1
|
Fragnière N, Kameni-Hekam M, Cissé A, Vienne P. Primary Isolated Arthrodesis of the First Metatarsophalangeal Joint for Hallux Rigidus: Clinical, Radiologic, and Pedobarographic Evaluation. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241265344. [PMID: 39070905 PMCID: PMC11283670 DOI: 10.1177/24730114241265344] [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: 07/30/2024] Open
Abstract
Background Arthrodesis of the first metatarsophalangeal joint is an effective treatment of advanced hallux rigidus. Numerous options have been described for performing this intervention. The aim of this study was to evaluate the outcomes following a consistent surgical technique of joint preparation with hand tools and fixation with 2 crossed screws and a dorsal compression plate. Methods Thirteen patients (16 feet) who underwent primary isolated arthrodesis of the first metatarsophalangeal joint between March 2019 and June 2021 were available for clinical, radiologic, and pedobarographic evaluation at a minimum of 12 months after surgery. American Orthopaedic Foot & Ankle Society scores, numerical pain rating scale, the radiologic hallux valgus and intermetatarsal 1-2 angles as well as the distribution of plantar pressure during gait were compared between the pre- and postoperative conditions. Results After an average follow-up period of 26 months, union was achieved in all cases and the mean AOFAS score raised significantly by 39 points. All the patients were satisfied with the result. Only 1 patient complained of mild residual pain at walk. Hardware removal was performed in 2 cases. The mean hallux valgus angle dropped from 12.3 to 6.3 degrees. The mean postoperative dorsiflexion angle was 21.6 degrees. After the procedure, peak pressure was significantly higher beneath the first metatarsal head and heel, whereas pressure-time integral was significantly lower beneath the hallux and medial lesser toes. Conclusion Arthrodesis of the first metatarsophalangeal joint with 2 crossed screws and a dorsal compression plate is a safe and effective treatment of advanced hallux rigidus. This procedure provides adequate pain relief and functional improvement of gait. Level of Evidence Level IV, therapeutic, retrospective case series.
Collapse
|
2
|
Sethi M, Limaye N, Alderton E, Limaye R, Kulkarni A. Silastic Joint Arthroplasty as a Joint-Preserving Alternative for End-Stage Hallux Rigidus: Outcomes From 112 First Metatarsophalangeal Joint Arthroplasties. Cureus 2023; 15:e46561. [PMID: 37933343 PMCID: PMC10625660 DOI: 10.7759/cureus.46561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/08/2023] Open
Abstract
Aim Osteoarthritis of the first metatarsophalangeal joint (MTPJ) is a common forefoot problem affecting patients in later years. It leads to pain, gait problems, and difficulty with activities of daily living. Treatment is controversial and varies according to patient symptoms and surgeon preference. Arthrodesis remains the gold standard but it has its own complications. It is associated with adjacent joint arthritis and transfer metatarsalgia. The aim of this study was to analyze the outcome of double-stemmed silastic joint arthroplasty (Wright-Medical, Memphis, TN) for end-stage hallux rigidus. Methods This retrospective analysis included 117 consecutive first MTPJ silastic arthroplasties done between January 2016 and February 2023 for end-stage hallux rigidus. There were 77 females and 40 males with a mean age of 65 years (46-82 years). Radiological and clinical assessments were performed, and patient-reported outcome measure data (PROMS) and visual analogue scale (VAS) scores were collected pre- and post-operatively. Results Findings showed 99.1% survivorship following a silastic joint arthroplasty with a mean follow-up of four years (six months to seven years). The MOXFQ (Manchester Oxford Foot Questionnaire) score improved from a mean of 81 (59.8-100) to 13 (0-57). The mean VAS scores improved from 7.2 (5-10) to 1.5 (0-7) postoperatively. Five patients were lost to follow-up. Two patients developed deep infection and one required revision. The other patient with infection was lost to follow-up. In total 10 patients (8.9%) developed complications, out of which eight patients responded to simple treatments. Conclusion Results have shown good to excellent outcomes following a silastic arthroplasty of the first MTPJ for the treatment of end-stage hallux rigidus. The survivorship at a mean follow-up of four years was 99.1% and the patient satisfaction rate was 90.1%. As historically reported, we did not see any soft tissue reaction or progressive osteolysis in any of our patients. It provides comparable and predictable outcomes to joint fusion for end-stage arthritis.
Collapse
Affiliation(s)
- Mohit Sethi
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
| | - Natalie Limaye
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
| | - Elizabeth Alderton
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
| | - Rajiv Limaye
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
| | - Ameet Kulkarni
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
| |
Collapse
|
3
|
Althoff AD, Ramamurti P, Vennitti C, Kamalapathy P, Park JS, Werner BC, Cooper MT. Preoperative Risk Factors for Primary Metatarsophalangeal Arthroplasty Revision to MTP Arthrodesis for Hallux Rigidus. Foot Ankle Int 2022; 43:1242-1249. [PMID: 35642682 DOI: 10.1177/10711007221094837] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Revision or conversion to arthrodesis following metatarsophalangeal (MTP) joint arthroplasty are salvage procedures to manage complications of MTP joint arthroplasty. The purpose of this study is to use a national administrative database to characterize nationwide trends of patients undergoing hallux MTP arthrodesis vs arthroplasty for hallux rigidus. Additionally, the authors sought to evaluate demographic trends and evaluate influence of patient-related risk factors in those undergoing MTP arthroplasty revision to arthrodesis. METHODS Patients who underwent MTP arthroplasty for diagnosis of hallux rigidus from 2010 to 2019 were identified in the Mariner subset of the PearlDiver database. Patients were included if they had undergone MTP arthroplasty for the diagnosis of hallux rigidus. Notably, the database lacks resolution about critical features of the arthroplasty design and materials. The revision cohort encompassed patients who underwent subsequent ipsilateral MTP arthrodesis or arthroplasty within 2 years of index arthroplasty procedure. Demographic characteristics and medical comorbidities were examined as potential patient-related risk factors for arthroplasty revision or revision to fusion. Univariate analyses were performed to analyze differences in patient demographics, comorbidities, and risk factors. A multivariate regression analysis was subsequently conducted to control for confounding variables. RESULTS 2750 patients underwent primary MTP arthroplasty for diagnosis of hallux rigidus. Of these, 44 (1.6%) underwent revision arthroplasty and 188 patients (6.8%) were revised to arthrodesis within the first 2 years after the index procedure. Multivariate regression analysis indicates that obesity (odds ratio [OR] 1.48, 95% CI 1.05-2.09), depression (OR 1.59, 95% CI 1.15-2.20), and steroid use (OR 2.94, 95% CI 1.30-6.65) were associated with a statistically significant increase in revision to arthrodesis from primary arthroplasty. CONCLUSION Revision arthrodesis following primary MTP arthroplasty for hallux rigidus within 2 years was found to be a relatively common occurrence in this national insurance database study. Risk factors for revision arthroplasty to arthrodesis within 2 years of primary arthroplasty include obesity, depression, and steroid use. LEVEL OF EVIDENCE Level III, case-control study.
Collapse
Affiliation(s)
- Alyssa D Althoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Corinne Vennitti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Joseph S Park
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Minton T Cooper
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
4
|
Metallic hemiarthroplasty or arthrodesis of the first metatarsophalangeal joint as treatment for hallux rigidus: A systematic review and meta-analysis. Foot Ankle Surg 2022; 28:139-152. [PMID: 33812802 DOI: 10.1016/j.fas.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/06/2021] [Accepted: 03/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthrodesis and metallic hemiarthroplasty are two surgical interventions for the treatment of end-stage osteoarthritis of the first metatarsophalangeal (MTP1) joint. This systematic review and meta-analysis aims to compare the two operations with regards to patient-reported outcomes, pain reduction, complications and revision rates. METHODS A systematic literature search identified all relevant studies. The methodological quality was assessed using two validated tools. Data of interest were derived and presented. For non-comparative studies, data was assessed for trends, while for comparative studies pooling statistics were performed. RESULTS A total of 33 studies were included for analysis. The majority of studies (>75%) reported an AOFAS-HMI score greater than 80 points after both metallic hemiarthroplasty and arthrodesis. The lowest VAS pain score was observed after arthrodesis (weighted mean difference -1.58, 95% confidence interval (CI) -2.16 to -1.00 P< 0.00001). Comparable numbers of complications (odds radio 1.48, 95% CI 0.81 to 2.73, P = 0.21, favoring: hemiarthroplasty) and revisions (odds ratio 1.16, 95% CI 0.62 to 2.15 P = 0.64, favoring: hemiarthroplasty) were observed after both interventions. The included non-comparative studies seem to confirm these findings of the comparative studies. CONCLUSION Metallic hemiarthroplasty and arthrodesis have excellent clinical outcomes and acceptable complication- and revision rates. Arthrodesis seems to be superior in pain reduction, while metallic hemiarthroplasty is a suitable alternative for patients performing activities that requires motion in the first metatarsophalangeal joint.
Collapse
|
5
|
Barták V, Heřt J, Štědrý J, Popelka S, Popelka S, Hromádka R. Long-term results of total joint arthroplasty and phalangeal hemiarthroplasty of the first metatarsophalangeal joint using the ToeFit Plus™ system. Foot Ankle Surg 2022; 28:56-61. [PMID: 33558143 DOI: 10.1016/j.fas.2021.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/29/2020] [Accepted: 01/25/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This paper compares long term success rate of MTP joint replacement for hallux rigidus. We provide long term results of MTP joint replacement with the use of the ToeFit Plus™ System. MATERIALS AND METHODS Our group consisted of 19 total joint replacements and 12 hemiarthroplasties in 18 and 11 patients respectively, performed between 2005-2009. The average follow-up period was 12.2 years (range 9.8-13.7, SD 1.1) for total arthroplasty group and 11.1 years (range 9.5-13.9, SD 1.7) for hemiarthroplasty group. In all followed patients AOFAS score was calculated along with the range of motion assessment. RESULTS Average AOFAS score improved from 37 preoperatively to 79 at the time of last follow-up in total arthroplasty group and from 45 to 86 in the hemiarthroplasty group, with consideration to the statistically considerable difference of both groups. The total range of motion improved on average from 14° to the current 32° in patients with total arthroplasty and from 15° to 32° with hemiarthroplasty. The total number of cases that required surgical revision was 7 (37%) in total arthroplasty group and 2 (17%) in hemiarthroplasty group. CONCLUSION Due to the high percentage of failure that was shown in our long term results, we no longer utilise the ToeFit Plus™ System.
Collapse
Affiliation(s)
- V Barták
- Department of Orthopaedic Surgery, 1st Faculty of Medicine Charles University, Motol University Hospital, Prague, Czech Republic.
| | - J Heřt
- Department of Orthopaedic Surgery, 1st Faculty of Medicine Charles University, Motol University Hospital, Prague, Czech Republic
| | - J Štědrý
- Department of Orthopaedic Surgery, 1st Faculty of Medicine Charles University, Motol University Hospital, Prague, Czech Republic
| | - S Popelka
- Department of Orthopaedic Surgery, 1st Faculty of Medicine Charles University, Motol University Hospital, Prague, Czech Republic
| | - S Popelka
- Department of Orthopaedic Surgery, 1st Faculty of Medicine Charles University, Motol University Hospital, Prague, Czech Republic
| | - R Hromádka
- Department of Orthopaedic Surgery, 1st Faculty of Medicine Charles University, Motol University Hospital, Prague, Czech Republic
| |
Collapse
|
6
|
Garcia-Ortiz MT, Talavera-Gosalbez JJ, Moril-Peñalver L, Fernandez-Ruiz MD, Alonso-Montero C, Lizaur-Utrilla A. First Metatarsophalangeal Arthrodesis After Failed Distal Chevron Osteotomy for Hallux Valgus. Foot Ankle Int 2021; 42:425-430. [PMID: 33143483 DOI: 10.1177/1071100720968831] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare the clinical outcomes after first metatarsophalangeal (MTP) joint arthrodesis for hallux rigidus between patients who underwent primary arthrodesis and those who had had a prior surgery for hallux valgus. METHODS Our design was a retrospective cohort study comparing 29 patients who underwent primary arthrodesis (primary group) and 34 patients with hallux rigidus after hallux valgus surgery (secondary group). The clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score and a visual analog scale (VAS) for pain. Radiological evaluation was also performed. Overall, the mean postoperative follow-up was 3.4 (range, 2-5) years. RESULTS At final follow-up, AOFAS and VAS pain scores significantly improved in both groups (P = .001). However, the mean AOFAS (P = .001) and VAS pain (P = .008) scores were significantly better in the primary group than in the secondary group. Radiologically, there were no significant differences between the groups in any angle after arthrodesis. Revision surgeries were not required in the primary group. In the secondary group, there was 1 revision due to deep infection, and 3 other patients required dorsal plate removal. Excluding plate removal, the Kaplan-Meier survival at 3 years was not significantly different between groups (P = .775). CONCLUSION Although arthrodesis of the first MTP joint was an effective procedure for hallux rigidus, the clinical outcomes in patients who had prior hallux valgus surgery were worse than those for patients who underwent primary surgery for hallux rigidus. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
| | | | - Lorena Moril-Peñalver
- Department of Orthopaedic Surgery, Elche University Hospital, Elche, Alicante, Spain
| | | | - Carolina Alonso-Montero
- Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain
| |
Collapse
|
7
|
Massimi S, Caravelli S, Fuiano M, Pungetti C, Mosca M, Zaffagnini S. Management of high-grade hallux rigidus: a narrative review of the literature. Musculoskelet Surg 2020; 104:237-243. [PMID: 32030657 DOI: 10.1007/s12306-020-00646-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/02/2020] [Indexed: 01/13/2023]
Abstract
Hallux rigidus is a disease characterized by an osteoarthritic degeneration of the first metatarsophalangeal joint. Aetiology of hallux rigidus is not clear in the literature. History of trauma is considered one of the most common causes of unilateral hallux rigidus. Also, repetitive microtraumas or inflammatory and metabolic causes such as gout, rheumatoid arthritis and seronegative arthropathy can cause degeneration of the joint. The aim of this literature narrative overview is to summarize and expose the great amount of management concepts and information, including the well-codified main operative procedures to treat of hallux rigidus. This may provide current information for med-school students, researchers and physicians. A comprehensive literature search using PubMed database has been performed. The management for hallux rigidus can involve a variety of therapeutic interventions, conservative or operative. High-grade hallux rigidus represents a complex disease characterized by several clinical and pathological findings, and to achieve optimal results, surgical treatment should be chosen between several surgical techniques depending on the degree of arthritis and other different clinical conditions.
Collapse
Affiliation(s)
- S Massimi
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - S Caravelli
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - M Fuiano
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - C Pungetti
- Department of Orthopaedic Surgery, Ospedale Maggiore "Pizzardi", Bologna, Italy
| | - M Mosca
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - S Zaffagnini
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| |
Collapse
|
8
|
Abstract
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.
Collapse
Affiliation(s)
- Timothy M Clough
- Wrightington and Leigh NHS Foundation Trust, Wrightington Hospital, Wigan, UK
| | - Joseph Ring
- Wrightington and Leigh NHS Foundation Trust, Wrightington Hospital, Wigan, UK
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|