1
|
Fragnière N, Kameni-Hekam M, Cissé A, Vienne P. Primary Isolated Arthrodesis of the First Metatarsophalangeal Joint for Hallux Rigidus: Clinical, Radiologic, and Pedobarographic Evaluation. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241265344. [PMID: 39070905 PMCID: PMC11283670 DOI: 10.1177/24730114241265344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Background Arthrodesis of the first metatarsophalangeal joint is an effective treatment of advanced hallux rigidus. Numerous options have been described for performing this intervention. The aim of this study was to evaluate the outcomes following a consistent surgical technique of joint preparation with hand tools and fixation with 2 crossed screws and a dorsal compression plate. Methods Thirteen patients (16 feet) who underwent primary isolated arthrodesis of the first metatarsophalangeal joint between March 2019 and June 2021 were available for clinical, radiologic, and pedobarographic evaluation at a minimum of 12 months after surgery. American Orthopaedic Foot & Ankle Society scores, numerical pain rating scale, the radiologic hallux valgus and intermetatarsal 1-2 angles as well as the distribution of plantar pressure during gait were compared between the pre- and postoperative conditions. Results After an average follow-up period of 26 months, union was achieved in all cases and the mean AOFAS score raised significantly by 39 points. All the patients were satisfied with the result. Only 1 patient complained of mild residual pain at walk. Hardware removal was performed in 2 cases. The mean hallux valgus angle dropped from 12.3 to 6.3 degrees. The mean postoperative dorsiflexion angle was 21.6 degrees. After the procedure, peak pressure was significantly higher beneath the first metatarsal head and heel, whereas pressure-time integral was significantly lower beneath the hallux and medial lesser toes. Conclusion Arthrodesis of the first metatarsophalangeal joint with 2 crossed screws and a dorsal compression plate is a safe and effective treatment of advanced hallux rigidus. This procedure provides adequate pain relief and functional improvement of gait. Level of Evidence Level IV, therapeutic, retrospective case series.
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Rajan RA, Kerr M, Hafesji-Wade A, Osler CJ, Outram T. A prospective clinical and biomechanical analysis of feet following first metatarsophalangeal joint arthrodesis for end stage hallux rigidus. Gait Posture 2024; 109:208-212. [PMID: 38350185 DOI: 10.1016/j.gaitpost.2024.02.010] [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: 06/30/2023] [Revised: 01/22/2024] [Accepted: 02/09/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Hallux Rigidus is the result of degeneration of the 1st metatarsophalangeal joint (1st MTPJ). In end-stage hallux rigidus, treatment is mainly surgical with arthrodesis being a favourable option. Although the biomechanical effects of arthrodesis have been examined, a detailed comparison of pre- and post-operative biomechanics has yet to be conducted. RESEARCH QUESTION Does 1st MTPJ arthrodesis positively affect foot kinematics and plantar pressure distribution? METHODS Twelve 1st MTPJ arthrodesis were performed in patients with a mean age of 53.5 ± 5.4 years and follow up time of 6.9 ± 1.0 months. Pre- and post-operative data were collected at a CMAS (Clinical Movement Analysis Society) accredited gait laboratory using a BTS motion capture system and pedobarographic pressure plates. Patient outcome measures were also assessed using the MOXFQ. Statistical analysis was conducted using a two-way repeated measures ANOVA. RESULTS Significant changes in stride length, cycle duration, cadence and velocity were identified following 1st MTPJ arthrodesis. A significant reduction in forefoot-hallux dorsiflexion at toe-off was identified for the operated foot from the pre-operative (20.23 ± 5.98°) to post-operative (7.56 ± 2.96°) assessment. Post-operative sagittal and transverse plane changes in the operated foot were also identified. Peak pressure and PTI results indicated significant lateralisation of load for the operated foot, but importantly this was not influenced following arthrodesis. Finally, there was a significant improvement in MOXFQ score. SIGNIFICANCE Following 1st MTPJ fusion there is an improvement in overall gait mechanics which accompanied by the improved MOXFQ score indicates a reduction in pain and improved confidence during gait. The lack of post-operative dorsiflexion at forefoot-hallux caused load to remain lateralised and compensatory mechanisms to occur at the more proximal joints within the foot. These results provide valuable information for clinicians and will enable more accurate counselling to be provided to patients with end-stage hallux rigidus.
Collapse
Affiliation(s)
- R A Rajan
- University Hospitals of Derby & Burton, Uttoxeter Road, Derby DE22 2NE, UK; University of Derby, Kedleston Road, Derby DE22 1GB, UK.
| | - M Kerr
- University Hospitals of Derby & Burton, Uttoxeter Road, Derby DE22 2NE, UK
| | - A Hafesji-Wade
- University Hospitals of Derby & Burton, Uttoxeter Road, Derby DE22 2NE, UK
| | - C J Osler
- University of Derby, Kedleston Road, Derby DE22 1GB, UK
| | - T Outram
- University of Derby, Kedleston Road, Derby DE22 1GB, UK
| |
Collapse
|
4
|
Di Caprio F, Mosca M, Ceccarelli F, Caravelli S, Di Ponte M, Zaffagnini S, Ponziani L. Interposition Arthroplasty in the Treatment of End-Stage Hallux Rigidus: A Systematic Review. Foot Ankle Spec 2023; 16:547-557. [PMID: 34724832 DOI: 10.1177/19386400211053947] [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: 11/16/2022]
Abstract
PURPOSE Patients affected by moderate to severe hallux rigidus may opt for interposition arthroplasty to avoid the movement restrictions of arthrodesis and the complications related to prosthetic replacement. The propose of this article was to review the current literature about interposition arthroplasty to examine the overall outcomes and to evaluate the advantages and disadvantages of different types of technique, compared with more consolidated procedures. METHODS A literature PubMed search was performed. Studies reporting the results of interposition arthroplasty in moderate to severe hallux rigidus were included. The data were pooled and weighted for number of patients in every study. RESULTS The overall results for interposition arthroplasties are comparable to other alternatives for end-stage hallux rigidus, providing better plantar load distribution than arthrodesis and avoiding the drawbacks of prosthetic replacement. Among the various interposition arthroplasty techniques, the Modified Oblique Keller Capsular Interposition Arthroplasty technique preserves toe length and flexor hallucis brevis function, showing the highest satisfaction rate, with lowest metatarsalgia and revision rate. CONCLUSION Although long-term randomized controlled trials are lacking for interposition arthroplasty, it represents a valid alternative for the treatment of end-stage hallux rigidus also in the young active patient who wants to avoid a definitive intervention immediately. LEVEL OF EVIDENCE III (systematic review of level III-IV-V studies).
Collapse
Affiliation(s)
| | - Massimiliano Mosca
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | | | - Silvio Caravelli
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Marco Di Ponte
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Stefano Zaffagnini
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Lorenzo Ponziani
- Operating Unit of Orthopaedics and Traumatology, ISS, Cailungo, San Marino
| |
Collapse
|
5
|
de Bot R, Stevens J, Smeets T, Witlox A, Beertema W, Hendrickx R, Meijer K, Schotanus M. Gait and dynamic pedobarographic analyses in hallux rigidus patients treated with Keller's arthroplasty, arthrodesis or cheilectomy 22 years after surgery. PeerJ 2023; 11:e16296. [PMID: 38025694 PMCID: PMC10666645 DOI: 10.7717/peerj.16296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Keller's arthroplasty, arthrodesis and cheilectomy are well-known surgical interventions for hallux rigidus. This study aimed to evaluate the effects of these surgical interventions on gait, plantar pressure distribution and clinical outcome in patients treated for hallux rigidus 22 years after surgery. Methods Spatio-temporal gait parameters and plantar pressure distribution, determined as pressure time integrals (PTIs) and peak pressures (PPs), were analyzed using a 7-foot tone analysis model. Patient-reported outcome was assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ). Of the 73 patients (89 feet) from the original study, 27 patients (33 feet) and 13 healthy controls (26 feet) were available for evaluation 22 years after hallux rigidus surgery. Results Spatio-temporal gait parameters were comparable between all groups and were in line with healthy controls (P > 0.05). No differences (P > 0.05) in PTIs and PPs were found in the seven plantar zones between groups and as compared to healthy controls. MOXFQ scores in all domains (walking/standing, range 21.4-24.1; pain, range 16.5-22.2 and social interaction, range 23.8-35.4) were not clinically and statistically different (P > 0.05) between the three different surgical interventions. Conclusion These results suggest no long-term functional and biomechanical differences after these surgical interventions for hallux rigidus correction. The interventions seem to be appropriate treatment options for a selective group of patients with symptomatic hallux rigidus.
Collapse
Affiliation(s)
- Robin de Bot
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Geleen, Limburg, The Netherlands
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Jasper Stevens
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Geleen, Limburg, The Netherlands
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Thijs Smeets
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Geleen, Limburg, The Netherlands
- Smeets Loopcomfort, Sittard, Limburg, The Netherlands
| | - Adhiambo Witlox
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Wieske Beertema
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Geleen, Limburg, The Netherlands
| | - Roel Hendrickx
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Geleen, Limburg, The Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Martijn Schotanus
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Geleen, Limburg, The Netherlands
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine & Life Sciences, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| |
Collapse
|
6
|
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 2023:19386400221147773. [PMID: 36727310 DOI: 10.1177/19386400221147773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [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.
Collapse
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
| | | |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Stevens J, de Bot RTAL, Hermus JPS, Schotanus MGM, Meijer K, Witlox AM. Gait analysis of foot compensation in symptomatic Hallux Rigidus patients. Foot Ankle Surg 2022; 28:1272-1278. [PMID: 35717495 DOI: 10.1016/j.fas.2022.06.001] [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: 09/05/2021] [Revised: 03/31/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Compensatory motion of foot joints in hallux rigidus (HR) are not fully known. This study aimed to clarify the kinematic compensation within the foot and to detect whether this affects plantar pressure distribution. METHODS Gait characteristics were assessed in 16 patients (16 feet) with HR and compared with 15 healthy controls (30 feet) with three-dimensional gait analysis by using the multi-segment Oxford Foot Model, measuring spatio-temporal parameters, joint kinematics and plantar pressure. RESULTS HR subjects showed less hallux plantar flexion during midstance and less hallux dorsiflexion during push-off, while increased forefoot supination was detected during push-off. No significant differences in plantar pressure were detected. Step length was significantly smaller in HR subjects, while gait velocity was comparable between groups. CONCLUSIONS HR significantly affects sagittal hallux motion, and the forefoot compensates by an increased supination during push-off. Despite this kinematic compensatory mechanism, no significant differences in plantar loading were detected.
Collapse
Affiliation(s)
- Jasper Stevens
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Robin T A L de Bot
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Joris P S Hermus
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Martijn G M Schotanus
- Department of Orthopedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, Heerlen, the Netherlands; School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Adhiambo M Witlox
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands.
| |
Collapse
|
9
|
Althoff AD, Ramamurti P, Vennitti C, Kamalapathy P, Park JS, Werner BC, Cooper MT. Preoperative Risk Factors for Primary Metatarsophalangeal Arthroplasty Revision to MTP Arthrodesis for Hallux Rigidus. Foot Ankle Int 2022; 43:1242-1249. [PMID: 35642682 DOI: 10.1177/10711007221094837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Revision or conversion to arthrodesis following metatarsophalangeal (MTP) joint arthroplasty are salvage procedures to manage complications of MTP joint arthroplasty. The purpose of this study is to use a national administrative database to characterize nationwide trends of patients undergoing hallux MTP arthrodesis vs arthroplasty for hallux rigidus. Additionally, the authors sought to evaluate demographic trends and evaluate influence of patient-related risk factors in those undergoing MTP arthroplasty revision to arthrodesis. METHODS Patients who underwent MTP arthroplasty for diagnosis of hallux rigidus from 2010 to 2019 were identified in the Mariner subset of the PearlDiver database. Patients were included if they had undergone MTP arthroplasty for the diagnosis of hallux rigidus. Notably, the database lacks resolution about critical features of the arthroplasty design and materials. The revision cohort encompassed patients who underwent subsequent ipsilateral MTP arthrodesis or arthroplasty within 2 years of index arthroplasty procedure. Demographic characteristics and medical comorbidities were examined as potential patient-related risk factors for arthroplasty revision or revision to fusion. Univariate analyses were performed to analyze differences in patient demographics, comorbidities, and risk factors. A multivariate regression analysis was subsequently conducted to control for confounding variables. RESULTS 2750 patients underwent primary MTP arthroplasty for diagnosis of hallux rigidus. Of these, 44 (1.6%) underwent revision arthroplasty and 188 patients (6.8%) were revised to arthrodesis within the first 2 years after the index procedure. Multivariate regression analysis indicates that obesity (odds ratio [OR] 1.48, 95% CI 1.05-2.09), depression (OR 1.59, 95% CI 1.15-2.20), and steroid use (OR 2.94, 95% CI 1.30-6.65) were associated with a statistically significant increase in revision to arthrodesis from primary arthroplasty. CONCLUSION Revision arthrodesis following primary MTP arthroplasty for hallux rigidus within 2 years was found to be a relatively common occurrence in this national insurance database study. Risk factors for revision arthroplasty to arthrodesis within 2 years of primary arthroplasty include obesity, depression, and steroid use. LEVEL OF EVIDENCE Level III, case-control study.
Collapse
Affiliation(s)
- Alyssa D Althoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Corinne Vennitti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Joseph S Park
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Minton T Cooper
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
10
|
Hanslik-Schnabel B, Flöry D, Borchert GH, Schanda JE. Clinical and Radiologic Outcome of First Metatarsophalangeal Joint Arthrodesis Using a Human Allogeneic Cortical Bone Screw. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221112944. [PMID: 35924004 PMCID: PMC9340918 DOI: 10.1177/24730114221112944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Different fixation techniques are established for first metatarsophalangeal joint (MTPJ) arthrodesis, including compression screws, plates, Kirschner wires, metal- and bioabsorbable screws as well as staples. The purpose of this study was to investigate and present first clinical and radiologic results using a novel human, allogeneic cortical bone screw for arthrodesis of the first MTPJ. Methods: Arthrodesis of the first MTPJ was performed in 31 patients with hallux rigidus. Percentage union and time to union were the first outcomes; visual analog scale for pain, hallux valgus angle (HVA), intermetatarsal angle, and American Orthopaedic Foot & Ankle Society (AOFAS) hallux score were secondary outcomes. Results: Median time to union was 89 days, and union was observed in all patients. There were 4 complications (2 osteolysis margin, 1 cystic brightening, and 1 severe swelling at the first follow-up) all of that resolved at last follow-up. Pain significantly decreased from visual analog scale 8.0 to 0.2 points ( P < .0001). The HVA decreased from 30.4 to 10.2 degrees in the patient group with deformities. The total AOFAS score increased significantly from 48 to 87 ( P < .0001). Conclusion: Primary and revision arthrodesis of hallux rigidus with the human, allogeneic cortical bone screw reveals satisfying results similar to clinical and radiologic outcomes of other surgical techniques. Within 1 year, the human, allogeneic cortical bone screw is fully remodeled to host bone. Level of Evidence: Level IV, retrospective case series without control group.
Collapse
Affiliation(s)
- Beatrice Hanslik-Schnabel
- Sickness Welfare Institution for the Employees of the City of Vienna, Sanatorium Hera, Vienna, Austria
| | - Daniel Flöry
- Department for Radiology, Diakonissenhospital Linz, Linz, Austria
| | | | - Jakob E. Schanda
- AUVA Trauma Center Vienna-Meidling, Vienna, Austria
- Ludwig Boltzmann Institut for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| |
Collapse
|
11
|
Grimm MPD, Irwin TA. Complications of Hallux Rigidus Surgery. Foot Ankle Clin 2022; 27:253-269. [PMID: 35680287 DOI: 10.1016/j.fcl.2021.11.016] [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: 02/02/2023]
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.
Collapse
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.
| |
Collapse
|
12
|
Hassel K. Unterschiede in der Therapie entzündlich rheumatischer und
degenerativer Füße. Die Vorfußchirurgie. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1814-4096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDer Unterschied zwischen rheumatischen und degenerativen Veränderungen am
Fuß liegt in der fortschreitenden Destruktion der Gelenke bei
persistierender Synovialitis der rheumatoiden Arthritis (RA). Unter der heute
wirksameren immunsuppressiven Therapie und eines frühen und aggressiven
Beginns zeigen sich mildere Verlaufsformen. So können zunehmend auch
gelenkerhaltende Verfahren der Vorfußchirurgie Anwendung finden.
Entscheidend ist hier jedoch die Remission mit sicherer Krankheitskontrolle
für den gelenkerhaltenden Eingriff. Dennoch ist das Rezidiv- und
Fehlstellungsrisiko aufgrund wiederkehrender arthritischer Phasen höher.
Rheumaorthopädische Standardverfahren, wie die Arthrodese des
Großzehengrundgelenkes mit Resektion der Metatarsaleköpfchen
haben aber Ihren Stellenwert beim Vollbild des erosiven rheumatischen
Vorfußes nicht verloren. Ein standardisiertes Vorgehen fehlt. Umso
wichtiger ist es, mit jedem Patienten individuell die richtigen
Maßnahmen zu festzulegen.
Collapse
Affiliation(s)
- Kathryn Hassel
- Orthopädische Rheumatologie, Vitos Orthopadische Klinik Kassel
gGmbH, Kassel, Germany
| |
Collapse
|
13
|
Artioli E, Mazzotti A, Zielli S, Bonelli S, Arceri A, Geraci G, Faldini C. Keller's arthroplasty for hallux rigidus: A systematic review. Foot Ankle Surg 2022; 28:526-533. [PMID: 35279396 DOI: 10.1016/j.fas.2022.02.019] [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: 01/13/2022] [Revised: 01/25/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several surgical procedures have been described to treat hallux rigidus. Keller arthroplasty is a joint-sacrificing procedure proposed in 1904. Considering the current trends to mini-invasiveness and the debate about the technique's suitability, this review intends to state Keller arthroplasty results and the conditions where it could be still adopted in the treatment of hallux rigidus. METHODS Selected articles were reviewed to extract: population data, surgical indications, different surgical techniques, clinical and radiological outcomes, and complications. RESULTS Seventeen retrospective studies were selected, counting 508 patients. Mean age at surgery was 55 years. Patients were affected by moderate-severe hallux rigidus. Three modified Keller arthroplasty were identified. Good clinical and radiological outcomes were reported. Metatarsalgia was the most frequent complication (12%). CONCLUSION Despite for many authors KA seems a viable surgical treatment for middle aged and elderly patients affected by moderate-severe hallux rigidus, the available literature provides little evidence on the real efficacy and safety of the technique. A non-negligible percentage of complications may occur, and therefore is essential to set correct indications through an accurate patients' selection.
Collapse
Affiliation(s)
- E Artioli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - A Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy.
| | - S Zielli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - S Bonelli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - A Arceri
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - G Geraci
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - C Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
| |
Collapse
|
14
|
Kang YS, Bridgen A. First metatarsophalangeal joint arthrodesis/fusion: a systematic review of modern fixation techniques. J Foot Ankle Res 2022; 15:30. [PMID: 35468802 PMCID: PMC9040205 DOI: 10.1186/s13047-022-00540-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background First metatarsophalangeal joint arthrodesis is commonly performed for symptomatic end-stage hallux rigidus. It has been postulated to produce good results in the literature. Various fixation techniques offer differences in union rates, complications and functional outcomes, stirring debates about which produces the best outcomes for patients. Therefore, this review aims to synthesise and compare the outcomes of modern fixation techniques used for first metatarsophalangeal joint (FMPJ) arthrodesis. Methods The electronic database searched were PubMed, CINAHL, Cochrane Library, and Google Scholar. The critical appraisal skills programme tool for cohort study was used. The interventions consisted of screw(s), plate(s), and staple(s). Studies comprising outdated fixation techniques such as suture, metallic wire, external fixation, Rush rods or Steinmann pins were excluded. Participants were adults over 18 years, undergoing FMPJ arthrodesis in the UK. Studies with the population consisting primarily of revision cases, patients with rheumatoid arthritis or diabetes were excluded. Results Seven UK studies included 277 feet and a 95.7% overall union rate at a mean union time of 83.5 days. Staples had the highest union rate of 98.2% at mean union time of 84 days, followed by plates (95.2%, 92 days), and finally screws (94.9%, 71 days). The overall complication incidence is 5.8%. All of the fixation techniques produced good functional outcomes postoperatively. Conclusions Whilst staple techniques showed the highest union rate, plating techniques are preferable over screws or staples for better results across several outcome measures, including reduced complication incidence, stability, early ambulation, and good functional outcome. The Manchester-Oxford Foot Questionnaire and EuroQol-5Dimensional are recommended as measurement tools to assess functional outcomes following FMPJ arthrodesis. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00540-9.
Collapse
Affiliation(s)
- Yang S Kang
- Department of Podiatry, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.
| | - Andy Bridgen
- Department of Podiatry, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| |
Collapse
|
15
|
Metallic hemiarthroplasty or arthrodesis of the first metatarsophalangeal joint as treatment for hallux rigidus: A systematic review and meta-analysis. Foot Ankle Surg 2022; 28:139-152. [PMID: 33812802 DOI: 10.1016/j.fas.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/06/2021] [Accepted: 03/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthrodesis and metallic hemiarthroplasty are two surgical interventions for the treatment of end-stage osteoarthritis of the first metatarsophalangeal (MTP1) joint. This systematic review and meta-analysis aims to compare the two operations with regards to patient-reported outcomes, pain reduction, complications and revision rates. METHODS A systematic literature search identified all relevant studies. The methodological quality was assessed using two validated tools. Data of interest were derived and presented. For non-comparative studies, data was assessed for trends, while for comparative studies pooling statistics were performed. RESULTS A total of 33 studies were included for analysis. The majority of studies (>75%) reported an AOFAS-HMI score greater than 80 points after both metallic hemiarthroplasty and arthrodesis. The lowest VAS pain score was observed after arthrodesis (weighted mean difference -1.58, 95% confidence interval (CI) -2.16 to -1.00 P< 0.00001). Comparable numbers of complications (odds radio 1.48, 95% CI 0.81 to 2.73, P = 0.21, favoring: hemiarthroplasty) and revisions (odds ratio 1.16, 95% CI 0.62 to 2.15 P = 0.64, favoring: hemiarthroplasty) were observed after both interventions. The included non-comparative studies seem to confirm these findings of the comparative studies. CONCLUSION Metallic hemiarthroplasty and arthrodesis have excellent clinical outcomes and acceptable complication- and revision rates. Arthrodesis seems to be superior in pain reduction, while metallic hemiarthroplasty is a suitable alternative for patients performing activities that requires motion in the first metatarsophalangeal joint.
Collapse
|
16
|
Mosca M, Caravelli S, Vocale E, Fuiano M, Massimi S, Di Ponte M, Censoni D, Grassi A, Ceccarelli F, Zaffagnini S. Hallux valgus associated to osteoarthritis: Clinical-radiological outcomes of modified SERI technique at mid- to long-term follow-up. A retrospective analysis. Foot Ankle Surg 2022; 28:49-55. [PMID: 33574005 DOI: 10.1016/j.fas.2021.01.012] [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: 09/07/2020] [Revised: 01/08/2021] [Accepted: 01/23/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Treatment of hallux valgus deformity associated with mild or moderate osteoarthritis (OA) is still a topic of debate. In the literature, there are few studies concerning the management of patients affected by this condition. This study aims to report the experience at mid- to long-term results of an original joint-preserving surgical technique. MATERIALS AND METHODS Patients affected by mild to moderate hallux valgus deformity and associated to grade 1-2 OA and treated with modified Simple-Effective-Rapid-Inexpensive (SERI) technique from 2008 to 2018 were selected. Inclusion criteria were mild or moderate hallux valgus angle (HVA) <40° and an intermetatarsal angle (IMA) <20° and associated grade 1-2 OA of the first metatarso-phalangeal joint (MTPJ). RESULTS 128 feet in 120 consecutive patients, undergone modified SERI procedure, have been retrospectively reviewed at a mean follow-up of 5.1 ± 3.8 years (range 2-11). American Orthopaedics Foot Ankle Society (AOFAS) score that was significantly improved from 44.2 ± 13.2 to 88.2 ± 9.6. Pre-operative average HVA and IMA values decreased respectively from 31.6° ± 3.9° to 9.1° ± 4.4° and from 16.2° ± 3.8° to 7.2° ± 3.1°. The average distal metatarsal articular angle (DMAA) value improved from 28.2° ± 6.5° to 7.1° ± 6°. OA of the first MTPJ highlighted a grade 1 in 46 feet and a grade 2 in 82 feet pre-operatively and a grade 0 in 30 feet, grade 1 in 82 feet, and grade 2 in 16 feet at the final follow-up. CONCLUSIONS The modifications to the SERI technique could extend the indications to patients affected by hallux valgus with mild to moderate OA. The wider case series and the longer follow-up of this study make us believe this technique is very useful for improving the quality of life in these patients. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- M Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - E Vocale
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Massimi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - D Censoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Grassi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - F Ceccarelli
- Clinica Ortopedica, Azienda ospedaliero-universitaria Parma, Parma, Italy
| | - S Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
17
|
Rajan R, Mishra A. A systematic review of total arthroplasty and arthrodesis for end-stage hallux rigidus: A biomechanical perspective. Foot (Edinb) 2021; 49:101838. [PMID: 34619518 DOI: 10.1016/j.foot.2021.101838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/25/2021] [Accepted: 05/24/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Both arthrodesis and total arthroplasty are acceptable surgical options for end stage hallux rigidus without significant angular deformity. Total arthroplasty preserves first metatarsophalangeal joint (MTPJ) motion, which may help restore a more physiological gait pattern. RESEARCH QUESTION Is there a difference in the findings of gait studies after 1st MTPJ total arthroplasty or arthrodesis for end-stage hallux rigidus? METHODS PRISMA guidelines were followed to conduct a systematic review of literature for studies reporting gait analysis after the above procedures. Predetermined criteria were used to select papers and evaluated the findings of kinematic (spatial-temporal and dynamic motion), kinetic and foot pressure (pedobarographic) studies. RESULTS 12 titles were short-listed for synthesis. There was 1 randomized controlled trial comparing the two procedures. Among the remaining cohort studies, 5 reported on total arthroplasty and 6 on arthrodesis of the 1st MTPJ. Due to significant heterogeneity, a narrative synthesis was undertaken. No studies in the arthroplasty group reported spatial-temporal or kinetic parameters. Only 2 papers, 1 in each group, recorded motion within the foot. One of them showed preserved dynamic motion at the 1st MTPJ after total arthroplasty. Pedobarographic studies had discordant findings in studies within both groups regarding restoration of weight bearing through the medial forefoot and the pulp of the great toe during gait. CONCLUSION Currently available studies are heterogenous and report inconsistent findings, which do not convincingly answer our research question. Prospective comparative studies with a large sample size, using standardized methodology in accredited laboratories with detailed reporting of kinetic, kinematic and pedobarographic components of gait analysis are required in order to draw concrete conclusions.
Collapse
Affiliation(s)
- Rohan Rajan
- Royal Derby Hospital, Uttoxeter Road, Derby, DE223NE, United Kingdom
| | - Arya Mishra
- Royal Derby Hospital, Uttoxeter Road, Derby, DE223NE, United Kingdom.
| |
Collapse
|
18
|
Rajan RA, Kerr M, Evans H, Outram T. A prospective clinical and biomechanical analysis of feet following first metatarsophalangeal joint replacement. Gait Posture 2021; 89:211-216. [PMID: 34340158 DOI: 10.1016/j.gaitpost.2021.07.020] [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: 10/07/2020] [Revised: 06/16/2021] [Accepted: 07/24/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is a lack of research providing a biomechanical outcome following 1st MTPJ replacement for hallux rigidus. Despite this, 1st MTPJ replacement continues to be an alternative surgical option to fusion for this painful debilitating condition. Several studies do consider the patient reported outcomes which are subjective. RESEARCH QUESTION The objective of this study is to provide an in depth biomechanical analysis to examine the effects of 1st MTPJ replacement for hallux rigidus on gait mechanics. METHODS Kinematic data was collected at our CMAS (Clinical Movement Analysis Society) UK accredited gait laboratory during the gait cycle together with pressure plate pressure readings and a validated patient outcome measure before surgery and at 6 and 12 months after surgery. A complete literature review is performed. RESULTS Kinematic data revealed a significant increase in stride length, cadence and velocity following 1st MTPJ replacement for hallux rigidus. Foot kinematic data revealed significantly reduced tibia-hindfoot abduction and pronation and reduced hindfoot-forefoot supination and adduction. There was no effect on 1st MTPJ weight bearing range of motion. Pressure plate data revealed an increase in peak pressure and pressure time integral towards the 1st metatarsal following surgery. There was a significant improvement in the patient reported outcome measure. SIGNIFICANCE This study has demonstrated objectively that following 1st MTPJ replacement, biomechanically, a restoration of the foot posture to allow medialisation of foot pressures towards the medial column and normalisation of gait including an increase in the stride length, cadence and velocity and that clinically, there was an improvement in the MOXFQ.
Collapse
Affiliation(s)
- R A Rajan
- University Hospitals of Derby & Burton, Uttoxeter Road, Derby, DE22 2NE, UK; University of Derby, Kedleston Road, Derby, DE22 1GB, UK; Gait Laboratory, University Hospitals of Derby & Burton, London Road Site, Derby, UK.
| | - M Kerr
- Gait Laboratory, University Hospitals of Derby & Burton, London Road Site, Derby, UK
| | - H Evans
- Gait Laboratory, University Hospitals of Derby & Burton, London Road Site, Derby, UK
| | - T Outram
- Department of Sport, Outdoor & Exercise Science, School of Human Sciences, University of Derby, Kedleston Road, Derby, UK
| |
Collapse
|
19
|
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.
Collapse
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)
| |
Collapse
|
20
|
Restuccia G, Cosseddu F, Del Chiaro A, Ceccoli M, Lippi A, Shytaj S. First metatarsophalangeal fusion with dorsal plate: clinical outcomes. J Orthop Surg Res 2021; 16:361. [PMID: 34092260 PMCID: PMC8183079 DOI: 10.1186/s13018-021-02453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND First metatarsophalangeal joint (MTPJ) fusion is the most effective technique for the treatment of MTPJ primary arthritis, severe hallux valgus and failure of primary corrective surgery of these conditions. It can be achieved through different techniques. We evaluated the outcomes in a cohort of patients treated with dorsal plate arthrodesis. MATERIALS AND METHODS We treated 30 feet for 28 patients; the mean follow-up was 35 months. For each foot, we collected radiological and clinical assessment, with the visual analogue scale (VAS) for pain and the Manchester and Oxford Foot questionnaire (MOFQ). The technique consisted in a cup and cone arthrodesis with the application of a low profile dorsal plate. Patients were allowed for immediate weight bearing. RESULTS Consolidation was achieved in all cases; in 29 cases, radiographic union was recorded within 6 months from surgery, in one case after 9 months. Comparison between the preoperative and postoperative of VAS and MOXFQ values showed a statistically significant difference (p < 0.05). Only one case developed wound dehiscence as complication. CONCLUSIONS Even if there is still a debate regarding the best system for MTPJ fusion, we believe cup and cone fusion with dorsal plating is an effective method. Moreover, the stability of the osteosynthesis obtained allows for immediate post-operative weight bearing, making patients able to return soon to their normal life. TRIAL REGISTRATION We present a retrospective study; all patients enrolled were retrospectively registered.
Collapse
Affiliation(s)
- Giuseppe Restuccia
- Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, 56123, Pisa, Italy
| | - Fabio Cosseddu
- Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, 56123, Pisa, Italy
| | - Andrea Del Chiaro
- Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, 56123, Pisa, Italy
| | - Matteo Ceccoli
- Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, 56123, Pisa, Italy
| | - Alessandro Lippi
- Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, 56123, Pisa, Italy
| | - Sheila Shytaj
- Orthopaedic and Trauma Unit, University of Pisa, Via Paradisa 2, 56123, Pisa, Italy.
| |
Collapse
|
21
|
Cöster ME, Montgomery F, Cöster MC. Patient-reported outcomes of joint-preserving surgery for moderate hallux rigidus: a 1-year follow-up of 296 patients from Swefoot. Acta Orthop 2021; 92:109-113. [PMID: 32972279 PMCID: PMC7919882 DOI: 10.1080/17453674.2020.1824762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Hallux rigidus (HR) may cause decreased range of motion, joint pain, and gait disturbances. There is a lack of evidence regarding the outcome of different surgical procedures for moderate HR. We report patient-reported outcomes after joint-preserving surgical procedures for moderate HR.Patients and methods - We included 296 patients registered in Swefoot (Swedish national registry of foot and ankle surgery) who underwent primary surgery for moderate HR 2014 through 2018. We extracted information on anthropometrics, grading of HR, chosen surgical procedure, and patient-reported data including the PROMs SEFAS (summary score 0-48) and EQ-5D-3L (index 0-1) preoperatively and 1 year postoperatively.Results - 115 patients underwent metatarsal decompression (i.e., Youngswick) osteotomy (YOT) and 181 underwent cheilectomy. The mean improvement in SEFAS score 1 year after surgery was 12 points (95% CI 10 - 13) for YOT and 10 points (CI 9 - 12) for cheilectomy. Also, EQ-5D improved in both groups. Patients who underwent YOT were more satisfied with the procedure (84% vs. 70% for cheilectomy, p = 0.02).Interpretation - Surgically treated patients with moderate HR improved after both YOT and cheilectomy, according to patient-reported data from Swefoot. Patients who underwent a YOT were more satisfied with their procedure. One possible explanation may be that more patients in the YOT group had a concomitant hallux valgus; however, we have no information on this.
Collapse
Affiliation(s)
- Marcus E Cöster
- Department of Clinical Sciences, Lund University; ,Department of Orthopedics, Central Hospital in Växjö; ,Correspondence:
| | | | - Maria C Cöster
- Department of Clinical Sciences, Lund University; ,Department of Orthopedics, Skåne University Hospital in Malmö, Sweden
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Clinical and radiological outcomes after arthrodesis of the first metatarsophalangeal joint. INTERNATIONAL ORTHOPAEDICS 2020; 45:711-719. [PMID: 32929546 DOI: 10.1007/s00264-020-04807-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The main aim of this study was to investigate the correlation between radiographic findings and clinical outcomes following the first metatarsophalangeal (MTP) joint arthrodesis. METHODS In a comparative retrospective study, on 46 patients (48 ft), the correlation between post-operative radiographic findings including hallux valgus angle (HVA) and first MTP dorsiflexion angle (MTPDA) and clinical outcomes including VAS pain, modified AOFAS hallux score, and FFI questionnaire were evaluated. Moreover, clinical outcomes were compared between cases with pre-operative diagnosis of first MTP inflammatory arthritis, hallux valgus, hallux varus, and grade 3 and 4 of hallux rigidus. The effect of first MTP arthrodesis on Meary's angle and intermetatarsal angle (IMA) were found out. RESULTS The mean age of the patients was 56.3 ± 9.1 (range, 29-69) years, including 42 (91.3%) females and 4 (8.7%) males. We had fusion rate of 97.9%, one asymptomatic nonunion case (2.1%). Totally, mean scores of modified AOFAS hallux score, FFI percentage, and VAS pain were 88.9 ± 12.6, 9.4 ± 16.5, and 1.23 ± 2.24, respectively. Hallux varus was associated with the most favourable outcomes; whereas, patients with first MTP arthritis got the worst outcome. Regression analysis test between clinical outcomes and HVA > 15° and first MTPDA >15° showed correlation coefficient of almost zero. No statistically significant differences were found between the clinical outcomes of grade 3 and 4 of hallux rigidus (p value of modified AOFAS hallux score, FFI percentage, and VAS pain: 0.879, 0.906, and 0.298, respectively). Mean of HVA and IMA reduction in 15 hallux valgus underwent first MTP fusion were 34.4° and 8.4°, respectively. Meary's angle increased about 4° with statistically significant difference (p value 0.001). CONCLUSION Patients with first MTP fusion > 15° in coronal and transverse plans could have acceptable clinical outcomes. The clinical outcome of first MTP arthrodesis for grade 3 hallux rigidus is comparable with grade 4. First MTP fusion would have positive effect on IMA and Meary's angle.
Collapse
|
24
|
刘 中, 芦 浩, 袁 玉, 徐 海. [Evaluation of therapeutic efficacy of arthroplasty with Swanson prosthesis in the surgical treatment of 2-5 metatarsophalangeal joint diseases]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52:726-729. [PMID: 32773810 PMCID: PMC7433636 DOI: 10.19723/j.issn.1671-167x.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Metatarsophalangeal joint is an important joint for daily weight-bearing walking. Osteoarthritis, osteochondrosis of the metatarsal head, rheumatoid arthritis can often cause the destruction of 2-5 metatarsophalangeal joint, leading to pain, limited joint movement and toe deformities, severely affecting the forefoot function. The purpose of this study is to report the results of middle-long term follow-up after performing Swanson double-stem silicon implant arthroplasty in patients with diseases of 2-5 metatarsophalangeal joint. METHODS From January 2010 to October 2015, 21 patients with 2-5 metatarsophalangeal joint replacement were performed with Swanson double-stem silicone prosthesis. In the study, 16 cases were successfully followed up, 2 men and 14 women with an average age (66.7±5.5) years. There were 9 cases diagnosed with rheumatoid arthritis, 5 cases with severe osteoarthritis and 2 cases with osteochondrosis of the metatarsal head. The American Association of foot and ankle surgery Maryland foot scoring system and visual analogue score (VAS) were used to evaluate the walking function, metatarsophalangeal joint mobility and pain degree before and after surgery. RESULTS The follow-up time ranged from 17 months to 5 years, with an average of 3.2 years. According to Maryland foot scoring system of the American Association of foot and ankle surgery, the preoperative score was (60.69±6.12) points and postoperative score was (88.13±5.84) points. Range of motion of metatarsophalangeal joint: preoperative: back extension 5.4°±3.1°, plantar flexion 4.4°±2.7°; postoperative: back extension 15.7°±4.5°, plantar flexion 12.2°±4.3°, the motion of 2-5 metatarsophalangeal joint after operation was significantly improved compared with that before operation (P < 0.01). The preoperative VAS was (6.8±0.9) points and the last follow-up was (2.3±0.8) points, the pain symptom of metatarsophalangeal joint was improved obviously after operation. The postoperative score was significantly higher than the preoperative score according to Maryland foot scoring system (P < 0.01), the excellent rate was 81.3%. CONCLUSIONS With the advantages of alleviating pain, preserving the length and alignment of metatarsophalangeal joint, improving the function of walking, and correcting the deformity, Swanson double-stem silicon implant arthroplasty is a reproducible and safe option for the reconstruction of the 2-5 metatarsophalangeal joint. However, there is still some probability of adverse reactions and still room for improvement.
Collapse
Affiliation(s)
- 中砥 刘
- />北京大学人民医院创伤骨科,北京大学人民医院创伤救治中心,北京 100044Department of Trauma and Orthopedics, Trauma Medical Center, Peking University People's Hospital, Beijing 100044, China
| | - 浩 芦
- />北京大学人民医院创伤骨科,北京大学人民医院创伤救治中心,北京 100044Department of Trauma and Orthopedics, Trauma Medical Center, Peking University People's Hospital, Beijing 100044, China
| | - 玉松 袁
- />北京大学人民医院创伤骨科,北京大学人民医院创伤救治中心,北京 100044Department of Trauma and Orthopedics, Trauma Medical Center, Peking University People's Hospital, Beijing 100044, China
| | - 海林 徐
- />北京大学人民医院创伤骨科,北京大学人民医院创伤救治中心,北京 100044Department of Trauma and Orthopedics, Trauma Medical Center, Peking University People's Hospital, Beijing 100044, China
| |
Collapse
|
25
|
Santos Silva M, Rodrigues-Pinto R, Barros LH, Sousa A, Muras J. Arthrodesis versus Arthroplasty of the First Metatarsophalangeal Joint in the Treatment of Hallux Rigidus - A Comparative Study of Appropriately Selected Patients. Rev Bras Ortop 2020; 55:40-47. [PMID: 32153308 PMCID: PMC7051855 DOI: 10.1055/s-0039-1700815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 12/04/2018] [Indexed: 12/11/2022] Open
Abstract
Objective
Historical results of arthroplasty of the first metatarsophalangeal joint (1MTP) are relatively poor; however, improvements in the understanding of the normal foot biomechanics, implant materials and design currently make arthroplasty a reasonable option in appropriately selected patients. The present study aimed to compare the clinical and radiographic results of 1MTP arthrodesis and arthroplasty in the treatment of
hallux rigidus
and to present a rationale for patient selection for arthroplasty.
Methods
A total of 36 patients (38 feet) with
hallux rigidus
submitted to surgery (12 arthrodesis and 26 arthroplasties) were prospectively included in the study. Pain was assessed using the visual analogue scale (VAS) and the functional status was assessed using the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI) scale. Complications and radiographic results were also analyzed, and survival rates were calculated for both procedures.
Results
All of the patients reported significant improvement in pain and functional status after surgery. Patients submitted to arthroplasty had better functional results on the AOFAS-HMI scale (89.7 versus 65.7 points;
p
< 0.001) and better pain relief (VAS 1.6 versus 3.9 points;
p
= 0.002) when compared with the group submitted to arthrodesis. There was one case of infection in the arthroplasty group and 2 cases of pseudarthrosis in the arthrodesis group.
Conclusion
Arthrodesis provides pain relief and satisfactory results but alters the biomechanics of gait. Like arthrodesis, arthroplasty improves pain significantly, being a more physiological alternative to preserve the biomechanics of the foot. While the two surgical methods yielded good clinical results, selected patients submitted to arthroplasty had better clinical scores and lower revision rates.
Collapse
Affiliation(s)
- Marta Santos Silva
- Departamento de Ortopedia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Departamento de Ortopedia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal.,Trofa Saúde Hospital Privado de Alfena, Alfena, Portugal.,Trofa Saúde Hospital Privado Braga Centro, Braga, Portugal
| | - Luís H Barros
- Departamento de Ortopedia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Arnaldo Sousa
- Departamento de Ortopedia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - José Muras
- Trofa Saúde Hospital Privado de Alfena, Alfena, Portugal.,Trofa Saúde Hospital Privado Braga Centro, Braga, Portugal.,Centro Hospitalar Póvoa de Varzim/ Vila do Conde, Largo da Misericórdia, Póvoa de Varzim, Portugal
| |
Collapse
|
26
|
Fuld RS, Kumparatana P, Kelley J, Anderson N, Baldini T, Younger ASE, Hunt KJ. Biomechanical Comparison of Low-Profile Contoured Locking Plate With Single Compression Screw to Fully Threaded Compression Screws for First MTP Fusion. Foot Ankle Int 2019; 40:836-844. [PMID: 30880450 DOI: 10.1177/1071100719837524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Open metatarsophalangeal (MTP) arthrodesis using locked plates produces good clinical outcomes. However, arthroscopic fusion with new-generation fully threaded compression screws is emerging as an alternative. The purpose of this study was to compare low-profile contoured locked plates with fully threaded compression screws for first MTP fusion, in a biomechanical cadaveric model. METHODS The first rays of 8 matched pairs of fresh frozen cadaveric feet underwent dissection and dual-energy x-ray absorptiometry (DEXA) scanning to measure bone mineral density (BMD). The "plate" group was prepared with cup-and-cone reamers, and fixation of the MTP joint with 1 compression screw and low-profile dorsal locked plate. The matched-pair "screws" group was prepared through a simulated arthroscopic technique, achieving fixation with 2 new-generation fully threaded compression screws. The plantar MTP gap was recorded with an extensometer during 250 000 90-N cyclic loads followed by a single load to failure. RESULTS The screw group demonstrated significantly greater stiffness, 31.6 N/mm (plates) and 51.7 N/mm (screws) (P = .0045). There was no significant difference in plantar gapping or load to failure, 198.6 N (plates) and 290.1 N (screws) (P = .2226). Stiffness and load to failure were highly correlated to BMD for the screw group, r =0.79 and r = 0.94, respectively, but less so for the plate group, r = 0.36 and r = 0.62, respectively. The maximum metatarsal head height measured on the lateral view was strongly correlated with load to failure for both the plate- and screw-only groups (r > 0.9). CONCLUSION These data demonstrate that hallux MTP arthrodesis utilizing fully threaded compression screws had similar plantar gapping and load to failure when compared with the low-profile locking plate, but with significantly more stiffness. These results support an increased role of fully threaded screws for MTP arthrodesis using either the arthroscopic or open technique. However, with decreased BMD plate fixation may remain the better fixation choice. CLINICAL RELEVANCE Our data suggest that with regard to construct stability, fully threaded headless compression screws may be just as effective as low-profile locking plates, but BMD and MTP joint fluoroscopic measurements should be considered in the decision-making process for fixation.
Collapse
Affiliation(s)
- Richard S Fuld
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Pam Kumparatana
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Judas Kelley
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Nicholas Anderson
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Todd Baldini
- 2 Orthopedics Biomechanics Laboratory, University of Colorado, Aurora, CO, USA
| | - Alastair S E Younger
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, BC, USA
| | - Kenneth J Hunt
- 1 Department of Orthopedics, University of Colorado, Aurora, CO, USA
| |
Collapse
|
27
|
Diniz P, Pacheco J, Flora M, Quintero D, Stufkens S, Kerkhoffs G, Batista J, Karlsson J, Pereira H. Clinical applications of allografts in foot and ankle surgery. Knee Surg Sports Traumatol Arthrosc 2019; 27:1847-1872. [PMID: 30721345 DOI: 10.1007/s00167-019-05362-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/14/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this review is to systematically analyse current literature on the use of allografts in the surgical treatment of foot and ankle disorders in adult patients. Based on this study, we propose evidence-based recommendations. METHODS The database for PubMed was searched for all published articles. No timeframe restrictions were applied. Clinical studies eligible for inclusion met the following criteria: performed on patients over 18 years old; subject to surgical treatment of foot and ankle disorders; with report on the outcome of the use of allografts; with a report and assessment of pain and function, or equivalent; minimum follow-up of 1 year was required. Two reviewers independently screened and selected studies for full-text analysis from title and abstract. 107 studies were included from 1113 records. Studies were grouped according to surgical indications into ten categories: musculoskeletal tumours (n = 16), chronic ankle instability (n = 15), ankle arthritis (n = 14), osteochondral lesions of the talus (n = 12), Achilles tendon defects (n = 11), other tendon defects (n = 9), fusions (n = 9), fractures (n = 8), hallux rigidus (n = 3) and other indications (n = 10). RESULTS Most studies displayed evidence level of IV (n = 57) and V (n = 39). There was one level I, one level II and nine level III studies. Most studies reported allografting as a good option (n = 99; 92.5%). Overall complication rate was 17% (n = 202). CONCLUSIONS Fair evidence (Grade B) was found in favour of the use of allografts in lateral ankle ligament reconstruction or treatment of intra-articular calcaneal fracture. Fair evidence (Grade B) was found against the use of allogeneic MSCs in tibiotalar fusions. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- Pedro Diniz
- Department of Orthopaedic Surgery, Hospital de Sant'Ana, Rua de Benguela, 501, 2775-028, Parede, Portugal. .,Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal. .,Fisiogaspar, Lisbon, Portugal.
| | - Jácome Pacheco
- Department of Orthopaedic Surgery, Hospital de Sant'Ana, Rua de Benguela, 501, 2775-028, Parede, Portugal
| | - Miguel Flora
- Department of Orthopaedic Surgery, Hospital de Sant'Ana, Rua de Benguela, 501, 2775-028, Parede, Portugal
| | - Diego Quintero
- Department of Applied Anatomy in Physiatry Orthopedics and Traumatology of the Chair of Normal Anatomy, Faculty of Medical Sciences, National University of Rosario, Rosario, Argentina
| | - Sjoerd Stufkens
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Gino Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jorge Batista
- Clinical Department Club Atletico Boca Juniores, CAJB-Centro Artroscopico, Buenos Aires, Argentina
| | - Jon Karlsson
- Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden
| | - Hélder Pereira
- Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal.,Ripoll y De Prado Sports Clinic: FIFA Medical Centre of Excellence, Murcia-Madrid, Spain.,University of Minho, ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| |
Collapse
|
28
|
Stibolt RD, Patel HA, Lehtonen EJ, DeBell HA, Moon AS, Naranje S, Shah A. Hemiarthroplasty Versus Total Joint Arthroplasty for Hallux Rigidus: A Systematic Review and Meta-analysis. Foot Ankle Spec 2019; 12:181-193. [PMID: 30132693 DOI: 10.1177/1938640018791017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND When surgery is indicated for hallux rigidus, toe arthroplasty is an alternative procedure to arthrodesis for patients who wish to preserve toe range of motion. Our study investigated midterm outcomes of first metatarsophalangeal joint (MTPJ) arthroplasty in an effort to discern whether or not partial or total joint replacement confers benefit in these patients. METHODS A systematic review of MTPJ arthroplasty was performed for the years 2000 to 2017. A Forest plot was created comparing preoperative and postoperative American Orthopedic Foot and Ankle Score (AOFAS), Visual Analogue Scale (VAS), and range of motion (ROM) results for both hemitoe and total-toe arthroplasty. Statistical analysis was performed. RESULTS Mean postoperative AOFAS scores in patients undergoing hemiarthroplasty improved by 50.7 points (95% CI = 48.5, 52.8), whereas the mean AOFAS score improvement in total joint arthroplasty patients was 40.6 points (95% CI = 38.5, 42.8). VAS outcomes were comparable. Mean postoperative MTPJ ROM improved by 43.0° (95% CI = 39.3°, 46.6°) in hemitoe patients, which exceeded the mean ROM improvement of 32.5° (95% CI = 29.9°, 35.1°) found in total joint arthroplasty cases. A meta-analysis revealed no significant difference. CONCLUSION Hemisurface implants in MTPJ arthroplasty may improve postoperative AOFAS and ROM results to a greater extent than total-toe devices. LEVEL OF EVIDENCE Level IV: Systematic review.
Collapse
Affiliation(s)
- Robert D Stibolt
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
| | - Harshadkumar A Patel
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
| | - Eva J Lehtonen
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
| | - Henry A DeBell
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
| | - Andrew S Moon
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
| | - Sameer Naranje
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
| | - Ashish Shah
- University of Alabama at Birmingham, Birmingham, Alabama (RDS, HAP, EJL, HAD, AM, SN, AS).,University of Miami School of Medicine, Miami, Florida (EJL).,Tufts University School of Medicine, Boston, Massachusetts (AM)
| |
Collapse
|
29
|
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
Collapse
|
30
|
Glazebrook M, Blundell CM, O'Dowd D, Singh D, de Vries G, Le ILD, Nielsen D, Pedersen ME, Sakellariou A, Solan M, Wansbrough G, Younger ASE, Baumhauer JF, Daniels TR. Midterm Outcomes of a Synthetic Cartilage Implant for the First Metatarsophalangeal Joint in Advanced Hallux Rigidus. Foot Ankle Int 2019; 40:374-383. [PMID: 30501401 DOI: 10.1177/1071100718815469] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: A prospective, randomized, noninferiority clinical trial of synthetic cartilage implant hemiarthroplasty for hallux rigidus demonstrated functional outcomes and safety equivalent to first metatarsophalangeal (MTP) joint arthrodesis at 24 months. We prospectively assessed safety and efficacy outcomes for synthetic cartilage implant hemiarthroplasty at a minimum of 5 years. METHODS: Of 135 eligible patients from the original trial, 112 (83.0%) were enrolled (mean age, 58.2 ± 8.8 years; 87 females). Pain visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL), and FAAM Sports subscales were completed preoperatively and 2 and 5 years postoperatively. Great toe active dorsiflexion, weightbearing radiographs, secondary procedures, and safety parameters were also evaluated. RESULTS: At 24 months, 14/152 (9.2%) patients had undergone implant removal and conversion to arthrodesis. In years 2 to 5, 9/119 (7.6%) patients underwent implant removal and conversion to arthrodesis. At mean 5.8 ± 0.7 (range, 4.4-8.0) years' follow-up, pain VAS, FAAM ADL, and FAAM Sports scores improved by 57.9 ± 18.6 points, 33.0 ± 17.6 points, and 47.9 ± 27.1 points, respectively, from baseline. Clinically significant changes in VAS pain, FAAM ADL, and FAAM Sports were reported by 103/106 (97.2%), 95/105 (90.5%), and 97/104 (93.3%) patients, respectively. Patient-reported outcomes at 24 months were maintained at 5.8 years in patients who were not revised. Active MTP joint peak dorsiflexion was maintained. Ninety-nine of 106 (93.4%) patients would have the procedure again. CONCLUSION: Clinical and safety outcomes for synthetic cartilage implant hemiarthroplasty observed at 2 years were maintained at 5.8 years. The implant remains a viable treatment option to decrease pain, improve function, and maintain motion for advanced hallux rigidus. LEVEL OF EVIDENCE: Level IV, case series.
Collapse
Affiliation(s)
- Mark Glazebrook
- 1 Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada
| | | | | | - Dishan Singh
- 3 Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Gwyneth de Vries
- 4 Dalhousie University and Memorial University of Newfoundland, Fredericton, NB, Canada
| | - Ian L D Le
- 5 University of Calgary, Calgary, AB, Canada
| | | | | | | | - Matthew Solan
- 9 Royal Surrey County Hospital, Guildford, Surrey, UK
| | | | - Alastair S E Younger
- 11 Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Judith F Baumhauer
- 12 Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Timothy R Daniels
- 13 Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, ON, Canada
| |
Collapse
|
31
|
Leiß F, Baier C, Schwarz T, Grifka J. [Degenerative forefoot : Diagnostics and treatment]. Z Rheumatol 2019; 78:255-264. [PMID: 30848344 DOI: 10.1007/s00393-019-0605-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The hallux valgus deformity is the most common toe deformity of the forefoot and is often associated with a splayfoot. Malpositioning of the small toes may be isolated but are more common in other foot deformities. The understanding of the complex pathoanatomy of the foot is necessary for orthopedic treatment. Conservative treatment is reserved for the early stages. The indications for surgery should be based on clinical and radiographic findings. Countless surgical procedures are available and minimally invasive surgical techniques are also increasingly being used.
Collapse
Affiliation(s)
- F Leiß
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - C Baier
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - T Schwarz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| |
Collapse
|
32
|
Park YH, Jung JH, Kang SH, Choi GW, Kim HJ. Implant Arthroplasty versus Arthrodesis for the Treatment of Advanced Hallux Rigidus: A Meta-analysis of Comparative Studies. J Foot Ankle Surg 2019; 58:137-143. [PMID: 30583775 DOI: 10.1053/j.jfas.2018.08.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Indexed: 02/03/2023]
Abstract
Implant arthroplasty and arthrodesis of the first metatarsophalangeal joint are the main surgical treatment options for advanced hallux rigidus. The superiority of each modality continues to be debated, because there are few high-quality evidence-based studies, such as randomized controlled clinical trials or meta-analyses of comparative studies. The purpose of this study was to identify whether implant arthroplasty or arthrodesis is superior for the treatment of advanced hallux rigidus through meta-analysis of comparative studies. A comprehensive search of the MEDLINE, EMBASE, and Cochrane library databases was conducted. Only retrospective or prospective comparative studies were included in this meta-analysis. The literature search, data extraction, and quality assessment were conducted by 2 independent reviewers. The primary outcomes were clinical scores and patient satisfaction. The rate of reoperation and complication were also investigated. Seven comparative studies were included (2 prospective and 5 retrospective studies). There were no significant differences between the 2 groups in the American Orthopedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal score, patient satisfaction rate, reoperation rate, or complication rate. The visual analogue scale for pain was significantly lower in the arthrodesis group than the implant arthroplasty group. This meta-analysis revealed that implant arthroplasty and arthrodesis of the first metatarsophalangeal joint led to similar clinical outcomes, patient satisfaction, reoperation rates, and complication rates, whereas pain was significantly lower in arthrodesis. Further studies of high methodological quality are required to confirm these conclusions.
Collapse
Affiliation(s)
- Young Hwan Park
- Orthopedist, Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jae Hyun Jung
- Assistant Professor, Department of Rheumatology, Korea University Guro Hospital, Seoul, Korea
| | - Seong Hyun Kang
- Orthopedist, Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Gi Won Choi
- Assistant Professor, Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Hak Jun Kim
- Professor, Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea.
| |
Collapse
|