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Rajeev A, Yallop W, Koshy G, Devalia K. Midterm functional outcomes of synthetic cartilage implant (SCI) arthroplasty for hallux rigidus. J Foot Ankle Surg 2024:S1067-2516(24)00220-5. [PMID: 39369950 DOI: 10.1053/j.jfas.2024.09.006] [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: 05/17/2024] [Revised: 09/01/2024] [Accepted: 09/14/2024] [Indexed: 10/08/2024]
Abstract
Hallux rigidus is a common degenerative condition of first metatarso-phalangeal joint most commonly affecting patients above 50 years of age. The aim of our study is to evaluate the five-year results of synthetic cartilage implant (Cartiva) arthroplasty for hallux rigidus. A retrospective study of 70 patients who underwent synthetic cartilage implant interpositional arthroplasty were collected and analysed. Patients with Grade 3 to 4 hallux rigidus and who had failed conservative management were included. Patients who had previous forefoot surgery, hallux varus or valgus deformity of more than 250 and neuromuscular disease were excluded. Mean age at the time of operation was 63.4 years (range 42-84 years). The mean follow-up was 62.6 months. The functional evaluation was done using Manchester-Oxford Foot Questionnaire (MOxFQ). EQ-5D and EQVAS. 86 patients were matriculated in the study with 70 patients being assessed at five years. The average preoperative MOxFQ score improved from 35.74 (31.44-40.04) to 19.11 (11.31- 26.91) at one year after surgery. The EQ-5D scores improved from preoperative average of 9.40 (8.14-10.66) to 4.26 (2.09-6.43) at one year. The preoperative EQVAS was 61.66 (51.25-72.07) to 71.45 (60.87-82.03 at one year. At five years follow up the average MOxFQ score was 17.6 (9.92-24.38), EQ-5D - 4.8 (2.26- 6.45) and EQVAS - 72.48 (62.40-82.56). Three patients had revision to first MTP fusion due to ongoing pain. Synthetic cartilage implant has demonstrated clinical efficacy and good functional outcomes at the end of five years for the treatment of Hallux rigidus. Level of Clinical Evidence: 4.
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Affiliation(s)
- Aysha Rajeev
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead NE9 6SX, Tyne and Wear.
| | - William Yallop
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead NE9 6SX, Tyne and Wear.
| | - George Koshy
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead NE9 6SX, Tyne and Wear.
| | - Kailash Devalia
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead NE9 6SX, Tyne and Wear.
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Lewis TL, Trowbridge S, Franklin S, Lau B, Shehata R, Lyle S, Ray R. Cartiva interpositional arthroplasty versus arthrodesis in the treatment of Hallux rigidus: A retrospective comparative study with mean 2 year follow up. Foot Ankle Surg 2024; 30:587-593. [PMID: 38744636 DOI: 10.1016/j.fas.2024.05.003] [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] [Received: 01/22/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Hallux rigidus is a common condition characterised by first metatarsophalangeal joint (MTPJ) degeneration, pain and limited range of motion (ROM). The gold standard surgical treatment is arthrodesis, providing good pain relief, but sacrifices ROM. The Cartiva synthetic cartilage implant (SCI) has been utilised as an interpositional arthroplasty, aiming to reduce pain whilst preserving range of motion. Current evidence for Cartiva SCI is limited. The aim was to evaluate the clinical outcomes of Cartiva SCI compared to arthrodesis undertaken in our centre. METHODS A retrospective cohort study was conducted, enrolling all adult patients who underwent primary first MTPJ SCI arthroplasty or arthrodesis for the treatment hallux rigidus. The primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire (MOXFQ). Secondary outcomes included EQ-5D, complication rates, VAS Pain and FAAM (ADL). RESULTS Between 2017 and 2020 there were 33 cases divided into two groups (17 Cartiva SCI, 16 arthrodesis, mean age 59.0 ± 9.9 years) with a mean follow up of 2.3 years. There was no statistically significant difference in any of the MOXFQ, EQ-5D, VAS Pain or FAAM (ADL) outcome scores between the Arthrodesis and SCI groups (p > 0.05). The mean MOXFQ Index score was 7.2 ± 6.4 for the SCI group and 3.9 ± 5.8 for the Arthrodesis group at final follow up (p = 0.15). Although complications were high in both groups, the overall hallux reoperation rate was 29.4 % in the SCI cohort and 0.0 % for arthrodesis. CONCLUSION This retrospective comparative study found no significant superiority of Cartiva SCI over arthrodesis in terms of PROMs. Due to the higher rate of further surgical intervention in the SCI cohort, we recommend arthrodesis as the preferred surgical option for hallux rigidus. LEVEL OF EVIDENCE III.
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Affiliation(s)
- T L Lewis
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom.
| | - S Trowbridge
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - S Franklin
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - B Lau
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - R Shehata
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - S Lyle
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
| | - R Ray
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, United Kingdom
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Fletcher WR, Collins T, Fox A, Pillai A. Mid-term efficacy of the Cartiva synthetic cartilage implant in symptomatic hallux rigidus. Bone Jt Open 2024; 5:799-805. [PMID: 39314066 PMCID: PMC11420640 DOI: 10.1302/2633-1462.59.bjo-2024-0031.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Aims The Cartiva synthetic cartilage implant (SCI) entered mainstream use in the management of first metatarsophalangeal joint (MTPJ) arthritis following the positive results of large trials in 2016. Limited information is available on the longer-term outcomes of this implant within the literature, particularly when independent from the originator. This single-centre cohort study investigates the efficacy of the Cartiva SCI at up to five years. Methods First MTPJ arthritis was radiologically graded according to the Hattrup and Johnson (HJ) classification. Preoperative and sequential postoperative patient-reported outcome measures (PROMs) were evaluated using the Manchester-Oxford Foot Questionnaire (MOXFQ), and the activities of daily living (ADL) sub-section of the Foot and Ankle Ability Measure (FAAM). Results Patients were followed up for a mean of 66 months (SD 7.1). Of an initial 66 cases, 16 did not return PROM questionnaires. A total of six failures were noted, with survival of 82%. Overall, significant improvement in both objective scores (MOXFQ and FAAM ADL) was maintained versus preoperatively: 18.2 versus 58.0 (p > 0.001) and 86.2 versus 41.1 (p > 0.001), respectively. The improvement was noted to be less pronounced in males. Subjective scores had deteriorated since early follow-up, with an interval decrease in patient satisfaction from 89% to 68%. Furthermore, a subset of cases demonstrated clinically important interval deterioration in objective scores. However, no specific patient factors were found to be associated with outcomes following analysis. Conclusion This study represents the longest-term independent follow-up in the literature. It shows reassuring mid-term efficacy of the Cartiva SCI with better-than-expected survival. However, deterioration in scores for a subset of patients and lower satisfaction may predict ongoing failure in this group of patients. Additionally, males were noted to have a lower degree of improvement in scores than females. As such, ongoing observation of the SCI to assess durability and survivability, and identify predictive factors, is key to improving patient selection.
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Affiliation(s)
| | | | - Anna Fox
- Orthopaedics, Wythenshawe Hospital, Manchester, UK
| | - Anand Pillai
- Orthopaedics, Wythenshawe Hospital, Manchester, UK
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Budde K, Claassen L, Plaass C, Stukenborg-Colsman C, Daniilidis K, Yao D. Synthetic cartilage implant vs. first metatarsophalangeal arthrodesis for the treatment of hallux rigidus. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05534-9. [PMID: 39287788 DOI: 10.1007/s00402-024-05534-9] [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: 05/26/2024] [Accepted: 09/01/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND This study evaluated the outcome of the Cartiva synthetic cartilage implant (SCI) in the treatment of hallux rigidus. METHODS In the present retrospective matched case-control study, we compared 18 patients with Cartiva SCI (mean follow-up: 17.7 months) to 18 patients with metatarsophalangeal joint arthrodesis (mean follow-up: 20 months) using multiple function measures, along with four specified visual analog subscales for pain. Pre- and postoperative radiographs were compared, and radiographic abnormalities were documented. RESULTS We observed no significant differences in function measures between groups. While both groups experienced significant pain reduction, the arthrodesis group reported significantly lower exertion pain than the Cartiva SCI group (p = 0.004). Radiographic abnormalities, including implant site enlargement (6/18, 33.3%), erosive changes of the metatarsal bone (11/18, 61.1%) or articular surfaces (10/18, 55.6%), and bright sclerotic margins (12/18, 66.7%), occurred in the Cartiva SCI group. CONCLUSION The present study showed good functional results and a high satisfaction rate after MTP joint arthrodesis, which is considered the gold standard surgical treatment for higher grade hallux rigidus. While the Cartiva SCI group did not show significant differences from the arthrodesis in most aspects of function and clinical scores, the arthrodesis group tended to have better results in terms of satisfaction, residual pain, and revision rate. Even after the short follow-up period, there were some remarkable radiographic findings in the Cartiva SCI group, the long-term effects of which are not yet evident, but which may lead to implant loss. Cartiva SCI has advantages for patients who prioritize postoperative mobility, but the potential risks should be considered in the patient's informed consent. Therefore, the present study highlights the importance of MTP joint arthrodesis for the treatment of hallux rigidus. LEVEL OF EVIDENCE Level IV - Retrospective matched case-control study.
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Affiliation(s)
- Konrad Budde
- Orthopedic Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Leif Claassen
- Orthopedic Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Rueckenprofis Hannover, Luisenstraße 10-11, 30159, Hannover, Germany
| | - Christian Plaass
- Orthopedic Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | | | | | - Daiwei Yao
- Orthopedic Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Emma Klinik, Klinik für operative Medizin GmbH & Co. KG, Frankfurter Straße 51, 63500, Seligenstadt, Germany
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Murawski CD, Anderson RB. Managing Hallux Rigidus in the Elite Athlete. Foot Ankle Clin 2024; 29:455-469. [PMID: 39068021 DOI: 10.1016/j.fcl.2023.12.004] [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
Hallux rigidus can present a difficult problem to both competitive and elite athletic populations. Once an appropriate diagnostic workup has been performed, nonoperative management strategies, including anti-inflammatory medications, injection therapies, shoewear modifications, and orthotic devices, represent the mainstay conservative management options. Surgical management can be considered where an athlete's athletic performance is limited. A joint-sparing cheilectomy can provide a predictable return to sport at the most elite levels. The addition of a proximal phalangeal osteotomy can be considered when necessary. Arthroplasty or arthrodesis techniques can be used for persistent symptoms or progressive disease, but with less predictable outcomes.
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Affiliation(s)
- Christopher D Murawski
- Foot & Ankle Institute, OrthoCarolina, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207, USA
| | - Robert B Anderson
- Foot & Ankle Institute, OrthoCarolina, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207, USA.
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Daniels T, Cristofaro C, Halai M. Cartiva: A Review of the Best Evidence. Foot Ankle Clin 2024; 29:485-493. [PMID: 39068023 DOI: 10.1016/j.fcl.2023.11.004] [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
The Cartiva implant is a synthetic polyvinyl alcohol hydrogel cartilage substitute that is used as a treatment of first metatarsophalangeal joint arthritis. The implant was designed to relieve the pain associated with hallux rigidus while preserving or restoring range of motion. A summary of outcomes, reasons for these outcomes, and technique pearls will be reviewed here. Seminal articles and current evidence are all included in this article. The aim is for the surgeon to understand all the literature, allowing the surgeon to counsel their patients appropriately, optimize patient selection and to deal with complications.
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Affiliation(s)
- Timothy Daniels
- Department of Orthopaedics, University of Toronto, Canada; Department of Orthopaedics, St Michael's Hospital, Toronto, Canada
| | - Caroline Cristofaro
- Department of Orthopaedics, University of Toronto, Canada; Department of Orthopaedics, St Michael's Hospital, Toronto, Canada
| | - Mansur Halai
- Department of Orthopaedics, University of Toronto, Canada; Department of Orthopaedics, St Michael's Hospital, Toronto, Canada.
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Choi JY, Park CH. Minimally Invasive Forefoot Surgeries Using the Shannon Burr: A Comprehensive Review. Diagnostics (Basel) 2024; 14:1896. [PMID: 39272681 PMCID: PMC11394102 DOI: 10.3390/diagnostics14171896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/18/2024] [Accepted: 08/28/2024] [Indexed: 09/15/2024] Open
Abstract
Since the early 2000s, minimally invasive forefoot surgery (MIS), particularly hallux valgus correction, has significantly advanced with the introduction of the Shannon burr. However, despite numerous relevant studies being published, no comprehensive review articles have summarized MIS for various forefoot conditions. Therefore, in this comprehensive review, we examined the relevant studies about the application of MIS (excluding arthroscopy and endoscopy) for various forefoot conditions. Additionally, we discuss the essential considerations for achieving favorable surgical outcomes and preventing complications associated with each technique. We analyzed the characteristics of each surgical procedure and identified areas for future focus. Effective surgical treatment not only requires MIS, but also the appropriate selection of patients based on suitable indications and executing procedures within the surgeon's capabilities. We hope that this review will help readers to enhance their expertise in this field.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Juhwa-ro 170, Ilsanseo-gu, Goyang 10380, Republic of Korea
| | - Chul Hyun Park
- Department of Orthopedic Surgery, College of Medicine, Yeungnam University, Hyeonchung-ro 170, Nam-gu, Daegu 42415, Republic of Korea
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Chopra A, Fletcher AN, Madi NS, Parekh SG. Revision Surgery After Failed Index Synthetic Cartilage Implant Resurfacing for Hallux Rigidus: Single-Surgeon 5-Year Experience. Foot Ankle Spec 2024; 17:365-374. [PMID: 36727310 DOI: 10.1177/19386400221147773] [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: 02/03/2023]
Abstract
BACKGROUND While metatarsophalangeal joint (MTPJ) arthrodesis is regarded as the gold standard treatment option for end-stage hallux rigidus (HR), synthetic cartilage implant (SCI) resurfacing has gained popularity. This study aimed to identify the SCI resurfacing failure rate for a single surgeon, while also comparing clinical outcomes of patients who underwent SCI replacement or MTPJ arthrodesis after failed index SCI resurfacing. METHODS Health records were queried from 2016 to 2021 for patients with HR who were treated with SCI resurfacing by a single surgeon. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, and hallux valgus angles were compared. A subgroup analysis was performed on patients who underwent revision with SCI replacement or MTPJ arthrodesis. SCI replacement included the use of bone graft, bone putty, or a custom 3D printed baseplate to prevent implant subsidence. RESULTS A total of 219 SCI resurfacing procedures were performed by a single surgeon, including 23 revisions. When analyzing index procedures, an 8.2% revision rate was determined. The revision cohort (n = 23) consisted of 19 female patients and presented with a mean body mass index of 29.5 ± 5 kg/m2, mean age of 52.8 ± 11 years, mean follow-up duration of 22.3 (range, 3-54) months, and mean time to a revision surgery of 12.1 ± 12 (range, 1-50) months. Specifically, 12 procedures resulted in an SCI replacement, while 11 procedures resulted in arthrodesis. While all patients experienced significant improvement in their VAS pain scores (P < .001), the arthrodesis cohort experienced a greater improvement than the SCI revision cohort (P = .04). CONCLUSION When analyzing SCI revision procedures, MTPJ arthrodesis reduced pain more significantly than SCI replacement. LEVELS OF EVIDENCE Level IV: Retrospective case series.
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Affiliation(s)
- Aman Chopra
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Amanda N Fletcher
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Naji S Madi
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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El Masry S, Boden AL, DiGiovanni GM, Cororaton AD, Ellis SJ. A Comparison of PROMIS Scores of Metatarsophalangeal Joint Arthrodesis and Polyvinyl Alcohol Hydrogel Implant Hemiarthroplasty for Hallux Rigidus. JB JS Open Access 2024; 9:e23.00158. [PMID: 39161931 PMCID: PMC11328988 DOI: 10.2106/jbjs.oa.23.00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
Background The current literature shows similar clinical outcomes between first metatarsophalangeal (MTP) joint arthrodesis and synthetic cartilage implant (SCI) hemiarthroplasty in the treatment of hallux rigidus; however, prior studies have not reported validated patient-reported outcome measures (PROMs). To our knowledge, this is the first study to compare PROMs using 6 domains of the validated Patient-Reported Outcomes Measurement Information System (PROMIS) in patients treated for hallux rigidus with MTP joint arthrodesis and with SCI hemiarthroplasty. In addition, this novel study provides comparative data on the complication and revision rates for each procedure. Methods A single-center, retrospective registry search identified all patients with preoperative PROMIS scores who underwent MTP joint arthrodesis or SCI hemiarthroplasty for hallux rigidus between February 2016 and June 2021. The study aimed to determine if the 2 procedures showed statistically or clinically equivalent PROMIS scores in 6 domains: physical function, pain interference, pain intensity, global physical health, global mental health, and depression. A multivariable linear regression analysis was performed to compare adjusted 1-year postoperative PROMIS scores between the 2 cohorts. Complication and revision rates were also compared. Results The study included 82 patients who underwent SCI hemiarthroplasty and 101 who underwent MTP joint arthrodesis. Demographic data and preoperative hallux rigidus severity showed no significant differences between the cohorts. PROMIS scores were mostly comparable between the 2 groups, except for the pain intensity domain. The patients who underwent MTP joint arthrodesis exhibited significantly better pain relief at 1 and 2 years postoperatively, which was supported by adjusted postoperative PROMIS scores. At 2 years, the SCI group had worse pain intensity scores and lower global physical health scores. There were no differences between the cohorts in additional PROMIS scores or complication data. Conclusions While outcomes in most of the domains were similar, MTP joint arthrodesis was more effective at mitigating pain intensity compared with SCI hemiarthroplasty. This information can guide patient counseling and decision-making when considering surgical intervention for hallux rigidus. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Seif El Masry
- Department of Foot and Ankle Surgery, the Hospital for Special Surgery, New York, NY
| | - Allison L. Boden
- Department of Foot and Ankle Surgery, the Hospital for Special Surgery, New York, NY
| | - Grace M. DiGiovanni
- Department of Foot and Ankle Surgery, the Hospital for Special Surgery, New York, NY
| | - Agnes D. Cororaton
- Department of Foot and Ankle Surgery, the Hospital for Special Surgery, New York, NY
| | - Scott J. Ellis
- Department of Foot and Ankle Surgery, the Hospital for Special Surgery, New York, NY
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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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Sánchez Guzmán J, Gallo Oropeza R, Reyes Donado M, Martin Oliva X, Díaz Sánchez T. Arthrodesis vs arthroplasty for moderate and severe Hallux rigidus: Systematic review. Foot Ankle Surg 2024; 30:174-180. [PMID: 38262785 DOI: 10.1016/j.fas.2023.12.002] [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] [Received: 08/29/2023] [Revised: 11/13/2023] [Accepted: 12/17/2023] [Indexed: 01/25/2024]
Abstract
Hallux rigidus is the most frequent arthritis of the foot, due to multiple factors. Arthrodesis and interposition arthroplasty are treatments considered in advanced stages of the disease, when conservative treatment has failed. Although arthrodesis may be considered the technique recommended by multiple authors, for patients in whom joint mobility is to be preserved, arthroplasty could represent a reliable alternative. The purpose of this systematic review is to investigate and compare the clinical outcomes and complications of arthrodesis and interposition arthroplasty for moderate and severe stages of hallux rigidus. METHODS For this systematic review we searched COCHRANE, EMBASE, PUBMED databases. Twenty-six research papers were obtained, with a total of 1348 feet, which were included for qualitative analysis. The following groups were included: Cartiva hemiarthroplasty (286), double stem silicone arthroplasty (276), total metallic arthroplasty (394) and arthrodesis (392). RESULTS In the arthrodesis group, the AOFAS-HMI score was the most used, ranging from 36 to 45 in the preoperative period and from 79 to 89 in the postoperative period. The greatest improvement in the VAS PAIN score was from 86 to 4. The fusion rate was 98.6% of the total number of cases, the most frequent complication was pain due to material discomfort. In the total metallic arthroplasty group, the ROTO-GLIDE system reported an AOFAS score of 95 points, with low complication rates; but, with the TOEFIT-PLUS and BIOMED-MERCK systems, despite the good postoperative value, they report 37% and 15% revision due to aseptic loosening in the series with the longest follow-up, respectively. The Cartiva group showed a significative increase in FAAM ADL and FAAM SPORT from 59.4 to 90.4 and from 60.9 to 89.7, respectively; similarly, 20.5% implant removal and conversion to arthrodesis were reported. Finally, the double stem silicone arthroplasty group, in the series with the longest follow-up, it manages to improve the MOXFQ score from 78.1 to 11.0, with an average range of mobility of 22.3 degrees. Lysis was reported in 10% of cases. CONCLUSIONS Arthrodesis has proven to be the best option for the treatment of advanced hallux rigidus. Arthroplasty can be a valid option for patients who demand to maintain the range of mobility of the joint; however, it is important to inform about the complications that may arise in the short and medium term. LEVEL OF CLINICAL EVIDENCE II.
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Affiliation(s)
| | | | | | - Xavier Martin Oliva
- Clinica Del Remei, Barcelona, Spain; Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Tània Díaz Sánchez
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
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12
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Ellis S. The Data Have Landed: You May Now Fuse the First MTP Joint in Young Patients. Foot Ankle Int 2024; 45:223-224. [PMID: 38158809 DOI: 10.1177/10711007231218005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
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13
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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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14
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Schapira B, Johnson O, Faroug R. Surgical Outcomes of Synthetic Cartilage Implant Hemiarthroplasty for Metatarsophalangeal Arthropathy. Cureus 2023; 15:e49036. [PMID: 38116339 PMCID: PMC10728759 DOI: 10.7759/cureus.49036] [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: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Metatarsophalangeal joint (MTPJ) arthropathy in the great toe causes considerable pain and debilitation, severely impacting quality of life. Traditional management options included conservative measures, steroid injections, and arthrodesis. New options include Cartiva, a synthetic cartilage hemiarthroplasty for the MTPJ. This prosthesis has evidence of improved pain and function without the sacrifice of joint movement seen with arthrodesis. However, the implant itself has mixed reviews. This study aims to identify the pre-, peri, and short-term post-surgical outcomes of Cartiva surgery and review the literature for existing reported outcomes. Methods We retrospectively reviewed a cohort of 22 consecutive Cartiva procedures between 2016 and 2022 in a single UK institution. Hospital records were analyzed for peri-operative complications, implant survival, additional operative interventions, patient-reported outcomes, and functional improvement. Results Twenty-one patients underwent Cartiva for the first MTPJ pathology and one for the third MTPJ pathology. Prior to surgery, 40.9% of patients had undergone alternative therapies, including MTPJ steroid injections (seven patients), cheilectomy (four patients), and bunionectomy (one patient). Total complication rates, inclusive of medical, surgical, and implant complications were 45.5% (10/22). Total reoperation rates were 18.2% (4/22) including two revisions to arthrodesis and two manipulations under anesthesia (MUA) with local anesthetic injection. At the final follow-up, 55% were still experiencing pain, 15% neurovascular symptoms, 10% swelling, and 50% stiffness or reduced range of movement. However, 85% of patients returned to usual activities of daily living within two years. Conclusion Cartiva surgery for metatarsophalangeal arthropathy has demonstrated outcomes of persistent pain, limited range of movement, and restricted function at short-term follow-up. Rates of reoperation and revision to arthrodesis were comparable with similar studies.
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Affiliation(s)
| | - Oscar Johnson
- Trauma and Orthopedics, Lister Hospital, Stevenage, GBR
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15
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Anderson MR, Ho BS, Baumhauer JF. Republication of "Current Concepts Review: Hallux Rigidus". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231188123. [PMID: 37506124 PMCID: PMC10369095 DOI: 10.1177/24730114231188123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Arthritis of the first metatarsophalangeal (MTP) joint, hallux rigid, is a common and disabling source of foot pain in the adult population. Hallux rigidus is characterized by diseased cartilage and large, periarticular osteophytes that result in a stiff, painful joint. Activity modification, sensible shoes, orthotics, anti-inflammatory medications and occasional intra-articular steroid injections can be attempted to alleviate the discomfort associated with hallux rigidus. A number of surgical options exist for the treatment of recalcitrant hallux rigidus. Cheilectomy is a useful treatment for dorsal impingement pain seen in mild hallux rigidus. A new polyvinyl alcohol hemi-arthroplasty implant has shown promising early and midterm results in the treatment of advanced hallux rigidus; however, arthrodesis of the first MTP joint remains the gold standard treatment for advanced hallux rigidus because of unpredictable outcomes after early-generation joint replacement implants.
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16
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Oliveira AS, Silva JC, Loureiro MV, Marques AC, Kotov NA, Colaço R, Serro AP. Super-Strong Hydrogel Composites Reinforced with PBO Nanofibers for Cartilage Replacement. Macromol Biosci 2023; 23:e2200240. [PMID: 36443994 DOI: 10.1002/mabi.202200240] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/28/2022] [Indexed: 11/30/2022]
Abstract
Cartilage replacement materials exhibiting a set of demanding properties such as high water content, high mechanical stiffness, low friction, and excellent biocompatibility are quite difficult to achieve. Here, poly(p-phenylene-2,6-benzobisoxazole) (PBO) nanofibers are combined with polyvinyl alcohol (PVA) to form a super-strong structure with a performance that surpasses the vast majority of previously existing hydrogels. PVA-PBO composites with water contents in the 59-76% range exhibit tensile and compressive moduli reaching 20.3 and 4.5 MPa, respectively, and a coefficient of friction below 0.08. Further, they are biocompatible and support the viability of chondrocytes for 1 week, with significant improvements in cell adhesion, proliferation, and differentiation compared to PVA. The new composites can be safely sterilized by steam heat or gamma radiation without compromising their integrity and overall performance. In addition, they show potential to be used as local delivery platforms for anti-inflammatory drugs. These attractive features make PVA-PBO composites highly competitive engineered materials with remarkable potential for use in the design of load-bearing tissues. Complementary work has also revealed that these composites will be interesting alternatives in other industrial fields where high thermal and mechanical resistance are essential requirements, or which can take advantage of the pH responsiveness functionality.
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Affiliation(s)
- Andreia S Oliveira
- Centro de Química Estrutural, Institute of Molecular Sciences, and Department of Chemical Engineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, Caparica, 2829-511, Portugal.,Instituto de Engenharia Mecânica and Department of Mechanical Engineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal
| | - João C Silva
- Institute for Bioengineering and Biosciences and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal.,Associate Laboratory i4HB-Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal.,Centre for Rapid and Sustainable Product Development, Politécnico de Leiria, Rua de Portugal-Zona Industrial, Marinha Grande, 2430-028, Portugal
| | - Mónica V Loureiro
- Centro de Recursos Naturais e Ambiente, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal
| | - Ana C Marques
- Centro de Recursos Naturais e Ambiente, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal
| | - Nicholas A Kotov
- Biointerfaces Institute, Department of Chemical Engineering, and Department of Materials Science and Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Rogério Colaço
- Instituto de Engenharia Mecânica and Department of Mechanical Engineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal
| | - Ana P Serro
- Centro de Química Estrutural, Institute of Molecular Sciences, and Department of Chemical Engineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, Caparica, 2829-511, Portugal
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17
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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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18
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Kim JS, Amendola A, Barg A, Baumhauer J, Brodsky JW, Cushman DM, Gonzalez TA, Janisse D, Jurynec MJ, Lawrence Marsh J, Sofka CM, Clanton TO, Anderson DD. Summary Report of the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society's Symposium on Targets for Osteoarthritis Research: Part 2: Treatment Options. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221127013. [PMID: 36262470 PMCID: PMC9575443 DOI: 10.1177/24730114221127013] [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: 11/23/2022] Open
Abstract
UNLABELLED This second of a 2-part series of articles recounts the key points presented in a collaborative symposium sponsored jointly by the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society with the intent to survey current treatment options for osteoarthritis (OA) of the foot and ankle. A meeting was held virtually on December 10, 2021. A group of experts were invited to present brief synopses of the current state of knowledge and research in this area. Topics were chosen by meeting organizers, who then identified and invited the expert speakers. Part 2 overviews the current treatment options, including orthotics, non-joint destructive procedures, as well as arthroscopies and arthroplasties in ankles and feet. Opportunities for future research are also discussed, such as developments in surgical options for ankle and the first metatarsophalangeal joint. The OA scientific community, including funding agencies, academia, industry, and regulatory agencies, must recognize the importance to patients of addressing the foot and ankle with improved basic, translational, and clinical research. LEVEL OF EVIDENCE Level V, review article/expert opinion.
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Affiliation(s)
- Jason S. Kim
- The Arthritis Foundation, Atlanta, GA,
USA,Jason S. Kim, PhD, The Arthritis
Foundation, 1355 Peachtree St NE, Suite 600, Atlanta, GA 30309, USA.
| | | | - Alexej Barg
- Department of Orthopaedics, University
of Utah, Salt Lake City, UT, USA
| | - Judith Baumhauer
- Department of Orthopaedic Surgery,
University of Rochester Medical Center, Rochester, NY, USA
| | | | - Daniel M. Cushman
- Division of Physical Medicine &
Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Tyler A. Gonzalez
- Department of Orthopaedic Surgery,
University of South Carolina, Lexington, SC, USA
| | | | - Michael J. Jurynec
- Department of Orthopaedics and Human
Genetics, University of Utah, Salt Lake City, UT, USA
| | - J. Lawrence Marsh
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | | | - Donald D. Anderson
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
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19
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Guyton GP. Philosophies of Surgical Care Are Embedded in Outcome Studies: An Illustrative Reanalysis of the Cartiva MOTION Trial. Foot Ankle Int 2022; 43:1364-1369. [PMID: 35979930 DOI: 10.1177/10711007221112928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subjective assumptions on the definition of surgical success are inherent to the design of clinical trials with a categorial outcome. The current study used reasonable alternative assumptions about surgical care to reassess data for the randomized controlled Cartiva trial (MOTION). METHODS Data from the published study were augmented by publicly accessible internal US Food and Drug Administration documents. As in the published report, 1-sided lower bound 95% CIs (LBCI95) for the difference of proportions were calculated for a series of alternative scenarios in which the assumptions underlying what constitutes surgical success were altered. RESULTS Using a noninferiority margin of -15%, the MOTION trial reported success based on a 1-sided LBCI95 of -10.9%. Each of the 3 independent alternative scenarios analyzed yielded results that altered the primary outcome of the trial: (1) eliminating failures based solely upon radiographs findings, thereby considering a painless pseudarthrosis as a success (1-sided LBCI95 of -15.9%), (2) considering only major surgical revision as a failure and discounting isolated hardware removal (1-sided LBCI95 of -15.1%), and (3) using a visual analog scale (VAS) pain threshold of <30 as the success criterion rather than a 30% reduction in VAS pain score (1-sided LBCI95 of -15.8%). CONCLUSION In this reanalysis, applying any of 3 reasonable alternative assumptions about the definition of surgical success to the data resulted in failure to prove noninferiority of Cartiva over arthrodesis, a reversal of the reported trial result. These results highlight the effect of subjective assumptions in the design of clinical trials with a categorical outcome and illustrate how differing philosophies about what constitutes surgical success can be pivotal in determining the final result. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Gregory P Guyton
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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20
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Zanzinger C, Harrasser N, Gottschalk O, Dolp P, Hinterwimmer F, Hoerterer H, Walther M. One-year Follow-Up Results with Hydrogel Implant in Therapy of Hallux Rigidus: Case Series with 44 Patients. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:414-421. [PMID: 33647994 DOI: 10.1055/a-1365-9655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Cartiva implant (CI) is being increasingly used in the surgical therapy of hallux rigidus. Despite a growing number of studies, numerous questions regarding patient selection remain unanswered. PATIENTS AND METHODS As part of a retrospective case series with prospective follow-up (average follow-up period: 12 months), a total of 44 patients (male/female = 16/28; mean age at the time of surgery: 55.4 years) with 44 CI were analysed (VAS, EFAS-, AOFAS-score). Using a correlation analysis and a machine learning algorithm, risk factors for therapy failure were investigated. RESULTS The overall survival rate of the CI was 93% at 12 months. The VAS, EFAS and AOFAS scores showed a significant improvement in comparison to the preoperative condition. The mobility of the metatarsophalangeal joint showed no increase. Patients with a medium osteoarthritis grade and a medium level of clinical restraint showed the greatest improvement in relation to their preoperative condition. CONCLUSION The CI can be seen as an effective therapy for hallux rigidus. Nonetheless, realistic patient expectations must be communicated.
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Affiliation(s)
- Christoph Zanzinger
- Specialist Centre for Foot and Ankle Joint Surgery, Schön Clinic Munich-Harlaching, Munich, Germany
| | - Norbert Harrasser
- Orthopaedics, Clinics Rechts der Isar of the Technical University of Munich, Germany
| | - Oliver Gottschalk
- Specialist Centre for Foot and Ankle Joint Surgery, Schön Clinic Munich-Harlaching, Munich, Germany.,Department of Gerneral, Trauma and Reconstructive Surgery, LMU Munich, Germany
| | - Patrick Dolp
- Specialist Centre for Foot and Ankle Joint Surgery, Schön Clinic Munich-Harlaching, Munich, Germany
| | - Florian Hinterwimmer
- Orthopaedics, Clinics Rechts der Isar of the Technical University of Munich, Germany
| | - Hubert Hoerterer
- Specialist Centre for Foot and Ankle Joint Surgery, Schön Clinic Munich-Harlaching, Munich, Germany.,Department of Gerneral, Trauma and Reconstructive Surgery, LMU Munich, Germany
| | - Markus Walther
- Specialist Centre for Foot and Ankle Joint Surgery, Schön Clinic Munich-Harlaching, Munich, Germany
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21
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Metikala S, Mahmoud K, O'Connor KM, Chao W, Wapner KL, Farber DC. Adverse Events Related to Cartiva Hemiarthroplasty of First Metatarsal: An Analysis of Reports to the United States Food and Drug Administration. Foot Ankle Spec 2022; 15:113-118. [PMID: 32723089 DOI: 10.1177/1938640020943715] [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] [Indexed: 11/15/2022]
Abstract
Background: The results supporting Cartiva, a synthetic cartilage implant (Wright Medical) in hallux rigidus have come from limited institutions creating observational bias. Complications experienced in community centers are not routinely included in the published literature. To look at a broader range of potential complications, we reviewed the United States Food and Drug Administration's (FDA) voluntary device database and compared that data with published literature. Methods: The Manufacturer and User Facility Device Experience (MAUDE) database of the FDA was retrospectively reviewed between July 2016 and October 2019 using the product code: PNW, assigned for Cartiva. Results: A total of 49 events have been reported and implant subsidence was the most common with 16 reports. Others include fragmentation (9), infection (4), bone erosion (3), foreign body reaction (1) and unspecified (16). Thirty-five events mentioned further surgeries at a mean interval of 4.75 months. Conclusions: The analysis of the MAUDE database disclosed certain device-related dysfunctions that have been underreported in the published literature. Because of the voluntary nature of reporting, the true incidence of each complication is unknown with this data representing a baseline. The MAUDE database could be further strengthened by a more robust reporting mechanism or mandatory reporting of device-related complications.Levels of Evidence: Level IV: Case series from large database analysis.
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Affiliation(s)
- Sreenivasulu Metikala
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Karim Mahmoud
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kathryn M O'Connor
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Wen Chao
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Keith L Wapner
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Daniel C Farber
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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22
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Cercone M, Chevalier J, Kennedy JG, Miller AD, Fortier LA. Early Failure of a Polyvinyl Alcohol Hydrogel Implant With Osteolysis and Foreign Body Reactions in an Ovine Model of Cartilage Repair. Am J Sports Med 2021; 49:3395-3403. [PMID: 34424105 DOI: 10.1177/03635465211033601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hemiarthroplasty using a polyvinyl alcohol (PVA) hydrogel synthetic implant has been suggested as a good alternative to arthrodesis for the treatment of hallux rigidus. However, failure rates as high as 20% have been recorded. PURPOSE To characterize the pathological processes in bone, cartilage, and the synovial membrane after PVA hemiarthroplasty in an ovine model with 6 months of follow-up. STUDY DESIGN Controlled laboratory study. METHODS A unilateral osteochondral defect (8-mm diameter × 10-mm depth) was made in the medial femoral condyle in 6 sheep. Animals were randomized to receive a PVA implant (n = 4) or to have an empty defect (n = 2) and were monitored for 6 months. Patellofemoral radiographs were obtained at monthly intervals, and quantitative computed tomography was performed at the end of the study. After death, the joints were macroscopically evaluated and scored. Osteochondral and synovial membrane histological findings were assessed using modified Osteoarthritis Research Society International (OARSI) and aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) scoring systems. Immunohistochemistry using Iba1 was performed to evaluate activated macrophage infiltration. RESULTS Overall, 2 sheep with PVA implants were euthanized at 1 and 5 months because of uncontrollable pain and lameness (failed implants). Quantitative computed tomography showed that sheep with failed implants had 2.1-fold more osteolysis than those with successful implants. The sheep with failed implants had osteoarthritis with extensive glycosaminoglycan loss and cartilage fibrillation of the condyle and opposing tibial surface on histological examination. A foreign body reaction with severe chronic lymphoplasmacytic and granulomatous inflammation with giant cells was detected surrounding the implant. The synovial membrane ALVAL score was 9 of 19 and 14 of 19 in failed implants with synovial hyperplasia and lymphoplasmacytic and macrophage infiltration. In contrast, the synovial membrane in successful implants and empty defects was normal (ALVAL score = 0/19). Immunolabeling for Iba1 in failed implants confirmed extensive and dense macrophage infiltration within the condyle and synovial membrane, with the highest immunoreactive score (9/9). CONCLUSION PVA hydrogel implants had a 50% failure rate with uncontrollable pain, severe osteolysis, inflammation, and foreign body reactions. CLINICAL RELEVANCE The failure rate and pathological characteristics of the PVA implants suggest that their use should not be continued in human patients without further in vivo safety studies.
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Affiliation(s)
- Marta Cercone
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Jacqueline Chevalier
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - John G Kennedy
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Andrew D Miller
- Section of Anatomic Pathology, Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Lisa A Fortier
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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23
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Joo PY, Baumhauer JF, Waldman O, Hoffman S, Houck J, Kohring JM, Flemister AS, Ketz JP, DiGiovanni BF, Oh I. Physical Function and Pain Interference Levels of Hallux Rigidus Patients Before and After Synthetic Cartilage Implant vs Arthrodesis Surgery. Foot Ankle Int 2021; 42:1277-1286. [PMID: 34024138 DOI: 10.1177/10711007211007843] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux rigidus is a common and painful degenerative condition of the great toe limiting a patient's physical function and quality of life. The purpose of this study was to investigate pre- and postoperative physical function (PF) and pain interference (PI) levels of patients undergoing synthetic cartilage implant hemiarthroplasty (SCI) vs arthrodesis (AD) for treatment of hallux rigidus using the Patient-Reported Outcomes Measurement Information System (PROMIS). METHODS PROMIS PF and PI t scores were analyzed for patients who underwent either SCI or AD. Postoperative final PROMIS t scores were obtained via phone survey. Linear mixed model analysis was used to assess differences in PF and PI at each follow-up point. Final follow-up scores were analyzed using independent sample t tests. RESULTS Total 181 (59 SCI, 122 AD) operatively managed patients were included for analysis of PROMIS scores. Final phone survey was performed at a minimum of 14 (mean 33, range, 14-59) months postoperatively, with 101 patients (40 SCI, 61 AD) successfully contacted. The mean final follow-up was significantly different for SCI and AD: 27 vs 38 months, respectively (P < .01). The mean age of the SCI cohort was lower than the AD cohort (57.5 vs 61.5 years old, P = .01). Average PF t scores were higher in the SCI cohort at baseline (47.1 and 43.9, respectively, P = .01) and at final follow-up (51.4 vs 45.9, respectively, P < .01). A main effect of superior improvement in PF was noted in the SCI group (+4.3) vs the AD group (+2) across time intervals (P < .01). PI t scores were similar between the 2 procedures across time points. CONCLUSION The SCI cohort reported slightly superior PF t scores preoperatively and at most follow-up time points compared with the arthrodesis group. No differences were found for PI or complication rates between the 2 treatment groups during this study time frame. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Peter Y Joo
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Judith F Baumhauer
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Olivia Waldman
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Samantha Hoffman
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey Houck
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Jessica M Kohring
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - A Samuel Flemister
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - John P Ketz
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Benedict F DiGiovanni
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Irvin Oh
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
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Smyth NA, Murawski CD, Hannon CP, Kaplan JR, Aiyer AA. The Use of a Synthetic Cartilage Implant for Hallux Rigidus: A Systematic Review. Foot Ankle Spec 2021; 14:366-371. [PMID: 32618201 DOI: 10.1177/1938640020937160] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background. Hallux rigidus is a common pathology afflicting the foot, for which various joint salvage techniques have been described with a multitude of different implants. Recently, a synthetic cartilage implant composed of polyvinyl alcohol (PVA) received FDA premarket approval for the treatment of arthritis of the great toe. The purpose of this study was to (1) systematically review the clinical evidence supporting the use of a PVA implant in hallux rigidus and (2) determine the strength of the recommendation that can be made supporting the use of a PVA implant by evaluating the quality of evidence available. Methods. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Using the terms "cartiva OR polyvinyl alcohol OR synthetic cartilage OR hemiarthroplasty AND hallux rigidus OR great toe arthritis OR first toe arthritis" we searched the PubMed/Medline database. The quality of the included studies was evaluated using the American Academy of Orthopaedic Surgeons Clinical Practice Guideline and Systematic Review Methodology. Results. Seven studies met the inclusion criteria, 6 of these were derived from a single randomized controlled trial. A moderate recommendation can be given for the use of a PVA implant for hallux rigidus based on short-term outcomes. A limited recommendation can be given for the use of a PVA implant for hallux rigidus based on mid-term outcomes. Conclusion. There are limited studies available detailing the outcomes of a PVA implant for hallux rigidus; however, the results that are available demonstrate a high level of evidence.Levels of Evidence: Level I: Systematic review.
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Affiliation(s)
- Niall A Smyth
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
| | - Christopher D Murawski
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
| | - Jonathan R Kaplan
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
| | - Amiethab A Aiyer
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida (NAS).,Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (CDM).,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA (CPH).,Orthopaedic Specialty Institute, Orange, California (JRK).,Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida (AAA)
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Kilmartin TE, Posmyk L. Synthetic Cartilage Implant Hemiarthroplasty for Second MTP Joint Osteoarthrosis. J Foot Ankle Surg 2021; 59:942-948. [PMID: 32505725 DOI: 10.1053/j.jfas.2019.08.035] [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] [Received: 08/08/2018] [Revised: 08/12/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023]
Abstract
Synthetic cartilage hemiarthroplasty has been used successfully in the first metatarsophalangeal (MTP) joint and might also provide an alternative surgical intervention for second MTP joint osteoarthritis and Freiberg disease. Synthetic cartilage implant hemiarthroplasty was performed on 23 consecutive patients for the treatment of painful second MTP joint disease. Joint damage ranged from mild to severe. Mean follow-up period was 43 months ± 17.6 (range, 28-79 months). Mean age at the time of surgery was 55 years ± 16 (range, 20-73 years). Each participant attended for clinical assessment and an interview which included completion of 2 patient-reported outcome measures: the Manchester-Oxford Foot Questionnaire (MOXFQ) and the Foot and Ankle Ability Measure (FAAM). The implant failed in 2 participants (9%) and required removal and revision. Four participants (17%) reported dissatisfaction with the surgery because of continued pain. Nine participants (43%) reported second MTP joint stiffness; however, this was symptomatic in just 5 cases. Sixteen participants (70%) were pain free and totally satisfied with their outcome. Eleven of 21 participants (52%) reported an improvement in all 3 categories of the MOXFQ. FAAM scores demonstrated good overall function and activity, with a mean score of 91 ± 16 (range, 44-100). There were no postoperative infections, transfer metatarsalgia, or floating toe deformity. In preserving metatarsal and phalanx length as well as the collateral ligaments of the joint, synthetic cartilage implant hemiarthroplasty avoids some of the important risks of metatarsal osteotomy and basal phalangectomy. A range of alternative surgical options are still available if the synthetic cartilage implant fails to resolve symptoms.
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Affiliation(s)
- Tim E Kilmartin
- Consultant Podiatric Surgeon, Department of Podiatric Surgery, Ilkeston Hospital, Derbyshire, England; Consultant Podiatric Surgeon, Hillsborough Private Clinic, Hillsborough, Northern Ireland.
| | - Lesley Posmyk
- Podiatric Surgical Trainee, Department of Podiatric Surgery, Ilkeston Hospital, Derbyshire, England
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26
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Reddy SC. Early Catastrophic Failure of a Synthetic Cartilage Implant for Hallux Rigidus. Foot Ankle Spec 2021; 14:74-78. [PMID: 33158381 DOI: 10.1177/1938640020969585] [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: 11/16/2022]
Abstract
Hallux rigidus is a common arthritic disorder of the foot. Surgical treatments are varied, from isolated cheilectomy to arthrodesis. A synthetic cartilage implant has been embraced recently as a joint-sparing alternative to arthrodesis, with good early and midterm outcomes. However, early clinical failures have been described relating to implant subsidence. This case report focuses on another mode of failure consisting of early catastrophic wear resulting in conversion to a lengthening arthrodesis at short-term follow-up.Levels of Evidence: Level V.
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Affiliation(s)
- Sudheer C Reddy
- Shady Grove Orthopaedics, Adventist Health Care, Rockville, Maryland
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27
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Chrea B, Eble SK, Day J, Ellis SJ, Drakos MC. Comparison Between Polyvinyl Alcohol Implant and Cheilectomy With Moberg Osteotomy for Hallux Rigidus. Foot Ankle Int 2020; 41:1031-1040. [PMID: 32723096 DOI: 10.1177/1071100720947380] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In 2016, the US Food and Drug Administration (FDA) approved the use of a polyvinyl alcohol (PVA) hydrogel implant for the surgical management of hallux rigidus. Though recent studies have evaluated the safety and efficacy of the implant, no study has compared outcomes following PVA implantation with those following traditional joint-preserving procedures for hallux rigidus, such as cheilectomy with Moberg osteotomy. The purpose of this study was to compare clinical and patient-reported outcomes for patients undergoing cheilectomy and Moberg osteotomy, with or without PVA implant, at a single multisurgeon academic center. Our hypothesis was that the addition of the PVA implant would result in superior clinical and patient-reported outcomes. METHODS In total, 166 patients were identified who underwent cheilectomy and Moberg osteotomy with (PVACM; n = 72) or without (CM; n = 94) a PVA implant between January 2016 and December 2018 by 1 of 8 foot and ankle fellowship-trained orthopedic surgeons at our institution. Of these patients, 60 PVACM and 73 CM patients had both baseline and minimum 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores. The average time to survey follow-up was 14.5 months for PVACM patients and 15.6 months for CM patients. Retrospective chart review was performed to assess the incidence of postoperative complications and reoperations, with an average clinical follow-up of 27.7 (range, 16.0-46.4) months for PVACM patients and 36.6 (range, 18.6-47.8) months for CM patients. RESULTS Both PVACM and CM cohorts demonstrated significant improvement in the PROMIS Physical Function, Pain Interference, Pain Intensity, and Global Physical Health domains when comparing preoperative and postoperative scores within each group (P < .01). When comparing scores between the PVACM and CM cohorts, preoperative scores were similar, while CM patients demonstrated significantly higher postoperative Physical Function (51.8 ± 8.7 vs 48.8 ± 8.0; P = .04) and significantly lower Pain Intensity (39.9 ± 8.3 vs 43.4 ± 8.7; P = .02) scores. The pre- to postoperative change in Physical Function was also significantly greater for CM patients (7.1 ± 8.5 vs 3.6 ± 6.2; P = .011). In the PVACM group, there were 3 revisions (5%), 1 reimplantation, 1 conversion to arthrodesis, and 1 revision to correct hyperdorsiflexion. In the CM group, there was 1 revision (1.4%), a conversion to arthrodesis (P = .21). Other postoperative complications included persistent pain (7 out of 60 PVACM patients [11.7%] and 8 out of 73 CM patients [11.0%]; P = .90) and infection in 3 PVACM patients (5%) and no CM patients (P = .05). CONCLUSION Though our results generally support the safety and utility of the PVA implant as previously established by the clinical trial, at 1 to 2 years of follow-up, CM without a PVA implant may provide equivalent or better relief compared with a PVACM procedure, while avoiding potential risks associated with the implant. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Bopha Chrea
- Hospital for Special Surgery, New York, NY, USA
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- Hospital for Special Surgery, New York, NY, USA
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Sansone V, Maiorano E, Melato M, Martinelli N, Pascale V. Novel treatment for hallux rigidus using a temporary metal interpositional device. Foot Ankle Surg 2020; 26:630-636. [PMID: 31439504 DOI: 10.1016/j.fas.2019.08.001] [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: 04/11/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this prospective study is to evaluate the results of a consecutive series of patients suffering from grade II-III hallux rigidus who underwent a mobility preserving surgical technique consisting of resection arthroplasty with implantation of a temporary metal spacer. METHODS Thirty consecutive patients, 18 female and 12 male with a diagnosis of a grade II-III hallux rigidus, not responding to conservative treatment, underwent a minimal resection arthroplasty followed by the implantation of a temporary metal interpositional device by the same surgeon. All spacers were removed after 6 months through a minimal incision under regional anaesthesia. Patients were clinically and radiographically evaluated at 3, 6, 12 months, and 5 years after spacer removal. RESULTS The clinical AOFAS scores improved already at first follow-up and continued to improve over time with a statistically significant change until the first year. At 3, 6, and 12 months follow-ups, the number of patients with severely limited ROM (i.e. under 30°, that means grade II-III according to Coughlin and Shaurnas classification) significantly decreased. There were only two minor complications, so defined as both of which resolved spontaneously and did not affect the procedure's effectiveness. CONCLUSIONS We observed good to excellent results with the use of this mobility preserving surgical technique for the treatment of symptomatic grades II and III hallux rigidus. The never before published procedure is easy to perform and inexpensive. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Valerio Sansone
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Emanuele Maiorano
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Marco Melato
- Department of Orthopaedic, Hospital SS. Antonio and Biagio and Cesare Arrigo Alessandria, Italy
| | - Nicoló Martinelli
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy.
| | - Valerio Pascale
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
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29
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Carpenter B, Klemeyer L. Motion Preservation in Hallux Rigidus After Failure of Hydrogel Implantation: Treatment Considerations and a Report of 2 Cases. J Foot Ankle Surg 2020; 59:162-168. [PMID: 31882138 DOI: 10.1053/j.jfas.2019.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/03/2019] [Accepted: 03/12/2019] [Indexed: 02/03/2023]
Abstract
Hallux rigidus is a common condition treated daily by surgeons worldwide. During the past decade, the standard treatment algorithm has been questioned by both patients and surgeons seeking alternatives to arthrodesis, which was previously considered the gold standard for advanced disease. Patients are living longer, and many have a more active lifestyle; thus, recreating and improving range of motion and achieving pain relief are increasingly desirable. The treatment spectrum and implant options for motion-preserving techniques in the metatarsophalangeal joint has been widened with the recent US Food and Drug Administration approval of a polyvinyl-alcohol hydrogel implant. In the controlled US Food and Drug Administration trial, the 2-year revision rate was 9.2% and all failures were revised to a first metatarsophalangeal arthrodesis. Outcomes comparison of these revisions to primary fusions showed less predictable pain relief and may warrant alternative treatment considerations, preferably those that allow for continuation of motion preservation. Revision of failed hydrogel implants to arthrodesis can be performed through various first metatarsophalangeal fusion techniques or, as introduced in this review, with a fourth-generation threaded hemiarthroplasty. Excellent 10-year results with primary hemiarthroplasty supported its use as revision procedure in 2 failed polyvinyl-alcohol implantations, preserving arthrodesis for future salvage if necessary. The purpose of this report was to outline a motion-preserving technique after failed hydrogel implants and describe preoperative, intraoperative, and postoperative considerations for optimized outcomes.
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Affiliation(s)
- Brian Carpenter
- Professor, Department of Orthopaedics, The University of North Texas Health Science Center, Fort Worth, TX.
| | - Lisa Klemeyer
- Physician, Private Practice, Aesthetic & Family Podiatry Center, Sarasota, FL
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30
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Engasser WM, Coetzee JC, Ebeling PB, Den Hartog BD, Seybold JD, Holthusen SM, McGaver RS, Seiffert KJ, Giveans MR. Patient-Reported Outcomes and Early Complications After Synthetic Cartilage Device Implantation. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420930691. [PMID: 35097387 PMCID: PMC8697263 DOI: 10.1177/2473011420930691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Previous Level I studies show promising results for the use of a hydrogel synthetic cartilage implant (SCI) for the treatment of hallux rigidus. A recent independent retrospective review has put those results into question, however. The purpose of this article is to report patient-reported outcomes and early complications using this implant so as to add to the paucity of data in the literature regarding this implant. Methods: This was a retrospective chart review of patients undergoing hydrogel synthetic cartilage implant for the treatment of hallux rigidus from July 2017 to November 2018. Data collected included patient demographics, radiographic grading, and outcomes: Veterans Rand 12 Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), patient satisfaction, and complications. Fifty-four patients (59 feet) with an average age of 57.6 (range, 39-78) years were analyzed. The average latest follow-up was 18.9 (range, 3-31.3) months. Body mass index was 26.7 (range, 18.7-35.2). None were diabetic and 5 were smokers. Results: The mean outcome improvements were 6.5 points (VR-12 Physical), 17.2 points (FAAM ADL), 27.4 points (FAAM Sport), and 18.4 points (VAS) (P < .01 for each). Scores were significantly improved from preoperatively to most recent follow-up for FAAM ADL (71.0 vs 88.2 points), FAAM Sports (44.6 vs 72.0 points), and VAS (49.4 vs 31.0) (P < .01). Overall, 72.5% patients would definitely or probably have the operation again. Ten patients (18.5%) went on to have revision surgery. Of these, 7 patients were revised to an arthrodesis, and 1 metal hemiarthroplasty and 2 implants were removed because of infection. Conclusion: Synthetic cartilage implantation for the treatment of hallux rigidus demonstrated improved pain and outcome scores at short-term follow-up. Reoperation and conversion to fusion rates were comparable to prior studies. Level of Evidence: Level IV, case series.
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31
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Dabash S, Buksbaum JR, Fragomen A, Rozbruch SR. Distraction arthroplasty in osteoarthritis of the foot and ankle. World J Orthop 2020; 11:145-157. [PMID: 32280604 PMCID: PMC7138864 DOI: 10.5312/wjo.v11.i3.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/08/2020] [Accepted: 03/01/2020] [Indexed: 02/06/2023] Open
Abstract
Post-traumatic osteoarthritis (PTOA) is a complex and painful problem in the foot and ankle. Ninety percent of osteoarthritis cases in the foot and ankle can be classified as post-traumatic. PTOA can affect any of the 33 joints in the foot and the ankle. Distraction arthroplasty is a method for treatment of early arthritic joints without fusing or replacing them and its effectiveness has been well documented. The purpose of this case series is to present our successful experiences and positive results using distraction arthroplasty to treat PTOA in the ankle, subtalar, first metatarsophalangeal, and second tarsometatarsal joints, and to present distraction arthroplasty as a viable alternative to invasive joint sacrificing procedures such as arthrodesis or arthroplasty. Distraction Arthroplasty effectively and safely treats PTOA and improves the stability of joints in the Foot and Ankle. Additionally, the use of bone marrow aspirate concentrate as an adjuvant can improve the long-term functional and structural outcomes of the joint, and can prolong the need for further, more aggressive surgical interventions such as fusion or arthroplasty.
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Affiliation(s)
- Sherif Dabash
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY 10021, United States
| | - Joshua R Buksbaum
- SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York, NY 11226, United States
| | - Austin Fragomen
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY 10021, United States
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY 10021, United States
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32
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Brandao B, Aljawadi A, Poh ZE, Fox A, Pillai A. Comparative study assessing sporting ability after Arthrodesis and Cartiva hemiarthroplasty for treatment of hallux rigidus. J Orthop 2020; 18:50-52. [PMID: 32189883 PMCID: PMC7067982 DOI: 10.1016/j.jor.2019.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - Ahmed Aljawadi
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | | | - Anna Fox
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Anand Pillai
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
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33
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Revision of Synthetic Cartilage Implant Hemiarthroplasty of the Great Toe to Metatarsophalangeal Joint Arthrodesis: Technique and Indications. TECHNIQUES IN FOOT AND ANKLE SURGERY 2020. [DOI: 10.1097/btf.0000000000000197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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.
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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
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de Cesar Netto C, Godoy-Santos AL, Cabe TN, Roberts LE, Harnroongroj T, Deland J, Drakos M. The use of polyvinyl alcohol hydrogel implants in the lesser metatarsal heads. Is it safely doable? A cadaveric study. Foot Ankle Surg 2020; 26:128-137. [PMID: 30655193 DOI: 10.1016/j.fas.2018.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/19/2018] [Accepted: 12/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The use of synthetic polyvinyl alcohol hydrogel (PVAH) implants for treatment of lesser toe metatarsophalangeal joint (MTPJ) arthritis is promising and currently limited by the size of implants available. The primary objective of this cadaveric study was to investigate the maximum drilling size and largest PVAH implant dimension that could be safely introduced while still preserving an intact bone rim of the lesser metatarsal heads. METHODS Height and width of all lesser metatarsals were measured on CT and during anatomic dissection. Sequential reaming of the second to fourth metatarsals was performed. Maximum reaming size, largest implant inserted, and failure of the metatarsal head were recorded. Metatarsal head sizes were compared and a multiple regression analysis evaluated measurements that influenced maximum drilling and implant size. RESULTS CT and anatomical measurements demonstrated significant correlation (ICC range, 0.-0.85). Mean values for height and width of the metatarsal heads were respectively: second (14.9 mm and 9.9 mm), third (14.8 mm and 8.8 mm), fourth (14.0 mm and 8.7 mm) and fifth (12.3 mm and 9.3 mm). All the second, third and fourth metatarsal heads could be safely drilled up to 7.5 mm, preserving an intact bone rim. At 80% of the time, the heads could be safely drilled up to 8.0 mm. Height of the metatarsal heads was the only factor to significantly influence the size of maximum reaming and implant introduced. In respectively 20%, 40% and 50% of the second, third, and fourth metatarsal heads, neither 8 mm nor 10 mm PVAH implants could be used. CONCLUSIONS Our cadaveric study found that the even though the majority of the lesser metatarsal heads could be safely drilled up to 8 mm, the smallest PVAH implant size currently available in most countries (8 mm) could be inserted in most of the second, but only in about half of the third and fourth metatarsal heads. The remaining bone rim around inserted implants was considerably thin, usually measuring less than 1 mm. In order to optimize the use PVAH in lesser metatarsal heads, smaller implant options are needed.
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Affiliation(s)
- Cesar de Cesar Netto
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Alexandre Leme Godoy-Santos
- Department of Orthopaedics, Foot and Ankle Surgery, University of Sao Paulo (USP), St. Ovidio Pires de Campos 333, Sao Paulo, SP, Brazil.
| | - Taylor N Cabe
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Lauren E Roberts
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Thos Harnroongroj
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Jonathan Deland
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Mark Drakos
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
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An TW, Cassinelli S, Charlton TP, Pfeffer GB, Thordarson DB. Radiographic and Magnetic Resonance Imaging of the Symptomatic Synthetic Cartilage Implant. Foot Ankle Int 2020; 41:25-30. [PMID: 31538827 DOI: 10.1177/1071100719877147] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Synthetic Cartilage Implantation (SCI; Cartiva) is a treatment of hallux rigidus associated with mixed clinical outcomes in the United States. Patients with persistent pain typically undergo diagnostic imaging for evaluation. We aimed to characterize the radiologic findings of SCI and surrounding tissues. METHODS This is a retrospective review of patients treated using SCI who underwent magnetic resonance imaging (MRI) for persistent pain. Metatarsophalangeal (MTP) joint spaces were compared on plain radiographs of the foot immediately postoperatively and at most recent follow-up. MRI of the foot were assessed for dimensions of the implant, bony channel, and presence of peri-implant fluid. Clinical follow-up, including Patient-Reported Outcome Measures Informational System (PROMIS) scores, satisfaction rating, and revision surgery, was collected. Eighteen cases of symptomatic SCI from 16 patients (13 females, 3 males) were included. All but 1 case involved a 10-mm implant. RESULTS Mean satisfaction rating was 2.25 (1-5 Likert scale). PROMIS scores indicated moderate physical dysfunction (41) and moderate pain interference (63). Six of 16 patients (37.5%) underwent revision surgery at average 20.9 months of follow-up. Plain radiographs over a 13.3-month interval showed joint space narrowing of 2 mm medially and 1.6 mm laterally (P < .001). One hundred percent of cases had radiographic evidence of osteoarthritis (OA) progression. MRI studies were obtained on average 11.5 months postoperatively. The implant diameter averaged 9.7 mm, which mismatched the bony channel diameter of 11.2 mm (P < .001). Fourteen of 18 cases had peri-implant fluid. All cases had edema in the metatarsal, proximal phalanx, and soft tissues. CONCLUSION Radiographic loss of MTP joint space and progression of arthritis were present for all cases studied. MRI revealed bony channel widening and a smaller implant, with peri-implant fluid suggesting instability at the implant-bone interface. Persistent edema was observed in soft tissues and bone. Diagnostic imaging of SCI in symptomatic patients demonstrated concerning findings that merit further correlation with patient outcomes. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Tonya W An
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Shi E, Todd N, Rush S, Jennings M, Yurgelon J, Sue A, Bourke C, Baravarian B, Allen J, Shofler D. First Metatarsophalangeal Joint Space Area Decreases Within 1 Month After Implantation of a Polyvinyl Alcohol Hydrogel Implant: A Retrospective Radiographic Case Series. J Foot Ankle Surg 2019; 58:1288-1292. [PMID: 31679683 DOI: 10.1053/j.jfas.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 03/10/2019] [Accepted: 04/04/2019] [Indexed: 02/03/2023]
Abstract
In 2016, the U.S. Food and Drug Administration approved the first and only polyvinyl alcohol hydrogel implant for the treatment of hallux rigidus. The implant functions as a bumper to maintain first metatarsophalangeal joint space to prevent contact of the phalangeal base with the first metatarsal head. Short-term and intermediate outcomes with this implant have reported positive outcomes with no radiographic outcomes of implant wear or subsidence. We performed a retrospective radiographic review of 27 consecutive patients who received the implant and measured preoperative and postoperative joint space area (JSA). We found a significant improvement in JSA (p < .001) between the preoperative JSA and JSA at the first postoperative visit at 1 to 2 weeks. We also found a significant decrease in JSA (p < .001) between the first postoperative visit and the second postoperative visit at 5 to 12 weeks. This information could have further implications for implant design as well as how we can better achieve functional improvements in the first metatarsophalangeal joint in patients with hallux rigidus.
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Affiliation(s)
- Eric Shi
- Fellow, Sutter Health Palo Alto Medical Foundation, Mountain View, CA.
| | - Nicholas Todd
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | - Shannon Rush
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | - Meagan Jennings
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | - Jesse Yurgelon
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | - Alan Sue
- Attending Physician, Sutter Health Palo Alto Medical Foundation, Mountain View, CA
| | | | - Bob Baravarian
- Assistant Clinical Professor UCLA School of Medicine, Los Angeles, CA
| | - Jamey Allen
- Fellow, University Foot and Ankle Institute, Santa Monica, CA
| | - David Shofler
- Assistant Professor, Department of Podiatric Medicine, Surgery, and Biomechanics, Western University College of Podiatric Medicine, Pomona, CA
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Sidon E, Rogero R, Bell T, McDonald E, Shakked RJ, Fuchs D, Daniel JN, Pedowitz DI, Raikin SM. Long-term Follow-up of Cheilectomy for Treatment of Hallux Rigidus. Foot Ankle Int 2019; 40:1114-1121. [PMID: 31307212 DOI: 10.1177/1071100719859236] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux rigidus is the most common arthritic condition in the foot. First metatarsophalangeal joint cheilectomy produces satisfactory results in retrospective studies with reported good to excellent results in up to 97% and pain relief and function in 92%. The results of cheilectomy for higher grades of hallux rigidus are less favorable. The purpose of this study was to evaluate the long-term functional results and survivorship of cheilectomy for treatment of hallux rigidus. METHODS This was a retrospective, questionnaire-based study investigating the long-term results of cheilectomy for treatment of hallux rigidus. The preoperative arthritic grade was graded retrospectively according to the Hattrup and Johnson (H&J) grading system. A questionnaire was administered via email or telephone that included questions regarding pain recurrence following surgery, current functional status, and satisfaction with the operation. Kaplan-Meier survival analysis was performed to estimate survival time between arthritic grades. We reviewed 165 patients (169 feet) with an average follow-up of 6.6 (5.0-10.9) years. RESULTS The overall survival rate (painless at the time of last follow-up) was 70.4% (119 feet), with no significant difference between the 3 H&J arthritic grades. Most of the recurrences (28 feet, 75%) were at the first 2 years following the surgery. Nine feet (5.3%) had a second procedure at a mean postoperative time of 3.6 (range, 1.6-7.4) years. Of the 169 feet, 117 (69.3%) reported being satisfied or very satisfied and 127 (75.1%) indicated they would repeat the operation under the same circumstances. CONCLUSION Our study supports the use of cheilectomy for treatment of hallux rigidus (grade 1-3 Coughlin and Shurnas) as a reliable procedure with favorable results. At long-term follow-up, patients who underwent cheilectomy had a low revision rate and a moderately low rate of pain recurrence. LEVEL OF EVIDENCE Level IV, retrospective case-series.
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Affiliation(s)
- Eliezer Sidon
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Ryan Rogero
- Rothman Orthopaedic Institute, Philadelphia, PA, USA.,Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Timothy Bell
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Elizabeth McDonald
- Rothman Orthopaedic Institute, Philadelphia, PA, USA.,Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Daniel Fuchs
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Cassinelli SJ, Chen S, Charlton TP, Thordarson DB. Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States. Foot Ankle Int 2019; 40:1140-1148. [PMID: 31195830 DOI: 10.1177/1071100719855049] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to determine the early outcomes and complications following the implantation of a hydrogel synthetic cartilage implant (SCI, Cartiva) for the treatment of hallux rigidus by a single surgeon. METHODS A retrospective chart review was performed of consecutive patients who underwent treatment for hallux rigidus with an SCI between August 2016 and April 2018 by a single surgeon. Demographic information, radiographic assessment, and concomitant operative procedures performed were evaluated for all patients. Postoperatively, PROMIS physical function (PF) and pain interference (PI) scores, patient satisfaction, reoperation, conversion to arthrodesis, and need for further clinical treatment were collected. Sixty-four SCIs were implanted in 60 patients. Follow-up averaged 18.5 months (range 12-30 months). RESULTS 14% (9/64) of patients were very satisfied, 28% (18/64) satisfied, 20% (13/64) neutral, 11% (7/64) unsatisfied, and 27% (17/64) very unsatisfied with their outcome. In addition, 45% of patients underwent additional procedures at the time of SCI, and 23% had a history of surgery on the hallux before implantation. PROMIS PF scores averaged 42 and PROMIS PI scores averaged 60. Overall, 63% completed PROMIS PI, 66% completed PROMIS PF, and 100% completed a satisfaction survey. In addition, 30% (19/64) underwent magnetic resonance imaging (MRI) postoperatively due to pain. There was a 20% reoperation rate, which included an 8% rate of conversion to arthrodesis. CONCLUSION Synthetic cartilage implantation yielded neutral patient satisfaction, mild pain, and physical dysfunction at early follow-up. We believe patient selection and counseling regarding early postoperative limitations are important before proceeding with SCI. LEVEL OF EVIDENCE Level IV, case series.
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40
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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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41
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Emmons BR, Carreira DS. Outcomes Following Interposition Arthroplasty of the First Metatarsophalangeal Joint for the Treatment of Hallux Rigidus: A Systematic Review. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011418814427. [PMID: 35097316 PMCID: PMC8696831 DOI: 10.1177/2473011418814427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Interposition arthroplasty of the first MTP joint has recently experienced renewed interest as a treatment for hallux rigidus. The purpose of this study was to systematically review the rapidly expanding literature on PRO following interposition arthroplasty of the first MTP joint. Methods: PubMed Central, Embase, and the Cochrane Central Register for Controlled Trials (CENTRAL) were searched. Inclusion criteria included length of time to follow-up, number of patients, outcome measure, and use of allogeneic or autogenous soft tissue or a synthetic matrix as interposition. Results: 20 studies were included in the review, comprising 498 patients and 539 feet with mean time to follow-up of 4.5 years. The most common substance used for interposition in the included studies was autogenous first MTPJ capsular tissue, a technique reported on in 12 (60.0%) of the included articles. In studies reporting preoperative and postoperative outcomes by way of a standardized outcome scoring system, mean group improvements exceed minimal clinically important differences in the majority of studies. Eighty-five percent of the studies included in this review were of Level IV quality evidence, and of this subset of studies, 70.6% were of a retrospective nature. Progression to further surgery was observed in 3.8% of toes. The most common complication reported was transfer metatarsalgia of 1 or more lesser toes, observed in up to 57.9% of patients in one study. Conclusion: Interposition arthroplasty appears to be a viable option for the treatment of moderate to severe hallux rigidus in patients looking to salvage motion through the first metatarsophalangeal joint. A wide array of autogenous, allogeneic, and synthetic implant materials have surfaced in recent years, but long-term follow-up and prospective, comparative study designs with low risk of bias are limited. Level of Evidence: Level IV, systematic review of Level III-IV studies
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42
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Rushing CJ, Rathnayake VR, Oxios AJ, Galan GP, Ramil M, Spinner SM, Hardigan P. Patient-Perceived Recovery and Outcomes After Silastic Implant Arthroplasty. J Foot Ankle Surg 2019; 57:1080-1086. [PMID: 30172719 DOI: 10.1053/j.jfas.2018.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Indexed: 02/03/2023]
Abstract
In some chronic musculoskeletal conditions, patients with persistent pain and disability have still achieved recovery through behavioral adaptations (readjustment) or cognitive coping (redefinition). Although the pendulum shift from physician-reported clinical indicators to patient-reported outcomes measures (PROMs) has recently focused on quantifying residual pain and disability to determine recovery (resolution), whether patients are capable of coping with any ongoing deficits and achieving other forms of recovery has not been considered. We performed a retrospective case series to assess patient-perceived recovery and outcomes after silastic implant arthroplasty for hallux rigidus. From July 2006 to July 2016, 28 patients at a single institution were enrolled. PROMs were prospectively obtained and compared between patients considering themselves recovered without or with residual deficits (recovered-resolved, recovered-not resolved) and those not recovered. Holistic satisfaction, procedure-specific satisfaction, complications, reoperations, and failure rates were recorded. Overall, 50.0% perceived themselves as recovered-resolved, 43% as recovered-not resolved, and 7% as not recovered. The mean modified Foot Function Index was 17.26, the verbal analog scale for pain score was 2.03, and implant survivorship 100% at a median of 67 (interquartile range 28.4 to 103.5) months. Although only 50% of patients reported complete symptom resolution, satisfaction was high, and most perceived themselves as recovered, suggesting recovery in hallux rigidus might not always be predicated by the complete resolution of all symptomatology. Although PROMs relying on pain inference and functional disability will continue to be utilized with increasing frequency, foot and ankle surgeons should be cognizant of their inherent limitations in assessing other forms of recovery.
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Affiliation(s)
| | | | - Adam J Oxios
- Resident, Westside Regional Medical Center, Plantation, FL
| | | | - Madelin Ramil
- Research Director, Westside Regional Medical Center, Plantation, FL
| | - Steven M Spinner
- Residency Director, Westside Regional Medical Center, Plantation, FL
| | - Patrick Hardigan
- Director, Statistical Consulting Center, Nova Southeastern University, Fort Lauderdale, FL
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43
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Weller WJ. Emerging Technologies in Upper Extremity Surgery: Polyvinyl Alcohol Hydrogel Implant for Thumb Carpometacarpal Arthroplasty and Processed Nerve Allograft and Nerve Conduit for Digital Nerve Repairs. Orthop Clin North Am 2019; 50:87-93. [PMID: 30477709 DOI: 10.1016/j.ocl.2018.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the field of upper extremity surgery there are myriad new and developing technologies. The purpose of this article is to highlight a few of the most compelling new technologies and review their background, indications for use, and most recently reported outcomes in clinical practice.
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Affiliation(s)
- William J Weller
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
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Baumhauer JF, Daniels T, Glazebrook M. New Technology in the Treatment of Hallux Rigidus with a Synthetic Cartilage Implant Hemiarthroplasty. Orthop Clin North Am 2019; 50:109-118. [PMID: 30477700 DOI: 10.1016/j.ocl.2018.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Synthetic cartilage implant surgery is an excellent option for the patient with great toe arthritis and good alignment of the toe who wishes to retain first metatarsophalangeal motion and obtain 90% improved pain relief and function. Patients with osteoporosis, osteopenia, or bone defects from surgery or disease may not maintain the implant position due to poor bone quality, resulting in less than desired outcomes. Despite this being a straightforward surgery, patients need to be aware that the pain relief may not begin until 3+ months after surgery because this procedure does require bone resection and implant placement.
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Affiliation(s)
- Judith F Baumhauer
- Ortho Department, University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
| | - Timothy Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, 800-55 Queen Street East, Toronto, Ontario M5C 1R6, Canada
| | - Mark Glazebrook
- Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax Infirmary, Room 4867, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada
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45
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In Vivo Investigation of Soft Tissue Response of Novel Silver/Poly(Vinyl Alcohol)/ Graphene and Silver/Poly(Vinyl Alcohol)/Chitosan/Graphene Hydrogels Aimed for Medical Applications – The First Experience. ACTA VET-BEOGRAD 2018. [DOI: 10.2478/acve-2018-0027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
In this paper, we have shown for the fi rst time the soft tissue response of novel silver/ poly(vinyl alcohol)/graphene (Ag/PVA/Gr) and silver/poly(vinyl alcohol)/chitosan/ graphene (Ag/PVA/CHI/Gr) nanocomposite hydrogels aimed for medical applications. These novel hydrogels were produced by in situ electrochemical synthesis of silver nanoparticles in the polymer matrices as described in our previously published works. Both Ag/PVA/Gr and Ag/PVA/CHI/Gr, as well as controls Ag/PVA, Ag/PVA/CHI and commercial Suprasorb©hydrogel discs, were implanted in the subcutaneous tissue of rats. Implants with the surrounding tissue were dissected after post-implantation on days 7, 15, 30 and 60, and then processed for histological examination. The tissue irritation index (TIrI) score, according to ISO 10993-6, 2007, as well as the number of leukocytes in the peri-implant zone and connective tissue capsule thickness were examined. The results show that each TIrI score, the leukocyte number around the implanted materials and capsule thickness gradually decreased during the observation period. At the endpoint of follow-up, the Ag/PVA/CHI/Gr implant was surrounded with a thinner capsule, while both the TIrI score and the number of leukocytes of the peri-implant zone were greater compared to the Ag/PVA/Gr implant. Despite the observed differences, we can conclude that our in vivo experiment suggested that both novel hydrogels were biocompatible and suitable for medical use.
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46
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Schuberth JM, Hamilton G, Cooper MT, Brigido SA. End-Stage Osteoarthritis of the First Metatarsophalangeal Joint: What Has Changed in Our Practice? Foot Ankle Spec 2018; 11:357-361. [PMID: 30012061 DOI: 10.1177/1938640018790161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John M Schuberth
- Chief Foot and Ankle Surgery Department of Orthopedic Surgery Kaiser Foundation Hospital San Francisco, CA
| | - Graham Hamilton
- Department of Orthopedic & Podiatric Surgery Palo Alto Foundation Medical Group Dublin, CA
| | - Minton Truitt Cooper
- Assistant Professor of Orthopaedic Surgery Foot and Ankle Fellowship Director University of Virginia Charlottesville, VA
| | - Stephen A Brigido
- Section Chief-Foot and Ankle Surgery Coordinated Health Bethlehem, PA Professor of Surgery Department of Clinical Sciences The Geisinger Commonwealth Medical College Scranton, PA
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47
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Abstract
Arthritis of the first metatarsophalangeal (MTP) joint, hallux rigid, is a common and disabling source of foot pain in the adult population. Hallux rigidus is characterized by diseased cartilage and large, periarticular osteophytes that result in a stiff, painful joint. Activity modification, sensible shoes, orthotics, anti-inflammatory medications and occasional intra-articular steroid injections can be attempted to alleviate the discomfort associated with hallux rigidus. A number of surgical options exist for the treatment of recalcitrant hallux rigidus. Cheilectomy is a useful treatment for dorsal impingement pain seen in mild hallux rigidus. A new polyvinyl alcohol hemi-arthroplasty implant has shown promising early and midterm results in the treatment of advanced hallux rigidus; however, arthrodesis of the first MTP joint remains the gold standard treatment for advanced hallux rigidus because of unpredictable outcomes after early-generation joint replacement implants.
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48
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Chang TJ. The Role of Polyvinyl Alcohol in Cartilage Repair of the Ankle and First Metatarsophalangeal Joint. Clin Podiatr Med Surg 2018; 35:133-143. [PMID: 29156163 DOI: 10.1016/j.cpm.2017.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Cartiva implant (Cartiva, Alpharetta, GA) is an exciting option in dramatically diminishing patient symptoms in advanced stages of hallux rigidus as well as allowing continued joint motion. The procedure does not burn many bridges in case a future revision to an arthrodesis is necessary. This advantage is in contradistinction to other current implants whereby more bone resection is required for implant placement.
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Affiliation(s)
- Thomas J Chang
- Redwood Orthopedic Surgery Associates, Inc, 208 Concourse Boulevard, #1, Santa Rosa, CA 95403, USA.
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49
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Goldberg A, Singh D, Glazebrook M, Blundell CM, De Vries G, Le ILD, Nielsen D, Pedersen ME, Sakellariou A, Solan M, Younger ASE, Daniels TR, Baumhauer JF. Association Between Patient Factors and Outcome of Synthetic Cartilage Implant Hemiarthroplasty vs First Metatarsophalangeal Joint Arthrodesis in Advanced Hallux Rigidus. Foot Ankle Int 2017; 38:1199-1206. [PMID: 28820949 DOI: 10.1177/1071100717723334] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We evaluated data from a clinical trial of first metatarsophalangeal joint (MTPJ1) implant hemiarthroplasty and arthrodesis to determine the association between patient factors and clinical outcomes. METHODS Patients ≥18 years with hallux rigidus grade 2, 3, or 4 were treated with synthetic cartilage implant MTPJ1 hemiarthroplasty or arthrodesis. Pain visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM) sports and activities of daily living (ADL) scores, and Short Form-36 Physical Function (SF-36 PF) subscore were obtained preoperatively, and at 2, 6, 12, 24, 52, and 104 weeks postoperatively. Final outcome data, great toe active dorsiflexion motion, secondary procedures, radiographs, and safety parameters were evaluated for 129 implant hemiarthroplasties and 47 arthrodeses. The composite primary endpoint criteria for clinical success included VAS pain reduction ≥30%, maintenance/improvement in function, no radiographic complications, and no secondary surgical intervention at 24 months. Predictor variables included hallux rigidus grade; gender; age; body mass index (BMI); symptom duration; prior MTPJ1 surgery; preoperative hallux valgus angle, range of motion (ROM), and pain. Two-sided Fisher exact test was used ( P < .05). RESULTS Patient demographics and baseline outcome measures were similar. Success rates between implant MTPJ1 hemiarthroplasty and arthrodesis were similar ( P > .05) when stratified by hallux rigidus grade, gender, age, BMI, symptom duration, prior MTPJ1 surgery status, and preoperative VAS pain, hallux valgus, and ROM. CONCLUSION Synthetic cartilage implant hemiarthroplasty was appropriate for patients with grade 2, 3, or 4 hallux rigidus. Its results in those with associated mild hallux valgus (≤20 degrees) or substantial preoperative stiffness were equivalent to MTPJ1 fusion, irrespective of gender, age, BMI, hallux rigidus grade, preoperative pain or symptom duration. LEVEL OF EVIDENCE Level II, randomized clinical trial.
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Affiliation(s)
- Andy Goldberg
- 1 Stanmore Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom.,2 Division of Surgery & Interventional Science, UCL, London, United Kingdom
| | - Dishan Singh
- 1 Stanmore Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Mark Glazebrook
- 3 Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
| | | | - Gwyneth De Vries
- 5 Dalhousie University and Memorial University of Newfoundland, Fredericton, New Brunswick, Canada
| | - Ian L D Le
- 6 University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Matthew Solan
- 10 Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - Alastair S E Younger
- 11 Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy R Daniels
- 12 Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Judith F Baumhauer
- 13 Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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