Moje first metatarsophalangeal replacement--a case series with functional outcomes using the AOFAS-HMI score

Comparison of Total Joint Replacement With Arthrodesis of the First Metatarsophalangeal Joint

BACKGROUND

The aim of this study was to compare outcome (clinical, patient-reported outcome measures, radiologic, joint motion and pedographic) of total joint replacement with Roto-Glide (RG) and arthrodesis (A) for severe osteoarthritis of the first metatarsophalangeal joint (MTP1).

METHODS

All consecutive patients with arthrodesis and RG from January 23, 2011, until September 18, 2019, at the authors' institution were considered for inclusion in the study. Preoperatively and at follow-up (FU), radiographs, and/or weightbearing computed tomographic imaging were obtained. Standard dynamic pedography was performed. Visual analog scale foot and ankle (VASFA), European Foot and Ankle Society (EFAS) score, MTP1 range of motion for dorsiflexion/plantarflexion (DF/PF) were registered and compared preoperatively and at FU.

RESULTS

Seventy RG and 72 arthrodesis patients were included. Preoperative VASFA and EFAS scores did not differ between the RG and arthrodesis groups (average scores: VASFA, 50.6 and 45.6; EFAS score, 10.7 and 10.6, respectively; each P > .05). Wound healing delays without further operative measures were registered in 4 patients (6%) for RG and 5 (7%) for arthrodesis (P = .67), and 5 revisions in 5 patients (7%) for RG and 12 in 8 (11%) for arthrodesis (P = .05). The longest available FU was higher in RG than in arthrodesis (47 vs 37 months on average, P < .001). Pedography showed higher first metatarsal head or sesamoids and lower great toe force percentage from force of entire foot in RG than in arthrodesis (P = .05) resulting in physiological pattern in RG only. VASFA and EFAS scores at FU was higher in RG than in arthrodesis (average scores: VASFA, 72.6 and 63.6; EFAS score, 16.1 and 14.1, respectively; each P < .05). DF/PF measurement was only possible in RG (average value: DF/PF, 36.1/14.0).

CONCLUSION

We found marginally lower revision rates and higher patient-reported outcome measures, joint motion (DF/PF), and more physiologic force distribution at slightly longer FU for the RG group than the arthrodesis group. Longer follow-up and broader clinical reporting are needed to identify the potential deficits of RG.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Valenti resection arthroplasty for hallux rigidus: A systematic review

BACKGROUND

Valente Valenti proposed in 1976 a "V" resection of the first metatarsophalangeal joint (MPT1) on the sagittal plane for advanced stages of hallux limitus/rigidus, preserving length of the first ray, flexor hallux brevis and sesamoid function. The available literature concerning correct indications, management and clinical outcomes of the Valenti procedure (VP) and its modifications in patients affected by hallux limitus/rigidus was systematically analyzed.

METHODS

Titles and abstracts of all selected articles were independently screened by two authors to assess their suitability to the research focus.

RESULTS

Selection produced 8 articles as full-text, for a total of 347 patients, with a mean follow-up of 6±7.1 (range 0.2-17.5) years. Most common complication was transient sesamoiditis in 21 (7.4%) patients. No substantial differences in clinical outcomes were found between the original and modified techniques.

CONCLUSIONS

VP appears to allow an early recovery with few complications, if compared to fusion, interposition arthroplasties or osteotomies. The wide joint resection does not prevent, if necessary, further procedures such as fusion or implants.

LEVEL OF EVIDENCE

Level I, systematic review.

Silastic first metatarsophalangeal joint arthroplasty for the treatment of end-stage hallux rigidus

AIMS

Arthroplasty for end-stage hallux rigidus (HR) is controversial. Arthrodesis remains the gold standard for surgical treatment, although is not without its complications, with rates of up to 10% for nonunion, 14% for reoperation and 10% for metatarsalgia. The aim of this study was to analyze the outcome of a double-stemmed silastic implant (Wright-Medical, Memphis, Tennessee, USA) for patients with end-stage HR.

METHODS

We conducted a retrospective review of 108 consecutive implants in 76 patients, between January 2005 and December 2016, with a minimum follow-up of two years. The mean age of the patients at the time of surgery was 61.6 years (42 to 84). There were 104 females and four males. Clinical, radiological, patient reported outcome measures (PROMS) data, a visual analogue score (VAS) for pain, and satisfaction scores were collected.

RESULTS

The survivorship at a mean follow-up of 5.3 years (2.1 to 14.1) was 97.2%. The mean Manchester Oxford Foot and Ankle Questionnaire (MOXFQ) scores improved from 78.1 to 11.0, and VAS scores for pain from 7/10 to 1.3/10. The rate of satisfaction was 90.6%. Three implants (2.8%) required revision; one for infection, one-month postoperatively, and two for stem breakage at 10.4 and 13.3 years postoperatively. There was a 1.9% reoperation rate other than revision, 23.1% of patients developed a minor complication, and 21.1% of patients had non-progressive and asymptomatic cysts on radiological review.

CONCLUSION

We report a 97.2% survivorship at a mean follow-up of 5.3 years with this implant. We did not find progressive osteolysis, as has been previously reported. These results suggest that this double-stemmed silastic implant provides a predictable and reliable alternative with comparable outcomes to arthrodesis for the treatment of end-stage HR. Cite this article: Bone Joint J 2020;102-B(2):220-226.

Hemiarthroplasty Versus Total Joint Arthroplasty for Hallux Rigidus: A Systematic Review and Meta-analysis

BACKGROUND

When surgery is indicated for hallux rigidus, toe arthroplasty is an alternative procedure to arthrodesis for patients who wish to preserve toe range of motion. Our study investigated midterm outcomes of first metatarsophalangeal joint (MTPJ) arthroplasty in an effort to discern whether or not partial or total joint replacement confers benefit in these patients.

METHODS

A systematic review of MTPJ arthroplasty was performed for the years 2000 to 2017. A Forest plot was created comparing preoperative and postoperative American Orthopedic Foot and Ankle Score (AOFAS), Visual Analogue Scale (VAS), and range of motion (ROM) results for both hemitoe and total-toe arthroplasty. Statistical analysis was performed.

RESULTS

Mean postoperative AOFAS scores in patients undergoing hemiarthroplasty improved by 50.7 points (95% CI = 48.5, 52.8), whereas the mean AOFAS score improvement in total joint arthroplasty patients was 40.6 points (95% CI = 38.5, 42.8). VAS outcomes were comparable. Mean postoperative MTPJ ROM improved by 43.0° (95% CI = 39.3°, 46.6°) in hemitoe patients, which exceeded the mean ROM improvement of 32.5° (95% CI = 29.9°, 35.1°) found in total joint arthroplasty cases. A meta-analysis revealed no significant difference.

CONCLUSION

Hemisurface implants in MTPJ arthroplasty may improve postoperative AOFAS and ROM results to a greater extent than total-toe devices.

LEVEL OF EVIDENCE

Level IV: Systematic review.

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.

Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux

BACKGROUND

The current gold standard in the treatment of severe hallux rigidus is arthrodesis of the first metatarsophalangeal (MTP-I) joint. We present the results of a new 3-component MTP-I prosthesis. We determined (1) the intraoperative and perioperative complications; (2) survivorship of prosthesis components and rate of secondary surgeries for any reason; (3) prosthetic component stability and radiographic alignment; (4) the degree of pain relief; and (5) the midterm functional outcomes including radiographic range of motion (ROM).

METHODS

From 2008 to 2010, we prospectively included 29 MTP-I prostheses in 25 patients. The average age of the patients was 63.1 years (range, 48-87 years). The average follow-up was 49.5 months (range, 36-62 months). We observed complications and reoperations. A visual analog scale for pain and the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score were obtained pre- and postoperation. Component stability and alignment were assessed using weight-bearing radiographs. Fluoroscopy was used to determine radiographic MTP-I ROM.

RESULTS

Seven (24.1%) patients underwent 1 or more secondary surgeries. Four cases (13.7%) eventually had a conversion to MTP-I arthrodesis. Two patients (3 cases) died from causes not related to the procedure. This left 22 feet in 19 patients for final follow-up. All but 3 remaining prostheses showed stable osteointegration and no migration, but MTP-I alignment showed high variability. The average pain score decreased from 5.9 (range, 3-9) to 1.2 (range, 0-5). The average AOFAS forefoot score increased from 55 (range, 0-80) to 83.5 (range, 58-95). Range of motion initially increased from 37.8 degrees (range, 0-60 degrees) to 88.6 degrees (range, 45-125 degrees) intraoperatively and decreased to 29.0 degrees (range, 11-52 degrees) at latest follow-up.

CONCLUSION

Our data suggest that total arthroplasty of MTP-I leads to a high amount of revision surgeries, but the remaining patients had significant pain relief at midterm follow-up. However, we observed high variability regarding the prosthesis component alignment and poor range of motion.

LEVEL OF EVIDENCE

Level IV, prospective cohort study.

Total Toe Replacement in the United States: What Is Known and What Is on the Horizon

Arthritis of the first metatarsophalangeal is a common problem of the forefoot. The gold standard surgical treatment has been fusion of the first metatarsophalangeal joint. Many patients are unwilling to accept pain relief at the expense of loss of motion and the corresponding loss of shoe wear choices and activities requiring dorsiflexion of the hallux. Early implants were plagued with loosening and continued pain but implants have evolved. Current implants use modern bearing surfaces with press-fit fixation. These implants have renewed optimism for total toe arthroplasty. This article reviews the literature for implants currently available and describes the surgical techniques.

Short-term clinical outcomes after first metatarsal head resurfacing hemiarthroplasty for late stage hallux rigidus

The purpose of the present study was to evaluate the short-term results of metatarsal head resurfacing hemiarthroplasty in the treatment of advanced hallux rigidus. We reviewed 14 consecutive patients (5 males [35.71%], 9 females [64.29%]; mean age, 58.7 ± 7.4 years). These patients underwent first metatarsal head resurfacing hemiarthroplasty (HemiCAP(®)) for hallux rigidus from March 2010 to September 2012 at our institution. According to the Coughlin and Shurnas clinical and radiographic classification, 10 feet (71.43%) were classified as grade III and 4 (28.57%) as grade IV. We clinically rated all patients before surgery and at the final follow-up visit using the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal scale, the visual analog scale for pain, and first metatarsophalangeal joint (MTPJ) range of motion. The mean follow-up duration was 24.2 ± 7.2 (range 12 to 36) months. The mean preoperative hallux metatarsophalangeal-interphalangeal scale score was 33.9 ± 9.8 (range 22 to 59), and it increased to 81.6 ± 10.1 (range 54 to 96; p < .05) postoperatively. The mean preoperative 10-cm visual analog scale for pain score was 8.4 ± 0.9 (range 7 to 10), which decreased to 1.21 ± 1.2 (range 0 to 5; p < .05) postoperatively. The mean preoperative MTPJ range of motion was 22.8° ± 7.7° (range 15° to 45°), which increased to 69.6° ± 11.8° (range 50° to 90°; p < .05) postoperatively. None of the 14 patients experienced component malalignment or loosening, infection, or neurovascular compromise during the follow-up period. One patient (7.14%) experienced postoperative pain and subsequently underwent first MTPJ arthrodesis. From the results of our investigation, first MTPJ arthroplasty is an effective treatment modality that can reduce pain and increase motion in the case of advanced hallux rigidus.

High frequency failure of the Moje thumb carpometacarpal joint arthroplasty

Arthroplasty is one of several options for treating symptomatic osteoarthritis of the thumb carpometacarpal joint. There are various hemi- and total arthroplasties available on the market. We report our experience of treating 12 patients with the Moje Acamo CMC1 prosthesis. We reviewed all the patients at a mean of 50 months postoperatively. All patients presented with loosening, migration or tilting of one or both implant components. Nine patients were symptomatic enough to warrant revision surgery with removal of the implant leaving a pseudarthrosis. At the last follow-up, five patients (42%) had already received revision surgery. All patients still possessing an implant showed progressive signs of implant loosening, although some of them had no symptoms. In order to assess their overall disadvantage compared with patients treated by primary trapeziectomy, the outcomes of these two groups were compared (matched pairs). The outcomes after revision surgery were comparable with those of primary trapeziectomy. We no longer use the Moje Acamo CMC1 implant and recommend that patients who have received this implant should be monitored carefully both clinically and radiologically.

MOJE ceramic metatarsophalangeal arthroplasty: disappointing clinical results at two to eight years

BACKGROUND

Among the surgical treatment options for osteoarthritis of the first metatarsophalangeal joint (MTPJ) are a number of different designs of total arthroplasty, including the MOJE, a ceramic press fit arthroplasty. We present a 2- to 8-year followup of 31 procedures.

METHODS

Thirty-two MOJE arthroplasties were undertaken for painful hallux rigidus in 30 patients (nine male, 21 female) over 6 years (mean age 61.9; range, 37 to 76). At followup patients' symptoms, levels of function and radiographs were scored using SF-36, modified Kitaoka and AOFAS systems. Followup rate was 97%, with mean followup time 58 months (range, 28 to 97).

RESULTS

Mean scores were: Kitaoka 53.8 (15 to 75), AOFAS 61.3/100 (range, 18 to 100), SF-36 physical combined 48.6 (27.6 to 58.7) SF-36 mental score 52.2 (19.5 to 62.2). Sixteen showed radiological evidence of component loosening (either lucency, subsidence or both) and one radiograph revealed component fracture. Eight implants have been revised. In patients who had not undergone subsequent fusion, 15 had less than 36 degrees of movement, nine had 36 to 45 degrees, four were in the 46 to 60 range, and only one had more than 60 degrees. There were no infections.

CONCLUSION

Although previous studies have suggested favorable initial outcomes with the MOJE prosthesis, all have focused only on the early results. In our series, the reoperation rate of 26% at up to 8 years is worryingly high, especially given that 16 (52%) showed loosening. Although there appears to be a cohort of patients who have satisfactory outcomes with the MOJE, we would suggest the continued use of this implant.

Surgical management of hallux rigidus

Hallux rigidus is the most common degenerative joint pathology of the foot. Untreated, it may result in notable limitations in gait, activity level, and daily function. Positive outcomes can be achieved with nonsurgical management; surgery is recommended for the sufficiently symptomatic patient for whom nonsurgical measures are unsuccessful. Surgery is selected based on grade of involvement. Early to mid-stage hallux rigidus is best managed with cheilectomy or cheilectomy and proximal phalanx osteotomy. Arthrodesis and arthroplasty are reserved for late-stage hallux rigidus.

Long-term results following Keller resection arthroplasty for hallux rigidus

BACKGROUND

We assessed the long-term results following Keller resection arthroplasty for the treatment of hallux rigidus. We then compared them with alternative surgical methods like cheilectomy, arthrodesis and joint replacement.

METHODS

Eighty-seven cases of Keller resection arthroplasty for hallux rigidus were reviewed with mean followup of 23 years. Their mean age at time of surgery was 50 years. Analysis included personal clinical evaluation with the AOFAS Hallux Score, quality-of-life assessment using the SF-36, radiographic assessment, pedobarographic evaluation and analysis of the patients' charts to detect any postoperative complications.

RESULTS

At the time of followup only five (5%) feet had undergone revision surgery. For all other cases we calculated a mean AOFAS score of 83 points. Sixty-nine of 73 unrevised patients (94%) would opt for this operation again under the same circumstances. SF-36 parameters showed age related normal values. Pedobarographic assessment revealed only moderate weightbearing alterations. Our long-term results compare favorably with published results following arthrodesis, cheilectomy or joint replacement for the treatment of painful hallux rigidus. Clinical results and subjective assessments were very good and complication rates were low compared to competing methods.

CONCLUSION

Keller resection arthroplasty remains a valuable surgical option for the treatment of advanced stages of hallux rigidus with high patient satisfaction, moderate weightbearing alterations and comparable low complication rate in our experience.

Quantitative review of operative management of hallux rigidus

INTRODUCTION

Surgical techniques for the management of hallux rigidus include cheilectomy, Keller resection arthroplasty, arthrodesis, Silastic implantation, phalangeal or metatarsal osteotomy, capsular arthroplasty, partial or total joint replacement, interposition arthroplasty. However, the optimal management is controversial.

SOURCES OF DATA

We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 2 November 2010. Sixty-nine articles published in peer reviewed journals were included in this comprehensive review.

AREAS OF AGREEMENT

Cheilectomy and first metatarsal or phalangeal corrective osteotomy may provide better outcome for patients with early and intermediate hallux rigidus (Stages I-II), while arthrodesis or arthroplasty are indicated to manage more severe conditions. The Coleman Methodology Score showed great heterogeneity in terms of study design, patient characteristics, management methods and outcome assessment and generally low methodological quality.

AREAS OF CONTROVERSY

Definitive conclusions on the use of these techniques for routine management of patients with hallux rigidus are not possible. Given the limitations of the published literature, especially the extensive clinical heterogeneity, it is not possible to compare outcomes of patients undergoing different surgical procedures and determine clear guidelines.

GROWING POINTS

To assess whether benefits from surgery, validated and standardized measures should be used to compare the outcomes of patients undergoing standard surgical procedures.

RESEARCH

There is a need to perform appropriately powered randomized clinical trials of using standard diagnostic assessment, common and validated scoring system comparing reported outcomes and duration of follow-up >2 years.