1 patient did not return to work postoperatively. Radiographs at final follow-up showed cyst formation (n = 2), subchondral periprosthetic radiolucency (n = 2), and non-preexisting joint space narrowing (n = 2). CONCLUSION This study shows that the metal implant is an effective technique when assessed at midterm follow-up for OCDs of the medial talar dome after failed previous surgery.
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Affiliation(s)
- Gwendolyn Vuurberg
- Orthopaedic Research Center Amsterdam, Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands,Gwendolyn Vuurberg, Orthopaedic Research Center Amsterdam, Academic Medical Center, Department of Orthopaedic Surgery, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands ()
| | - Mikel L. Reilingh
- Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | | | - Inge C.M. van Eekeren
- Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | - Rogier M. Gerards
- Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | - C. Niek van Dijk
- Academic Medical Center, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
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Wanivenhaus F, Fust J, Erschbamer M, Schirm A. Clinical and Radiologic Outcomes of Metatarsophalangeal Hemiarthroplasty: A Review of 12 Consecutive Cases. Orthopedics 2018; 41:e64-e69. [PMID: 29156072 DOI: 10.3928/01477447-20171114-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/28/2017] [Indexed: 02/03/2023]
Abstract
This study examined function, pain, satisfaction, and radiologic outcomes among patients treated with first metatarsophalangeal hemiarthroplasty. Patients were invited to participate in an outcome study conducted with questionnaires on subjective and objective outcomes and clinical and radiographic follow-up. A total of 12 patients (12 feet; mean patient age, 58.8±12.3 years) agreed to participate. Mean follow-up was 22.3±19.8 months. Of these patients, 7 were satisfied with the postoperative result. The mean visual analog scale pain score decreased significantly from 7.0±2.3 preoperatively to 3.5±3.3 postoperatively (P=.024). Mean passive range of motion of the first metatarsophalangeal joint was 32°±10° preoperatively, 93°±18° intraoperatively after implantation of the prosthesis and closure of the joint capsule, and 38°±19° at final follow-up (P=.26). Mean American Orthopaedic Foot and Ankle Society forefoot score increased significantly from 47.3±14.7 preoperatively to 71.8±15.2 at last follow-up (P=.033). During the follow-up period, 6 patients underwent additional procedures: 5 therapeutic joint infiltrations and 1 arthrodesis. No patients had radiologic loosening of the implant at final follow-up. Osseous dysplastic changes at the base of the proximal phalanx were noted among 6 of 11 patients (12 total cases) at final follow-up. Although first metatarsophalangeal hemiarthroplasty provided significant pain reduction at mean follow-up of 22.3 months, range of motion of the first metatarsophalangeal joint was not restored to anticipated levels and there were high rates of patient dissatisfaction and secondary interventions. [Orthopedics. 2018; 41(1):e64-e69.].
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