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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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Balesar VV, Koster LA, Kaptein BL, Keizer SB. Five-Year Prospective Roentgen Stereophotogrammetric and Clinical Outcomes of the BioPro MTP-1 Hemiarthroplasty. Foot Ankle Int 2022; 43:637-645. [PMID: 34962173 DOI: 10.1177/10711007211061366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mixed results for functional outcomes and long-term fixation have been reported for first metatarsophalangeal arthroplasty. This prospective study was designed to evaluate the migration of the BioPro metatarsophalangeal-1 (MTP-1) joint hemiprosthesis with Roentgen stereophotogrammetric analysis (RSA). Migration patterns of the prosthesis, prosthesis-induced erosion of the metatarsal bone, and clinical outcomes were evaluated sequentially to 5 years postoperation (PO). METHODS Eleven female patients received the BioPro-1 hemiprosthesis. Prosthesis translation and metatarsal erosion were measured with RSA at immediately PO, 6 weeks, and 3, 6, 12, 36, and 60 months postoperatively. Clinical assessment was done by patient questionnaires. RESULTS RSA data of 9 patients were available for analysis. Median (range) number of markers used in RSA analysis, condition number, and mean error of markers around the prosthesis were 4 (3-7), 320 (208-862), and 0.13 (0.02-0.28), respectively. Progressive subsidence was seen up to 3 years PO (mean 2.1 mm, SE 0.32). Progressive metatarsal erosion was found from 1 year PO (mean 0.49 mm, SE 0.15). Pain, function, and quality scores improved after surgery and did not deteriorate at later follow-up moments. CONCLUSION Model-based RSA of the BioPro-1 prosthesis shows nonstabilizing medial and distal translation and metatarsal erosion. Despite the measured migration and erosion, clinical outcomes improved and remained similar up to 5 years postoperation. LEVEL OF EVIDENCE Level II, prospective analysis of MTP-1 hemiprosthesis.
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Affiliation(s)
| | | | - Bart L Kaptein
- Leiden Universitair Medisch Centrum, Leiden, the Netherlands
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Metallic hemiarthroplasty or arthrodesis of the first metatarsophalangeal joint as treatment for hallux rigidus: A systematic review and meta-analysis. Foot Ankle Surg 2022; 28:139-152. [PMID: 33812802 DOI: 10.1016/j.fas.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/06/2021] [Accepted: 03/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthrodesis and metallic hemiarthroplasty are two surgical interventions for the treatment of end-stage osteoarthritis of the first metatarsophalangeal (MTP1) joint. This systematic review and meta-analysis aims to compare the two operations with regards to patient-reported outcomes, pain reduction, complications and revision rates. METHODS A systematic literature search identified all relevant studies. The methodological quality was assessed using two validated tools. Data of interest were derived and presented. For non-comparative studies, data was assessed for trends, while for comparative studies pooling statistics were performed. RESULTS A total of 33 studies were included for analysis. The majority of studies (>75%) reported an AOFAS-HMI score greater than 80 points after both metallic hemiarthroplasty and arthrodesis. The lowest VAS pain score was observed after arthrodesis (weighted mean difference -1.58, 95% confidence interval (CI) -2.16 to -1.00 P< 0.00001). Comparable numbers of complications (odds radio 1.48, 95% CI 0.81 to 2.73, P = 0.21, favoring: hemiarthroplasty) and revisions (odds ratio 1.16, 95% CI 0.62 to 2.15 P = 0.64, favoring: hemiarthroplasty) were observed after both interventions. The included non-comparative studies seem to confirm these findings of the comparative studies. CONCLUSION Metallic hemiarthroplasty and arthrodesis have excellent clinical outcomes and acceptable complication- and revision rates. Arthrodesis seems to be superior in pain reduction, while metallic hemiarthroplasty is a suitable alternative for patients performing activities that requires motion in the first metatarsophalangeal joint.
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Schramm M, Maestro M, Decroocq L. Metatarsophalangeal HAPY® spherical pyrocarbon implant: Technical note. Orthop Traumatol Surg Res 2021; 107:102926. [PMID: 33845174 DOI: 10.1016/j.otsr.2021.102926] [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: 10/30/2018] [Revised: 09/25/2020] [Accepted: 11/05/2020] [Indexed: 02/03/2023]
Abstract
We present a new arthroplasty concept for the first metatarsophalangeal joint (MTP1) involving the HAPY® pyrocarbon interposition implant. This is a spherical implant that does not integrate into bone. Instead, the goal is to achieve gliding of the implant on the bone/cartilage to maintain the function and mobility of the MTP1 joint. We describe the surgical technique used for its implantation. Since the implant is not anchored into bone, it is stabilized in a spherical cavity hollowed out in the metatarsal head. In a preliminary study of 22 cases with a mean follow-up of 36 (20-79) months, the mean AOFAS score improved from 64 (35-72) preoperatively to 91 (47-100) postoperatively (p<0.05). At the final assessment, no subchondral cyst or osteolysis was visible.
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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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Drobnič M, Vannini F, Kon E, Dulić O, Kecojević V, Andor B, Altschuler N, Robinson D. Treatment of hallux rigidus by a novel bi-phasic aragonite-based implant: results of a two year multi-centre clinical trial. INTERNATIONAL ORTHOPAEDICS 2020; 45:1033-1041. [PMID: 33184685 DOI: 10.1007/s00264-020-04872-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE The two year results of a multi-centre clinical trial were examined to evaluate surgical treatment of hallux rigidus using a novel, bi-phasic, biodegradable, and cell-free aragonite-based scaffold (Agili-C™, CartiHeal Ltd, Israel). METHODS Twenty patients with moderate-to-severe hallux rigidus were recruited. After thorough metatarsophalangeal joint (MTPJ-1) debridement, the scaffolds were implanted into the defect centre. Eight patients received concomitant osteotomy. Treatment outcome was followed clinically (Pain VAS, FAAM-ADL, FAAM-Sport, AOFAS-HMIS, maximum active range of extension ROM-EXT, and flexion ROM-FLEX), and by medical imaging, at six month intervals for two years. Adverse events were recorded throughout the study follow-up period. RESULTS Significant clinical improvement over time was observed in all evaluated parameters (screening to final evaluation averages: Pain VAS 59 to 26, FAAM-ADL 57 to 77, FAAM-Sport 39 to 66, AOFAS-HMIS 51 to 81, ROM-EXT 18° to 36°), except for ROM-FLEX. Radiographs showed stable MTPJ-1 width over the two years in 17/18 cases (94%). MRI demonstrated progressive implant biodegradation, coupled with articular cartilage and subchondral bone regeneration, with a repair tissue defect fill of 75-100% in 14/17 (82%) subjects at their final visit. Revision surgery with implant removal was performed in two patients. CONCLUSION Bi-phasic, osteochondral, biodegradable, aragonite-based scaffold demonstrated positive clinical outcome and a good safety profile in the treatment of medium-to-advanced hallux rigidus. According to the medical imaging, this implant has the potential to restore the entire osteochondral unit of metatarsal head.
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Affiliation(s)
- Matej Drobnič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Zaloška ulica 9, SI-1000, Ljubljana, EU, Slovenia. .,Chair of Orthopedics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - Francesca Vannini
- Clinic 1, Orthopedic Institute Rizzoli, Bologna University, Bologna, Italy
| | - Elizaveta Kon
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Oliver Dulić
- Department for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, Novi Sad, Serbia.,Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Vaso Kecojević
- Department for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Bogdan Andor
- Department of Orthopedics, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Dror Robinson
- Faculty of Medicine, Hasharon Hospital Affiliated to Tel Aviv University, Petah Tikwa, Israel
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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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Surgical options for hallux rigidus: state of the art and review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:57-65. [DOI: 10.1007/s00590-019-02528-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 12/14/2022]
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