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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
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2
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He Y, Shan F, Fan C, Zeng X, Yang G, Tang B. Effectiveness of the First Metatarsophalangeal Joint Arthrodesis Versus Arthroplasty for Rheumatoid Forefoot Deformity: A Systematic Review and Meta-Analysis of Comparative Studies. J Foot Ankle Surg 2021; 60:787-794. [PMID: 33775544 DOI: 10.1053/j.jfas.2020.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 02/03/2023]
Abstract
To compare the clinical outcomes of resection arthroplasty of metatarsals 2-5 with either first metatarsophalangeal joint arthrodesis or arthroplasty for rheumatoid forefoot deformity treatment. Comparative studies on the clinical effects of resection arthroplasty of metatarsals 2-5 with either first metatarsophalangeal joint arthrodesis or arthroplasty for the treatment of rheumatoid forefoot deformity were systematically reviewed and a meta-analysis conducted. A total of 337 patients (459 feet) with rheumatoid forefoot deformity from 6 comparative studies were included, with the mean follow-up times ranging from 25 to 80 months in the arthrodesis group and 35 to 102 months in the arthroplasty group. Postoperative pain, satisfaction, hallux valgus angle, the 1st -2nd intermetatarsal angle, adverse events mainly including non-union and the reoperation rate, and pedobarographic data were reported. In the pooled analysis, there were no significant pain score differences between 1st metatarsophalangeal joint arthrodesis and arthroplasty groups (SMD = 0.04, p = .734; I2 = 43.7%, p = .149), but the hallux valgus angle and the 1st -2nd intermetatarsal angle showed significant differences between these 2 groups (For hallux valgus angle, SMD = -0.439, p = .002; I2 = 96.6%, p = .000; for 1st -2nd intermetatarsal angle, SMD = -0.569, p = .000; I2 = 98.2%, p = .000). The rate of non-union varied from 0% to 26% in the arthrodesis group. The reoperation rate varied from 3% to 9.6% in the arthrodesis group and from 4% to 11.6% in the arthroplasty group. A comparison of the procedures showed that first metatarsophalangeal joint arthrodesis with resection arthroplasty of the lesser rays produced similar postoperative pain relief and better maintenance of the hallux valgus angle and the 1st -2nd intermetatarsal angle for rheumatoid forefoot deformity. However, the results should be interpreted with caution due to the high heterogeneity and relatively low quality of the reviewed articles.
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Affiliation(s)
- Yuan He
- Associate Professor, Division of Orthopedics, First People's Hospital of Xining City, Xining, Qinghai, China
| | - Farong Shan
- Associate Professor, Division of Orthopedics, First People's Hospital of Xining City, Xining, Qinghai, China
| | - Cheng Fan
- Resident, Sports Medicine Center, First People's Hospital of Xining City, Xining, Qinghai, China
| | - Xuezhu Zeng
- Resident, Sports Medicine Center, First People's Hospital of Xining City, Xining, Qinghai, China
| | - Guolei Yang
- Resident, Sports Medicine Center, First People's Hospital of Xining City, Xining, Qinghai, China
| | - Bo Tang
- Foot and Ankle Surgeon, Sports Medicine Center, First People's Hospital of Xining City, Xining, Qinghai, China.
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3
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Barták V, Štědrý J, Hornová J, Heřt J, Tichý P, Hromádka R. Biomechanical Study Concerning the Types of Resection in Arthrodesis of First Metatarsophalangeal Joint. J Foot Ankle Surg 2021; 59:1135-1138. [PMID: 32732150 DOI: 10.1053/j.jfas.2019.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 01/01/2019] [Accepted: 01/29/2019] [Indexed: 02/03/2023]
Abstract
This work concerns a biomechanical study aiming to ascertain the optimal type of joint resection when performing a joint arthrodesis. A 3-dimensional digital model of the first metatarsophalangeal joint including the entire first metatarsal bone and proximal phalanx using CT scans of the forefoot was created. Using this computer model, 4 types of resections; ball-and-socket, flat-on-flat, wedge 90°, and wedge 100° were simulated. Parameters measured using this model were the force necessary to separate the 2 fused surfaces, the surface area of the resected surfaces and the shortening of the first ray. By measuring the reactive force necessary to separate the phalanx from the first metatarsal, the 90° wedge resection was found to be the most stable, with comparable results in the case of the 100° wedge resection. Wedge resections are also more favorable when comparing the shortening of the first ray. Wedge resections, though being more technically difficult to perform prove to be the most stable for metatarsophalangeal joint-1 arthrodesis using this model.
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Affiliation(s)
- Vladislav Barták
- Surgeon, FN Motol Teaching Hospital, Department of Orthopaedic Surgery, 1st Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic.
| | - Jan Štědrý
- Surgeon, FN Motol Teaching Hospital, Department of Orthopaedic Surgery, 1st Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Jana Hornová
- Engineer, Faculty of Mechanical Engineering, Department of Mechanics, Biomechanics and Mechatronics, Czech Technical University, Prague, Czech Republic
| | - Jan Heřt
- Surgeon, FN Motol Teaching Hospital, Department of Orthopaedic Surgery, 1st Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Petr Tichý
- Engineer, Faculty of Mechanical Engineering, Department of Mechanics, Biomechanics and Mechatronics, Czech Technical University, Prague, Czech Republic
| | - Rastislav Hromádka
- Surgeon, FN Motol Teaching Hospital, Department of Orthopaedic Surgery, 1st Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic; Assisting Professor, Institute of Anatomy, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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4
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LaCoste KL, Andrews NA, Ray J, Harrelson WM, Shah A. First Metatarsophalangeal Joint Arthrodesis: A Narrative Review of Fixation Constructs and Their Evolution. Cureus 2021; 13:e14458. [PMID: 33996318 PMCID: PMC8117946 DOI: 10.7759/cureus.14458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
First metatarsophalangeal (MTP) joint arthrodesis is a surgical procedure in which the first metatarsal head is fused to the proximal phalanx of the great toe in order to permanently stiffen the first MTP joint. It was originally proposed as a treatment for severe cases of hallux valgus deformity, but the procedure's indications and utilization have expanded since its initial development. Despite a wide variety of indications, first MTP arthrodesis has been shown to have reliable, satisfactory outcomes. As a result, the development of a wide array of surgical approaches, joint preparation techniques, and fixation devices used in the procedure has occurred. In this narrative review, we highlight the evolution of fixation constructs used in first MTP arthrodesis in order to provide a frame of reference for the various types of fixation constructs available.
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Affiliation(s)
- Ketrick L LaCoste
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Nicholas A Andrews
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Jessyca Ray
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Whitt M Harrelson
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Ashish Shah
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
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Abstract
The severe foot and ankle deformities the authors' organization has encountered in humanitarian programs worldwide are more complicated than those surgeons treat in daily practice in developed countries. Severity of deformity, patients' economic limitations, patients' expectations and realistic needs in life, availability of surgical instrumentation, the local team's understanding of foot and ankle surgery and their ability to do consultation for patients postoperatively, and compliance of patients all account for success of the surgery. Regardless of the effort surgeons make, complications and recurrence occur. Educating and training local surgeons to take over medical care are the most important goals of the programs.
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Affiliation(s)
- Shuyuan Li
- Steps2Walk, 1209 Harbor Island Walk, Baltimore, MD 21230, USA
| | - Mark S Myerson
- Steps2Walk, 1209 Harbor Island Walk, Baltimore, MD 21230, USA.
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Santos Silva M, Rodrigues-Pinto R, Barros LH, Sousa A, Muras J. Arthrodesis versus Arthroplasty of the First Metatarsophalangeal Joint in the Treatment of Hallux Rigidus - A Comparative Study of Appropriately Selected Patients. Rev Bras Ortop 2020; 55:40-47. [PMID: 32153308 PMCID: PMC7051855 DOI: 10.1055/s-0039-1700815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 12/04/2018] [Indexed: 12/11/2022] Open
Abstract
Objective
Historical results of arthroplasty of the first metatarsophalangeal joint (1MTP) are relatively poor; however, improvements in the understanding of the normal foot biomechanics, implant materials and design currently make arthroplasty a reasonable option in appropriately selected patients. The present study aimed to compare the clinical and radiographic results of 1MTP arthrodesis and arthroplasty in the treatment of
hallux rigidus
and to present a rationale for patient selection for arthroplasty.
Methods
A total of 36 patients (38 feet) with
hallux rigidus
submitted to surgery (12 arthrodesis and 26 arthroplasties) were prospectively included in the study. Pain was assessed using the visual analogue scale (VAS) and the functional status was assessed using the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI) scale. Complications and radiographic results were also analyzed, and survival rates were calculated for both procedures.
Results
All of the patients reported significant improvement in pain and functional status after surgery. Patients submitted to arthroplasty had better functional results on the AOFAS-HMI scale (89.7 versus 65.7 points;
p
< 0.001) and better pain relief (VAS 1.6 versus 3.9 points;
p
= 0.002) when compared with the group submitted to arthrodesis. There was one case of infection in the arthroplasty group and 2 cases of pseudarthrosis in the arthrodesis group.
Conclusion
Arthrodesis provides pain relief and satisfactory results but alters the biomechanics of gait. Like arthrodesis, arthroplasty improves pain significantly, being a more physiological alternative to preserve the biomechanics of the foot. While the two surgical methods yielded good clinical results, selected patients submitted to arthroplasty had better clinical scores and lower revision rates.
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Affiliation(s)
- Marta Santos Silva
- Departamento de Ortopedia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Departamento de Ortopedia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal.,Trofa Saúde Hospital Privado de Alfena, Alfena, Portugal.,Trofa Saúde Hospital Privado Braga Centro, Braga, Portugal
| | - Luís H Barros
- Departamento de Ortopedia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Arnaldo Sousa
- Departamento de Ortopedia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - José Muras
- Trofa Saúde Hospital Privado de Alfena, Alfena, Portugal.,Trofa Saúde Hospital Privado Braga Centro, Braga, Portugal.,Centro Hospitalar Póvoa de Varzim/ Vila do Conde, Largo da Misericórdia, Póvoa de Varzim, Portugal
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Fuld RS, Kumparatana P, Kelley J, Anderson N, Baldini T, Younger ASE, Hunt KJ. Biomechanical Comparison of Low-Profile Contoured Locking Plate With Single Compression Screw to Fully Threaded Compression Screws for First MTP Fusion. Foot Ankle Int 2019; 40:836-844. [PMID: 30880450 DOI: 10.1177/1071100719837524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Open metatarsophalangeal (MTP) arthrodesis using locked plates produces good clinical outcomes. However, arthroscopic fusion with new-generation fully threaded compression screws is emerging as an alternative. The purpose of this study was to compare low-profile contoured locked plates with fully threaded compression screws for first MTP fusion, in a biomechanical cadaveric model. METHODS The first rays of 8 matched pairs of fresh frozen cadaveric feet underwent dissection and dual-energy x-ray absorptiometry (DEXA) scanning to measure bone mineral density (BMD). The "plate" group was prepared with cup-and-cone reamers, and fixation of the MTP joint with 1 compression screw and low-profile dorsal locked plate. The matched-pair "screws" group was prepared through a simulated arthroscopic technique, achieving fixation with 2 new-generation fully threaded compression screws. The plantar MTP gap was recorded with an extensometer during 250 000 90-N cyclic loads followed by a single load to failure. RESULTS The screw group demonstrated significantly greater stiffness, 31.6 N/mm (plates) and 51.7 N/mm (screws) (P = .0045). There was no significant difference in plantar gapping or load to failure, 198.6 N (plates) and 290.1 N (screws) (P = .2226). Stiffness and load to failure were highly correlated to BMD for the screw group, r =0.79 and r = 0.94, respectively, but less so for the plate group, r = 0.36 and r = 0.62, respectively. The maximum metatarsal head height measured on the lateral view was strongly correlated with load to failure for both the plate- and screw-only groups (r > 0.9). CONCLUSION These data demonstrate that hallux MTP arthrodesis utilizing fully threaded compression screws had similar plantar gapping and load to failure when compared with the low-profile locking plate, but with significantly more stiffness. These results support an increased role of fully threaded screws for MTP arthrodesis using either the arthroscopic or open technique. However, with decreased BMD plate fixation may remain the better fixation choice. CLINICAL RELEVANCE Our data suggest that with regard to construct stability, fully threaded headless compression screws may be just as effective as low-profile locking plates, but BMD and MTP joint fluoroscopic measurements should be considered in the decision-making process for fixation.
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Affiliation(s)
- Richard S Fuld
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Pam Kumparatana
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Judas Kelley
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Nicholas Anderson
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Todd Baldini
- 2 Orthopedics Biomechanics Laboratory, University of Colorado, Aurora, CO, USA
| | - Alastair S E Younger
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, BC, USA
| | - Kenneth J Hunt
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
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