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Butler JJ, Dhillon R, Wingo T, Lin CC, Samsonov AP, Azam MT, Kennedy JG. Polyvinyl alcohol hydrogel implant for the treatment of hallux rigidus is associated with a high complication rate and moderate failure rate at short-term follow-up: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1765-1778. [PMID: 38554163 DOI: 10.1007/s00590-024-03895-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/28/2024] [Indexed: 04/01/2024]
Abstract
PURPOSE Moderate-to-severe hallux rigidus is a debilitating pathology that is optimally treated with surgical intervention. Arthrodesis produces reliable clinical outcomes but is limited by restriction in 1st metatarsophalangeal joint range of motion. The advent of polyvinyl alcohol hydrogel (PVA) implants have produced early promise based on initial trials, but more recent studies have called into question the efficacy of this procedure. The purpose of this systematic review was to evaluate the clinical and radiological outcomes following the use of PVA for hallux rigidus. METHODS The MEDLINE, EMBASE and Cochrane library databases were systematically reviewed using the preferred reporting items for systematic reviews and meta-analyses guidelines. 18 studies were included. RESULTS In total, 1349 patients (1367 feet) underwent PVA at a weighted mean follow-up of 24.1 ± 11.1 months. There were 168 patients (169 feet) included in the cheilectomy cohort and 322 patients (322 feet) included in the arthrodesis cohort. All 3 cohorts produced comparable improvements in subjective clinical outcomes. Postoperative imaging findings in the PVA cohort included joint space narrowing, peri-implant fluid, peri-implant edema and erosion of the proximal phalanx. The complication rate in the PVA cohort, cheilectomy cohort and arthrodesis cohort was 27.9%, 11.8% and 24.1%, respectively. The failure rates in the PVA cohort, cheilectomy cohort and arthrodesis cohort was 14.8%, 0.3% and 9.0%, respectively. CONCLUSION This systematic review demonstrated that PVA produced a high complication rate (27.9%) together with concerning postoperative imaging findings at short-term follow-up. In addition, a moderate failure rate (14.8%) and secondary surgical procedure rate (9.5%) was noted for the PVA cohort. The findings of this review calls into question the efficacy and safety of PVA for the treatment of hallux rigidus. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- James J Butler
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY, 10002, USA.
| | | | - Taylor Wingo
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY, 10002, USA
| | - Charles C Lin
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY, 10002, USA
| | - Alan P Samsonov
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY, 10002, USA
| | - Mohammad T Azam
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY, 10002, USA
| | - John G Kennedy
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY, 10002, USA.
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Hoskins T, Barr S, Begley B, Fitzpatrick B, Senat S, Patel J, Heiman E, Mazzei C, Miller J, Wittig J, Epstein D. Synthetic cartilage implant hemiarthroplasty versus cheilectomy for the treatment of hallux rigidus. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-022-03469-8. [PMID: 36652016 DOI: 10.1007/s00590-022-03469-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023]
Abstract
Degenerative arthritis of the first metatarsophalangeal joint, hallux rigidus, is the most common type of arthritis of the foot, affecting nearly 2.5% of the population over the age of 50. Hallux rigidus can be treated surgically with either Cheilectomy or Synthetic cartilage implant (SCI) hemiarthroplasty. The purpose of this study is to compare outcomes from a single institution on the treatment of hallux rigidus using cheilectomy and SCI hemiarthroplasty. Between 2012 and 2020, 49 patients underwent either a SCI (Polyvinyl alcohol hydrogels) hemiarthroplasty or Cheilectomy for the treatment of hallux rigidus. Functional scores were assessed pre and postoperatively using the American Orthopedic Foot and Ankle scoring System (AOFAS) and the Foot and Ankle Outcome Score survey (FAOS). Plantar and Dorsal range of motion was also assessed pre and postoperatively. Outcomes, complications, and any reoperations were recorded for all patients. Mean pre-op AOFAS for Cheilectomy and SCI were 49.6 and 54.8, respectively, compared to 85.3 and 89.7, respectively, after surgery (p value < 0.05). Mean pre-op Dorsal range of motion (ROM) for Cheilectomy and SCI were 24.0 and 26.0 degrees, respectively, compared to 38.0 and 42.6 degrees, respectively, after surgery (p value < 0.05). SCI hemiarthroplasty patients had higher AOFAS and dorsal ROM at the latest follow up (p value < 0.05). Synthetic cartilage implant (SCI) hemiarthroplasty and cheilectomy both offer promising results and remain viable treatment options to decrease pain, improve function, and maintain motion for hallux rigidus. SCI hemiarthroplasty may offer superior range of motion and functional outcomes than cheilectomy for hallux rigidus. LEVEL OF CLINICAL EVIDENCE: 3.
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Affiliation(s)
- Tyler Hoskins
- Department of Orthopedic Surgery Morristown Medical Center, Morristown, NJ, USA
| | - Stephen Barr
- Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Brian Begley
- Cooper Medical School of Rowan University, 21 Braidburn Way Morristown, Camden, NJ, 07960, USA.
| | | | - Schamma Senat
- Department of Orthopedic Surgery Morristown Medical Center, Morristown, NJ, USA
| | - Jay Patel
- Department of Orthopedic Surgery Morristown Medical Center, Morristown, NJ, USA
| | - Erick Heiman
- Department of Orthopedic Surgery Morristown Medical Center, Morristown, NJ, USA
| | - Christopher Mazzei
- Department of Orthopedic Surgery Morristown Medical Center, Morristown, NJ, USA
| | - Justin Miller
- Department of Orthopedic Surgery Morristown Medical Center, Morristown, NJ, USA
| | - James Wittig
- Department of Orthopedic Surgery Morristown Medical Center, Morristown, NJ, USA
| | - David Epstein
- Department of Orthopedic Surgery Morristown Medical Center, Morristown, NJ, USA
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Simons P, Roth KE, Klos K. [Description of a technique that uses Lapidus arthrodesis plus osteochondral autotransplantation in the treatment of severe hallux rigidus]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2021; 33:495-502. [PMID: 34757448 DOI: 10.1007/s00064-021-00748-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this technique is the treatment a severe hallux rigidus deformity by reorientation of an elevated first metatarsal using arthrodesis of the first tarsometatarsal joint and performing a one-step transplantation of an osteochondral graft, which is harvested from the first cuneiform, to the head of the first metatarsal bone. INDICATIONS Severe arthritis of the first metatarsophalangeal joint (MTP) stage 3 and 4 in the Vanore classification. CONTRAINDICATIONS General contraindications for a foot surgery; ankylosis of MTP joint; severe arthritis of the sesamoid joint; osteonecrosis; short first metatarsal; previous infection in the metatarsophalangeal joint; large cysts at the head of the first metatarsal. SURGICAL TECHNIQUE The first step is the preparation of the metatarsophalangeal and the first tarsometatarsal joint. After mobilizing the first metatarsal in a medioplantar direction, a cartilage-bone cylinder is removed from the articular surface of the medial cuneiform using special osteochondral autograft transfer system (OATS) instruments (Small Joint OATS, Arthrex medical instruments GmbH, Munich, Germany). This is followed by the arthrodesis of the first tarsometatarsal joint with reorientation of the position of the first metatarsal bone. Then the removed osteochondral cylinder is implanted into the articular surface of the first metatarsal head. After that the capsule is closed and the skin sutured. POSTOPERATIVE MANAGEMENT Postoperative management is guided mainly by the requirements of the first tarsometatarsal arthrodesis. When a plantar plate is used pain orientated full weightbearing is allowed in a postoperative shoe with a stiffened sole for 6-8 weeks. Physiotherapy is prescribed to exercise the first metatarsophalangeal joint. RESULTS In the study, 5 patients were treated with the method described in the years 2011-2012 and were followed up for a period of 2 years. All of these patients were subjectively satisfied with the outcome of the operation. There were no relevant surgery-associated complications.
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Affiliation(s)
- Paul Simons
- Gelenkzentrum Rhein-Main, Frankfurter Str. 94, 65239, Hochheim am Main, Deutschland.
| | - Klaus Edgar Roth
- Gelenkzentrum Rhein-Main, Frankfurter Str. 94, 65239, Hochheim am Main, Deutschland
| | - Kajetan Klos
- Gelenkzentrum Rhein-Main, Frankfurter Str. 94, 65239, Hochheim am Main, Deutschland
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Emami Razavi SZ, Azadvari M, Fateh HR, Ghahvechi Akbari M, Kazemi S, Rezaee E. Short-term Efficacy of Ultrasonographic Guidance for Intra-articular Corticosteroid Injection in Hallux Rigidus: A Single-Blind Randomized Controlled Trial. Foot Ankle Int 2021; 42:1410-1418. [PMID: 34111992 DOI: 10.1177/10711007211015988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Multiple considerations should be taken before standardizing a clinical procedure such as efficacy, safety, or the cost. The aim of this study was to compare the effects of landmark-guided vs ultrasonography-guided intra-articular injection of corticosteroid into the first metatarsophalangeal joint cavity to reduce pain and dysfunction in patients with hallux rigidus. METHODS We carried out a single-blind randomized controlled trial with 2 parallel arms in an outpatient clinic affiliated with a medical university. In total, 50 participants (35 women) with the mean (SD) age of 49.8 (10.3) years were randomly allocated to landmark-guided or ultrasonography-guided groups (each n = 25). Each patient received a single intra-articular injection of 40-mg methylprednisolone plus 1 mL lidocaine into the affected first metatarsophalangeal joint. The primary outcome was joint pain and the secondary outcome was the American Orthopaedic Foot & Ankle Society score. We measured the outcomes at baseline and 2 and 6 weeks after the intervention. RESULTS Six weeks after the injections, there were no statistically significant differences between the study groups in pain reduction and increase in the American Orthopaedic Foot & Ankle Society scores (P = .131 and .241, respectively). We did not find any complications for the injections in both groups. There were statistically significant changes within each group in pain and the scores for the landmark (P < .001, and P = .007), and ultrasonography groups (both P < .001). CONCLUSION Landmark guidance is as effective as ultrasonographic guidance for intra-articular injection in patients with hallux rigidus. A single intra-articular injection of 40 mg methylprednisolone plus 1 mL lidocaine is an efficient and safe therapeutic measure for decreasing joint pain and maintaining its function, at least for 6 weeks. LEVEL OF EVIDENCE Level I, high-quality prospective randomized study.
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Affiliation(s)
| | - Mohaddeseh Azadvari
- Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid R Fateh
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shahrbanoo Kazemi
- Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Rezaee
- Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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