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Johnson JE, Phinney AR, Hastings MK, Jeong HJ, Chen L, Thome AP, McCormick JJ, Backus JD. Fifteen-Year Follow-up of the Modified Oblique Keller Capsular Interposition Arthroplasty Compared to Arthrodesis for Treatment of Advanced First Metatarsophalangeal Joint Arthritis. FOOT & ANKLE ORTHOPAEDICS 2025; 10:24730114251322766. [PMID: 40114855 PMCID: PMC11924083 DOI: 10.1177/24730114251322766] [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: 03/22/2025] Open
Abstract
Background Although metatarsophalangeal joint (MTPJ) arthrodesis is considered the "gold standard" for treatment of advanced MTPJ arthritis, a modified oblique Keller capsular interposition arthroplasty (MOKCIA) is an alternative treatment for hallux rigidus that retains MTPJ motion. We aim to retrospectively compare long-term patient-reported outcomes, radiographic alignment, MTPJ walking kinematics, and plantar pressure between the MOKCIA and MTPJ arthrodesis for advanced hallux rigidus. Methods Thirty-five patients were recruited from a retrospective chart review (MOKCIA [n = 15, average 15 years from surgery] or an arthrodesis [n = 20, average 13 years from surgery]). We measured visual analog scale (VAS) pain and satisfaction, Foot and Ankle Ability Measure (FAAM), Patient-Reported Outcomes Measurement Information System (PROMIS) physical function scores, radiographs, walking MTPJ sagittal plane kinematics, forefoot, and first toe peak plantar pressure during walking, MTPJ goniometer range of motion, and need for additional surgery. Two-sample t tests or χ2 were used to compare groups. A Spearman correlation was used to examine the relationships between measured variables. Results Groups did not differ on demographic characteristics, FAAM activities of daily living scale (MOKCIA = 94 ± 8, arthrodesis = 94 ± 7, P = .93), PROMIS physical function T-score (MOKCIA = 50 ± 6, arthrodesis = 48 ± 6, P = .41), forefoot, and first-toe walking peak plantar pressure. The MOKCIA had small but significantly lower VAS pain (MOKCIA = 0.1 ± 0.3, arthrodesis = 1.0 ± 1.6, P = .02) and higher satisfaction scores (MOKCIA = 9.5 ± 0.9, arthrodesis = 8.4 ± 1.8, P = .03). MTPJ passive arc of excursion in the MOKCIA group was 44 ± 15 degrees, and greater goniometric measured flexion of the first MTPJ correlated with greater patient satisfaction in the MOKCIA group (ρ = 0.70, P < .01). No MOKCIA patient in our study group required additional surgery. Conclusion Patients in both the MOKCIA and arthrodesis groups reported high function with little limitation due to their toe surgery. Patients in the MOKCIA group had similar pain and satisfaction compared with the arthrodesis group. These results suggest MOKCIA is a joint range of motion-preserving alternative to MTPJ arthrodesis for long-term treatment of hallux rigidus. Level of Evidence Level III, retrospective, cohort study.
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Affiliation(s)
- Jeffrey E Johnson
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrea R Phinney
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Orthopedic Surgery, Phelps Health Hospital, Rolla, MO, USA
| | - Mary K Hastings
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Hyo-Jung Jeong
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Ling Chen
- Institute for Informatics, Data Science, and Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew P Thome
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeremy J McCormick
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jonathon D Backus
- The Steadman Clinic and Steadman-Philippon Research Institute, Vail, CO, USA
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2
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Fayed AM, Jones M, Carvalho KAMD, Luo E, Acker A, Barbachan Mansur NS, de Cesar Netto C. Progressive First Metatarsal Shortening Is Observed Following Dermal Allograft Interpositional Arthroplasty in Hallux Rigidus: Short Report. Foot Ankle Int 2024; 45:1359-1363. [PMID: 39387460 DOI: 10.1177/10711007241281729] [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: 10/15/2024]
Abstract
BACKGROUND The main goal of this study was to evaluate postoperative changes in the length of the first metatarsal (M1) and the proximal phalanx of the hallux (P1) after acellular dermal allograft interpositional arthroplasty (ADA-IPA). We hypothesized that there would be a shortening of the first ray at the first metatarsal, the proximal phalanx, or both. METHODS In this retrospective study, we assessed patients who underwent ADA-IPA between 2019 and 2022. On standing anteroposterior (AP) foot radiographs, we measured first metatarsal (M1), second metatarsal (M2), proximal phalanx (P1), and the entire hallux (HX) lengths. M1/M2 and P1/HX ratios were calculated. The first metatarsophalangeal joint space was calculated. All measurements were recorded preoperatively, at 6 weeks postoperatively, and at final follow-up. RESULTS The pilot study included 11 patients. At final follow-up, we found shortening of M1 and P1 in comparison to the preoperative length, as evidenced by lower M1/M2 (82.6 ± 2.3 vs 75.4 ± 5.1; P = .001) and P1/HX ratios (53.4 ± 2.3 vs 48.9 ± 7.9; P = .001). Follow-up length was negatively correlated with M1/M2 (r = -0.76, P = .003). CONCLUSION ADA-IPA might be associated with shortening of both first metatarsal and proximal phalanx, with the former showing progressive shortening.
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Affiliation(s)
- Aly Maher Fayed
- Department of Orthopaedic Surgery, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
- Department of Orthopaedics and Traumatology, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Matthew Jones
- Department of Orthopedics and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Kepler Alencar Mendes de Carvalho
- Department of Orthopedics and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
- Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Duke University Health System, Chapel Hill, NC, USA
| | - Emily Luo
- Duke University School of Medicine, Durham, NC, USA
| | - Antoine Acker
- Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Duke University Health System, Chapel Hill, NC, USA
- Centre of Foot and Ankle Surgery, Clinique La Colline, Geneva, Switzerland
| | - Nacime Salomão Barbachan Mansur
- Department of Orthopedics and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, São Paulo, Brazil
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
- Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Duke University Health System, Chapel Hill, NC, USA
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Mahmood A, Atcha H, Khan S, Atkinson H. Two-Year Clinical Outcomes of Patients Undergoing Synthetic Cartilage Arthroplasty for First Metatarsophalangeal Osteoarthritis. Cureus 2024; 16:e75683. [PMID: 39677993 PMCID: PMC11645482 DOI: 10.7759/cureus.75683] [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: 12/13/2024] [Indexed: 12/17/2024] Open
Abstract
Background Severe osteoarthritis (OA) of the first metatarsophalangeal joint (MTPJ) is usually treated by arthrodesis, which results in a loss of mobility in the joint. Cartiva (Stryker Corporation, Kalamazoo, USA) is a synthetic cartilage implant (SCI) designed to repair osteochondral defects in the treatment of the first MTP OA. Treatment using the Cartiva SCI should relieve symptoms of OA whilst sparing motion in the first MTPJ and may provide a superior alternative to arthrodesis. Objectives The objective of this article is to assess the clinical outcomes of a novel SCI, Cartiva, for arthroplasty in the management of the first MTPJ arthritis. Study design and methods We retrospectively reviewed 64 patients who had received a total of 67 Cartiva implants between May 2016 and June 2020. The average age of these patients at the time of surgery was 54.3 years with a range from 19 to 77 years. Forty-five of the 67 implants were used in females and 22 were used in males. Radiological Grade 2 OA was present in 46 cases with Grade 3 in 21 (Hattrup and Johnson classification). Validated patient-reported outcomes measures (PROMs) were used to assess the functional efficacy of the implants. All cases were performed by a single surgeon. The PROMs data was collected via follow-up phone calls with the patients who were asked questions from the American Academy of Orthopaedic Surgeons' Foot and Ankle Measure (AAOS-FAM), the EQ-5D-3L survey and the Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ). All data collected was anonymised to preserve confidentiality and local hospital ethics committee approval was sought. All statistical analysis was done using Microsoft Excel (Microsoft® Corp., Redmond, WA) and Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 23.0, Armonk, NY). Results There was a significant improvement in all PROMs at three years, and one patient developed an implant-related infection. The average scores for the EQ-5D-3L survey significantly improved from 0.69 to 0.85 post-operative (post-op) (p<0.05). The mean MOXFQ scores improved from 42.5 to 15.4 post-op (p<0.05). The radiologic evaluation demonstrated satisfactory implant positioning in all cases at the last follow-up. Conclusions The data shows significant improvements between pre-op and post-op scores. The implication of this is that synthetic cartilage arthroplasty provides a viable alternative to arthrodesis in the treatment of OA affecting the first MTPJ. However, more studies may need to be done focusing on larger sample sizes and patients should be observed over a longer term, including a formal multi-centred clinical trial.
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Affiliation(s)
- Abid Mahmood
- Trauma and Orthopaedics, Maidstone and Tunbridge Wells NHS Trust, London, GBR
| | - Hussain Atcha
- Diabetes and Endocrinology, Essex Partnership University NHS Foundation Trust, Colchester, GBR
| | - Shahnawaz Khan
- Trauma and Orthopaedics, North Middlesex University Hospital NHS Trust, London, GBR
| | - Henry Atkinson
- Trauma and Orthopaedics, North Middlesex University Hospital NHS Trust, London, GBR
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Anastasio AT, Wixted C, Nunley JA. Interpositional Arthroplasty for Hallux Rigidus: Surgical Technique and Outcomes Discussion. Foot Ankle Clin 2024; 29:443-454. [PMID: 39068020 DOI: 10.1016/j.fcl.2023.10.004] [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
Interpositional arthroplasty for the treatment of hallux rigidus (HR) involves resection of the diseased joint surface and placement of spacer material within the joint to preserve length at the metatarsophalangeal joint while still allowing for range of motion. The majority of studies available in the literature have focused on capsular interpositional arthroplasty, revealing generally positive outcomes. Other forms of interpositional arthroplasty are less supported by long-term follow-up and large sample sizes. Moreover, there exists substantial heterogeneity in the studies evaluating interpositional arthroplasty. Despite the limitations of the current data, interpositional arthroplasty seems to be a viable treatment option for HR.
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Affiliation(s)
- Albert T Anastasio
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Duke University, 200 Trent Drive, Durham, NC 27710, USA
| | - Colleen Wixted
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Duke University, 200 Trent Drive, Durham, NC 27710, USA.
| | - James A Nunley
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Duke University, 200 Trent Drive, Durham, NC 27710, USA
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Dahmen J, Stufkens SA, Kerkhoffs GM. Prospective Outcomes of a Biological Resurfacing Arthroplasty with Fascia Lata Autograft (BioJoint) for the Treatment of Osteoarthritis of the Midtarsal Joint Complex. Cartilage 2024; 15:37-46. [PMID: 37887431 PMCID: PMC10985392 DOI: 10.1177/19476035231206740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE To determine the clinical, safety, and radiological outcomes after biological resurfacing arthroplasty for the treatment of osteoarthritis (OA) of one or more joints of the midtarsal joint complex. DESIGN All prospectively followed patients with OA to one of or multiple joints of the midtarsal joint complex who were operated with a biological resurfacing arthroplasty with a fascia lata autograft (BioJoint procedure) were included. A total of 7 patients were included (5 males, 2 females), with a median age of 52 (interquartile range [IQR] 44-55) years. The primary outcome was the Numeric Rating Scale (NRS) for pain during walking 2 years postoperatively. Range of motion (ROM), revision rates, and complications were assessed. A postoperative MRI scan was performed to assess progression of OA, graft position and ingrowth, and the degree of bone marrow edema. RESULTS There was a 100% follow-up of the patients (median follow-up: 33 [IQR 26-33] months). The NRS during walking improved from 6 preoperatively to 2 at 2 years postoperatively (P < 0.05). There were no reoperations nor severe complications. The limitations in the ROM remained limited in the majority of the cases. MRI at 2 years of follow-up showed no progression of OA, reduced bone marrow edema, and no loosening of the grafts. CONCLUSION Biological resurfacing arthroplasty with a fascia lata autograft (BioJoint procedure) for OA to one or more joints in the midtarsal joint complex showed clinically relevant pain reduction during walking, improvement in clinical and radiological outcomes, and proved to be safe and durable.
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Affiliation(s)
- Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd A.S. Stufkens
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
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6
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Georgiannos D, Lampridis V, Kazamias K, Kitridis D, Bisbinas I, Badekas A. Converting 1st metatarsophalangeal joint fusion to interposition arthroplasty. Mid-term results of a case series. Foot (Edinb) 2023; 56:102029. [PMID: 37001345 DOI: 10.1016/j.foot.2023.102029] [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: 08/01/2021] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Fusion of the first metatarsophalangeal (MTP) joint has been considered as the gold standard for treatment of advanced hallux rigidus. The main disadvantage is the restriction of movement which may not be as favorable as anticipated by several patients. The purpose of this study was to report clinical and functional outcomes on patients who were treated with interposition arthroplasty after a 1st MTP joint fusion which had not fulfilled their expectations. METHODS Between 2009 and 2014, 11 patients who were not satisfied by 1st MTP joint fusion for hallux rigidus, underwent a conversion to interposition arthroplasty. After removal of hardware, the fusion was taken down by removal of a bone block from the fused joint. A fascia lata graft was interposed. Intraoperative and postoperative complications, range of motion of the first MTP joint, length of first ray, and patients' satisfaction were recorded as the primary outcomes. RESULTS Mean age was 34 years (range, 24-42 y). The mean ± SD AOFAS/H/MTP/IP score was 61 ± 5.5 preoperatively, 90.5 ± 4.5 at one year and 92 ± 4 at five years postoperatively (p < 0.001). The mean ± SD VAS-FA score was 91 ± 3.5 preoperatively, 94.5 ± 2.5 at one year and 95 ± 2.5 at five years postoperatively (p > 0.05). Mean ROM at the final follow-up was 58° ± 5° of dorsiflexion and 27° ± 4° of plantarflexion. No inter- or postoperative complications were encountered. The length of the hallux was decreased by a mean of 1.5 mm (range, 1-2.5 mm). All patients were satisfied with the overall outcome, walking ability and shoe-wear convenience and graded their condition as excellent (9 cases) or good (2 cases). CONCLUSIONS Converting a 1st MTP joint fusion to interposition arthroplasty with a fascia lata allograft could be a safe alternative with promising results in selected cases especially in relatively young and athletic population. LEVEL OF EVIDENCE Level IV retrospective case series.
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Affiliation(s)
| | - Vasileios Lampridis
- 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Greece
| | | | - Dimitrios Kitridis
- 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Greece
| | - Ilias Bisbinas
- 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Greece
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7
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Koh D, Chandrakumara D, Socklingam R, Kon Kam King C. Clinical Outcomes After Joint-Preserving and Joint-Sacrificing Surgery for Hallux Rigidus. Cureus 2023; 15:e42155. [PMID: 37602074 PMCID: PMC10438958 DOI: 10.7759/cureus.42155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Hallux rigidus (HR) is a degenerative condition affecting the first metatarsal phalangeal joint, causing stiffness and pain. Surgery is indicated for those who have failed a trial of conservative management. The purpose of this paper is to evaluate the functional outcomes at short and medium term after surgery for HR. Methods All patients who underwent surgical treatment for HR between 2017 and 2022 at the time of this study were identified and invited to return for a follow-up evaluation. Outcomes were assessed by comparison of pre-operative and post-operative visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Results A total of 26 patients were included in our study with a mean follow-up of 31 months. There was a mean improvement in VAS score by 5.6 (p-value < 0.0001) and 5.7 (p-value = 0.0012) in patients who underwent joint-preserving (JP) and joint-sacrificing (JS) surgery, respectively. Patients who underwent JP surgery had a mean increase of 28.1 points (p-value < 0.0001) in the AOFAS Hallux score, while patients who underwent JS surgery had a mean increase of 27.29 points (p-value = 0.0066). Conclusion Functional outcomes after surgical management for HR are good at short- and medium-term follow-up. Good outcomes are seen with both JP and JS procedures. JP procedures should be considered as a first-line surgical option for HR as it allows revision procedures if required.
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Affiliation(s)
- Don Koh
- Orthopaedics, Changi General Hospital, Singapore, SGP
| | | | - Raj Socklingam
- Orthopaedic Surgery, Changi General Hospital, Singapore, SGP
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8
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Colò G, Fusini F, Alessio-Mazzola M, Samaila EM, Formica M, Magnan B. Interposition arthroplasty with bovine collagenous membrane for hallux rigidus: A long-term results retrospective study. Foot Ankle Surg 2022; 28:1473-1478. [PMID: 36117005 DOI: 10.1016/j.fas.2022.08.013] [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: 07/07/2022] [Revised: 08/27/2022] [Accepted: 08/31/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux rigidus (HR) is a degenerative arthritis of the first metatarsophalangeal joint (MTP1) with progressive loss of range of movement (ROM). Interposition arthroplasty (IA) is a technique widely used for the treatment of HR;however, few studies reported long-term clinical results. This study aims to report the clinical results of IA using a bovine pericardium collagen matrix for HR with a minimum 10-years follow-up. METHODS Thirty patients (31 feet) who underwent IA using a bovine pericardium collagen matrix from 2001 to 2009 were retrospectively evaluated with a mean follow up of 154.1 ± 28.6 (range 124-218) months. All HR ranged from grade II to grade III, according to Regnauld classification. All patients were clinically assessed with the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal- Interphalangeal Scale, a pain Visual Analog Scale, and the Foot and Ankle Disability Index. Scores before and after treatment, respectively achieved from clinical records and clinical evaluation at final follow-up were compared. RESULTS At final follow-up, an improvement of all the considered scores (p < 0.01) was recorded. The overall rate of unsatisfying results was 16.1 %. Two (6.4 %) patients complained discomfort due to first ray shortening and 3 (9.7 %) cases of persistent metatarsal pain. There was one (3.2 %) case of Complex Regional Pain Syndrome (CPRS). No revision surgeries, infection, or other adverse events were reported. CONCLUSION Interposition arthroplasty using bovine collagenous membrane is a reliable solution for high-grade HR with durable results over 10 years in more than 80 % of patients.
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Affiliation(s)
- Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy.
| | - Federico Fusini
- Department of Orthopaedics and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Via S. Rocchetto, 99, 12084 Mondovì, CN, Italy.
| | - Mattia Alessio-Mazzola
- IRCCS San Raffaele Hospital Orthopaedic and Trauma Unit Via Olgettina 60, 20132, Milan, Italy..
| | - Elena Manuela Samaila
- Department of Orthopedics and Trauma Surgery, University of Verona, Surgical Center "P. Confortini", P.le A. Stefani, 1, 37126 Verona, VR, Italy.
| | - Matteo Formica
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), University of Genoa, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Bruno Magnan
- Department of Orthopedics and Trauma Surgery, University of Verona, Surgical Center "P. Confortini", P.le A. Stefani, 1, 37126 Verona, VR, Italy.
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Abstract
Hallux rigidus can be treated with a variety of surgical procedures, including joint preserving techniques, arthrodesis, and arthroplasty. The most commonly reported complications for joint preserving techniques consist of progression of arthritis, continued pain, and transfer metatarsalgia. Although good outcomes have been reported for arthrodesis overall, careful attention must be paid to technique and positioning of the toe to avoid nonunion or malunion. Arthroplasty preserves motion but in the case of failure can present the additional challenge of bone loss. In these scenarios, the authors recommend distraction bone block arthrodesis with structural autograft.
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Affiliation(s)
- Maj Patrick D Grimm
- Dwight D. Eisenhower Army Medical Center, 300 West Hospital Road, Fort Gordon, GA 30905, USA
| | - Todd A Irwin
- OrthoCarolina Foot and Ankle Institute, Atrium Health Musculoskeletal Institute, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207, USA.
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10
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Matsumoto T, Kasai T, Uchio A, Izawa N, Takuo J, Tanaka S. Excision Arthroplasty With Interpositional Achilles Tendon Autograft: A Novel Approach to Talonavicular Joint Osteoarthritis Associated With Ankle Arthrodesis. J Foot Ankle Surg 2021; 59:440-444. [PMID: 32131019 DOI: 10.1053/j.jfas.2019.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/06/2019] [Accepted: 08/31/2019] [Indexed: 02/03/2023]
Abstract
Talonavicular joint arthritis is a great concern after ankle fusion. Although arthrodesis is the gold standard treatment for this complication, it could initiate a vicious cycle of further adjacent joint arthritis. An alternative that may delay or eliminate the need for arthrodesis is excision arthroplasty; however, there are only a few reports on its application on a talonavicular joint. We report 3 cases of excision arthroplasty with interpositional Achilles tendon autograft for the treatment of end-stage talonavicular osteoarthritis in low-demand elderly patients. In 1 patient, excision arthroplasty was performed after tibiotalocalcaneal arthrodesis, and in 2 patients, it was performed after tibiotalar arthrodesis, in which the subtalar joints were also damaged and fused simultaneously on performance of the interpositional arthroplasty of the talonavicular joint. In all cases, pain relief and functional activities of daily living improvement were achieved with this procedure. At a minimum follow-up of 1 year, no patient reported adjacent joint symptoms or flatfoot progression. These cases show that interpositional arthroplasty with Achilles tendon autograft is an effective treatment for end-stage talonavicular arthritis in patients with fused ankle and subtalar joints. This procedure was helpful in relieving pain and improving activities of daily living function in low-demand elderly patients with the preservation of movement of the talonavicular joint. Autograft was considered to be superior to other grafts with respect to availability, graft rejection, or allergy development. Fused subtalar joint resolved the concerning issues, such as flatfoot progression and muscular weakness of ankle plantar flexion, associated with this procedure.
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Affiliation(s)
- Takumi Matsumoto
- Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan; Surgeon, Department of Rheumatology, JCHO Yugawara Hospital, Kanagawa, Japan.
| | - Taro Kasai
- Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihiro Uchio
- Surgeon, Department of Rheumatology, JCHO Yugawara Hospital, Kanagawa, Japan
| | - Naohiro Izawa
- Surgeon, Department of Rheumatology, JCHO Yugawara Hospital, Kanagawa, Japan
| | - Juji Takuo
- Surgeon, Department of Rheumatology, JCHO Yugawara Hospital, Kanagawa, Japan
| | - Sakae Tanaka
- Professor, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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11
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Colò G, Samaila EM, Magnan B, Felli L. Valenti resection arthroplasty for hallux rigidus: A systematic review. Foot Ankle Surg 2020; 26:838-844. [PMID: 31839478 DOI: 10.1016/j.fas.2019.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/12/2019] [Accepted: 11/26/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Valente Valenti proposed in 1976 a "V" resection of the first metatarsophalangeal joint (MPT1) on the sagittal plane for advanced stages of hallux limitus/rigidus, preserving length of the first ray, flexor hallux brevis and sesamoid function. The available literature concerning correct indications, management and clinical outcomes of the Valenti procedure (VP) and its modifications in patients affected by hallux limitus/rigidus was systematically analyzed. METHODS Titles and abstracts of all selected articles were independently screened by two authors to assess their suitability to the research focus. RESULTS Selection produced 8 articles as full-text, for a total of 347 patients, with a mean follow-up of 6±7.1 (range 0.2-17.5) years. Most common complication was transient sesamoiditis in 21 (7.4%) patients. No substantial differences in clinical outcomes were found between the original and modified techniques. CONCLUSIONS VP appears to allow an early recovery with few complications, if compared to fusion, interposition arthroplasties or osteotomies. The wide joint resection does not prevent, if necessary, further procedures such as fusion or implants. LEVEL OF EVIDENCE Level I, systematic review.
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Affiliation(s)
- Gabriele Colò
- Clinica Ortopedica - IRCCS Ospedale Policlinico San Martino, Università di Genova, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
| | | | - Bruno Magnan
- Department of Orthopedics and Trauma Surgery, University of Verona, Italy.
| | - Lamberto Felli
- Clinica Ortopedica - IRCCS Ospedale Policlinico San Martino, Università di Genova, Largo Rosanna Benzi, 10, 16132, Genoa, GE, 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: 0.8] [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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Is interposition arthroplasty a viable option for treatment of moderate to severe hallux rigidus? - A systematic review and meta-analysis. Foot Ankle Surg 2019; 25:571-579. [PMID: 30321931 DOI: 10.1016/j.fas.2018.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/25/2018] [Accepted: 07/13/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION When conservative therapy for hallux rigidus fails, surgical options such as arthrodesis and interposition arthroplasty can be considered. Although arthrodesis of MTP joint is the gold standard treatment. However patients desiring MTP joint movement may opt for either interposition arthroplasty or implant arthroplasty to avoid the movement restrictions of arthrodesis. The purpose of this systematic review was to investigate clinical outcomes and complications following interposition arthroplasty for moderate to severe hallux rigidus, for patietns who would prefer to maintain range of motion in the MTP joint. METHODS A systematic search on MEDLINE, EMBASE and Cochrane library database was performed during February 2018. Demographics, surgical techniques, clinical outcomes, radiological outcomes and complications were recorded from each included study. Pooled statistics performed for variables with homogenous data across the studies. A linear regression model used to compare the clinical outcomes between autogenous vs allogenous material interposition arthroplasty. RESULTS Fifteen articles were included in the systematic review. Mean AOFAS scores improved from preoperative 41.35 to postoperative 83.17. Mean pain, function, and alignment score improved from preoperative values of 14.9, 24.9, and 10 to postoperative values of 33.3, 35.8, and 14.5. Mean dorsiflexion increased from 21.27° (5-30) to 42.03° (25-71). Mean ROM improved from 21.06° to 46.43°. Joint space increased from 0.8mm to 2.5mm. The most common postoperative complications included metatarsalgia (13.9%), loss of ground contact (9.7%), osteonecrosis (5.4%), great toe weakness (4.8%), hypoesthesia (4.2%), decreased push off power (4.2%), and callous formation (4.2%). CONCLUSION Interposition arthroplasty is an effective treatment option with acceptable clinical outcomes in patients with moderate-severe hallux rigidus who prefer to maintain range of motion and accept the risk of future complications. LEVEL OF EVIDENCE IV.
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Saxena A, Valerio DL, Behan SA, Hofer D. Modified Valenti Arthroplasty in Running and Jumping Athletes With Hallux Limitus/Rigidus: Analysis of One Hundred Procedures. J Foot Ankle Surg 2019; 58:609-616. [PMID: 30553745 DOI: 10.1053/j.jfas.2018.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Indexed: 02/03/2023]
Abstract
Despite hallux limitus/rigidus being a common condition, results of surgical procedures specifically pertaining to athletes are scarce. The results of 100 modified Valenti procedures, prospectively studied from January 2000 to June 2016 with an average 49.17 months of follow-up, are presented evaluating demographics, sport, time and ability to return to activity (RTA), decreased desired activity level, and need for additional surgery. Inclusion criteria included athletes who have exhausted conservative care without relief of daily pain, dorsiflexion <20°, and grade ≥2. Seventeen had grade 2, 79 had grade 3, and 4 had grade 4 disease. RTA for the 89 procedures where exact time could be determined was 9.25 weeks; however, 100% were confirmed to RTA to some degree. The RTA of dancers and runners (the largest portion of the cohort at 76) was around 8 weeks, whereas soccer players were the slowest at >16 weeks, which was significant. There was no other significant difference in RTA between sport, sex, or grade of hallux limitus/rigidus except for between runners and soccer players. Six patients (6%) stated a decreased desire to activity, although this was not a significant finding. The modified Valenti procedure is a safe and highly effective treatment for running and jumping athletes limited by hallux limitus/rigidus because 94% of patients were able to return to their desired level of activity.
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Affiliation(s)
- Amol Saxena
- Podiatrist, Department of Sports Medicine, Palo Alto Medical Foundation-Sutter, Palo Alto, CA.
| | - Dallas L Valerio
- 4th Year Student, California School of Podiatric Medicine, Oakland, CA
| | - Shontal A Behan
- 4th Year Student, California School of Podiatric Medicine, Oakland, CA
| | - Deann Hofer
- Podiatrist, Podiatry Associates, PC Castle Pines, CO
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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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Colò G, Alessio-Mazzola M, Dagnino G, Felli L. Long-Term Results of Surgical Treatment of Valenti Procedures for Hallux Rigidus: A Minimum Ten-Year Follow-Up Retrospective Study. J Foot Ankle Surg 2019; 58:291-294. [PMID: 30850097 DOI: 10.1053/j.jfas.2018.08.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Indexed: 02/03/2023]
Abstract
Few studies reporting long-term results of surgical treatment of hallux rigidus have been published. The aim of this study is to assess the clinical outcome of Valenti procedures in a series of patients with hallux limitus/rigidus with a minimum 10-year follow-up time. We retrospectively evaluated 38 patients (40 feet) who underwent a Valenti procedure with a mean follow-up of 132 ± 19.6 (range 114 to 184) months. All patients were clinically reassessed on the basis of the evaluation of pain (visual analogue scale), function (American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale Assessment and Foot & Ankle Disability Index), and subjective satisfaction. The scores before and after treatment, obtained from clinical recordings and clinical evaluation during the last follow-up visits, were compared. We found significant improvement of the mean values of the visual analogue score (p < .0001), Foot & Ankle Disability Index (p < .0001), and American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale Assessment (p < .0001) during the latest follow-up visits. The results suggest that the Valenti technique represents a safe, reproducible surgical procedure that allows satisfying long-term results. The few reported complications were essentially the progressive worsening of the joint stiffness, but no sesamoiditis, metatarsal overload, secondary surgeries, or failures were documented.
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Affiliation(s)
- Gabriele Colò
- Surgeon, Department of Surgical Sciences (DISC), Orthopaedic and Traumatologic Clinic, University of Genova, Genoa, Italy
| | - Mattia Alessio-Mazzola
- Surgeon, Department of Surgical Sciences (DISC), Orthopaedic and Traumatologic Clinic, University of Genova, Genoa, Italy.
| | - Giacomo Dagnino
- Surgeon, Department of Surgical Sciences (DISC), Orthopaedic and Traumatologic Clinic, University of Genova, Genoa, Italy
| | - Lamberto Felli
- Professor, Department of Surgical Sciences (DISC), Orthopaedic and Traumatologic Clinic, University of Genova, Genoa, Italy
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Ebina K, Hirao M, Tsuboi H, Kaneshiro S, Nishikawa M, Goshima A, Noguchi T, Nakaya H, Etani Y, Miyama A, Takami K, Hashimoto J, Yoshikawa H. Impact of combining medial capsule interposition with modified scarf osteotomy for hallux valgus. Mod Rheumatol 2019; 30:204-210. [PMID: 30676145 DOI: 10.1080/14397595.2019.1572261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objectives: To clarify the effect of combining medial capsule interposition with modified scarf osteotomy for hallux valgus.Methods: A multicenter, retrospective study included 64 cases [59 osteoarthritis patients (excluding rheumatoid arthritis); age 68.8 years, range 40-93 years] of modified scarf osteotomy which were performed from 2013 to 2017 and followed for 26.6 (range, 13-50) months. Patients were treated by either (1) without medial capsule interposition (33 cases) or (2) combined with interposition (31 cases) at each senior surgeon's discretion. The Japanese Society for Surgery of the Foot (JSSF) hallux metatarsophalangeal (MTP)-interphalangeal scale was evaluated along with radiographic parameters (hallux valgus angle [HVA], first and second metatarsals intermetatarsal angles, and Hardy grade).Results: All JSSF scale and radiographic parameters were similar at baseline and significantly improved at final follow-up in both groups (pre-operation vs. final follow-up: p < .001). However, compared to without interposition group, interposition group showed significantly higher improvement in the JSSF scale (pre-operation to final follow-up: p value between the two groups at final follow-up) for pain (without interposition: 19.4-34.2, interposition: 18.4-37.1; p = .02), function (without interposition: 20.8-33.6, interposition: 18.3-36.6; p = .005), total score (without interposition: 41.5-81.8, interposition: 38.5-88.5; p < .001), and the MTP joint space (without interposition: 1.4-1.5 mm, interposition: 1.6-2.6 mm; p < .001) with significant correlation between the total JSSF score (r = .40; p = .001).Conclusion: Combining medial capsule interposition with modified scarf osteotomy significantly improved mid-term clinical outcomes.
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Affiliation(s)
- Kosuke Ebina
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Makoto Hirao
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hideki Tsuboi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Shoichi Kaneshiro
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Masataka Nishikawa
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization, Osaka Hospital, Osaka, Japan
| | - Atsushi Goshima
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization, Osaka Hospital, Osaka, Japan
| | - Takaaki Noguchi
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan
| | - Hiroyuki Nakaya
- Department of Orthopaedic Surgery, Toneyama National Hospital, Osaka, Japan
| | - Yuki Etani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Akira Miyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kenji Takami
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jun Hashimoto
- Department of Rheumatology, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Watson TS, Panicco J, Parekh A. Allograft Tendon Interposition Arthroplasty of the Hallux Metatarsophalangeal Joint: A Technique Guide and Literature Review. Foot Ankle Int 2019; 40:113-119. [PMID: 30379090 DOI: 10.1177/1071100718807738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The "anchovy" interpositional arthroplasty technique can be used as a salvage option for failed hallux rigidus procedures. The operative technique utilized by the senior author is described. Careful soft-tissue handling, meticulous joint space and graft preparation, and interposition graft stabilization using a bone tunnel and suture anchors are unique aspects of this technique, which in the authors' experience have contributed to improved outcomes. Current literature regarding indications and outcomes is limited and controversial. The proposed benefits of soft-tissue interposition arthroplasty of the hallux metatarsophalangeal joint for patients with prior failed implant arthroplasty are improved pain scores and preservation of range of motion. Level of Evidence: Level V, technique guide.
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Affiliation(s)
- Troy S Watson
- 1 Foot and Ankle Institute, Desert Orthopaedic Center, Las Vegas, NV, USA
| | - Jordan Panicco
- 1 Foot and Ankle Institute, Desert Orthopaedic Center, Las Vegas, NV, USA
| | - Amit Parekh
- 2 Valley Hospital Medical Center, Las Vegas, NV, USA
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Vulcano E, Chang AL, Solomon D, Myerson M. Long-Term Follow-up of Capsular Interposition Arthroplasty for Hallux Rigidus. Foot Ankle Int 2018; 39:1-5. [PMID: 28975843 DOI: 10.1177/1071100717732124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Capsular interposition arthroplasty is a joint- and motion-sparing procedure that has been shown as an effective alternative to fusion. This study aimed to evaluate patient function and satisfaction after long-term follow-up. METHODS Sixty-four patients were treated with capsular interposition arthroplasty for hallux rigidus by the senior author performed between February 1998 and July 2011. Twenty-two patients could not be reached for follow-up and were thus excluded from the analysis. Therefore, 42 remaining patients were evaluated using the visual analog scale (VAS), Foot Function Index (FFI), Short Form 12 (SF-12), and patient satisfaction scores. The mean follow-up was 11.3 (range, 4-16) years. RESULTS The mean VAS for pain was 7.9 preoperatively and 1.8 postoperatively ( P = .003). The mean preoperative SF-12 physical score was 42.0 vs 64.2 postoperatively ( P = .02). The mean preoperative SF-12 mental score was 50.7, while the postoperative SF-12 mental score was 54.6 ( P = .01). The total FFI score also significantly improved, with a preoperative value of 98.3 and a postoperative mean score of 49.6 ( P = .001). The mean patient satisfaction score was 7.4 of 10. Overall, 39 of 42 patients (92.9%) stated they would have the surgery again. Four of the 42 patients (9.5%) required conversion to hallux metatarsophalangeal fusion at a mean of 6.1 years after the index procedure secondary to pain, but no other complications were reported. CONCLUSION Capsular interposition arthroplasty was a safe and effective treatment for severe hallux rigidus. These longer term results demonstrate a high level of patient satisfaction. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | | | | | - Mark Myerson
- 2 The Foot and Ankle Association, Inc, Baltimore, MD, USA
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Lam A, Chan JJ, Surace MF, Vulcano E. Hallux rigidus: How do I approach it? World J Orthop 2017; 8:364-371. [PMID: 28567339 PMCID: PMC5434342 DOI: 10.5312/wjo.v8.i5.364] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/20/2017] [Accepted: 04/06/2017] [Indexed: 02/06/2023] Open
Abstract
Hallux rigidus is a degenerative disease of the first metatarsalphalangeal (MTP) joint and affects 2.5% of people over age 50. Dorsal osteophytes and narrowed joint space leads to debilitating pain and limited range of motion. Altered gait mechanics often ensued as 119% of the body force transmit through the 1st MTP joint during gait cycle. Precise etiology remains under debate with trauma being often cited in the literature. Hallux valgus interphalangeus, female gender, inflammatory and metabolic conditions have all been identified as associative factors. Clinical symptoms, physical exam and radiographic evidence are important in assessing and grading the disease. Non-operative managements including nonsteroidal antiinflammatory drugs, intra-articular injections, shoe modification, activity modification and physical therapy, should always be attempted for all hallux rigidus patients. The goal of surgery is to relieve pain, maintain stability of the first MTP joint, and improve function and quality of life. Operative treatments can be divided into joint-sparing vs joint-sacrificing. Cheilectomy and moberg osteotomy are examples of joint-sparing techniques that have demonstrated great success in early stages of hallux rigidus. Arthrodesis is a joint-sacrificing procedure that has been the gold standard for advanced hallux rigidus. Other newer procedures such as implant arthroplasty, interpositional arthroplasty and arthroscopy, have demonstrated promising early patient outcomes. However, future studies are still needed to validate its long-term efficacy and safety. The choice of procedure should be based on the condition of the joint, patient's goal and expectations, and surgeon's experience with the technique.
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