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Alshehri AS, Alzahrani FA, Alqahtani LS, Alhadlaq KH, Alshabraqi HA, Aljaafri ZA. Outcomes of Operative Versus Nonoperative Management for Hallux Rigidus: A Tertiary Care Center Experience. Cureus 2023; 15:e46991. [PMID: 38022308 PMCID: PMC10640908 DOI: 10.7759/cureus.46991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background This study aims to investigate and report the outcomes of various management modalities used for hallux rigidus, a common form of degenerative joint disease affecting the foot and ankle. The research focuses on understanding the pathophysiology, classification systems, and nonoperative approaches such as medical therapy, intra-articular injections, shoe modifications, and physical therapy. Surgical techniques, including joint-sparing and joint-sacrificing procedures, are explored, considering factors such as disease stage and patient preferences. Methods A retrospective cohort study was conducted at King Abdulaziz Medical City (KAMC), Riyadh. The study included all patients who were diagnosed with hallux rigidus from the period 2016 to 2022. Data were collected through the BESTCare system at KAMC. All the data were collected through Microsoft Excel (Microsoft Corporation, Redmond, Washington) and transferred for analysis. Statistical analysis was performed using the IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York). Frequencies and percentages were used to detail categorical variables, whereas continuous variables were examined by the mean and standard deviation. A p-value of <0.05 was considered to report the statistical significance. Results A total of 84 patients were included. The majority were women (60.7%). Diabetes and hypertension were prevalent comorbidities, affecting 21.4% and 35.7% of patients, respectively. Nonoperative management was the most common approach (66.7%). Complications were minimal (2.4% infections, 1.2% metatarsalgia), and 67.9% of patients reported no persistence of symptoms after treatment. Conclusion The low complication rates and the lack of significant associations between treatment modalities and outcomes suggest the generally safe and effective nature of the employed interventions. These findings can guide clinicians in making informed decisions regarding the management of hallux rigidus, while also highlighting areas for further research to improve treatment strategies and outcomes.
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Affiliation(s)
- Ali S Alshehri
- Orthopedic Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, SAU
- Orthopedic Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Faisal A Alzahrani
- Orthopedic Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, SAU
- Orthopedic Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Lujain S Alqahtani
- Orthopedic Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, SAU
- Orthopedic Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Khalid H Alhadlaq
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Orthopedic Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Halah A Alshabraqi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Orthopedic Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Ziad A Aljaafri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Orthopedic Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
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Sethi M, Limaye N, Alderton E, Limaye R, Kulkarni A. Silastic Joint Arthroplasty as a Joint-Preserving Alternative for End-Stage Hallux Rigidus: Outcomes From 112 First Metatarsophalangeal Joint Arthroplasties. Cureus 2023; 15:e46561. [PMID: 37933343 PMCID: PMC10625660 DOI: 10.7759/cureus.46561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/08/2023] Open
Abstract
Aim Osteoarthritis of the first metatarsophalangeal joint (MTPJ) is a common forefoot problem affecting patients in later years. It leads to pain, gait problems, and difficulty with activities of daily living. Treatment is controversial and varies according to patient symptoms and surgeon preference. Arthrodesis remains the gold standard but it has its own complications. It is associated with adjacent joint arthritis and transfer metatarsalgia. The aim of this study was to analyze the outcome of double-stemmed silastic joint arthroplasty (Wright-Medical, Memphis, TN) for end-stage hallux rigidus. Methods This retrospective analysis included 117 consecutive first MTPJ silastic arthroplasties done between January 2016 and February 2023 for end-stage hallux rigidus. There were 77 females and 40 males with a mean age of 65 years (46-82 years). Radiological and clinical assessments were performed, and patient-reported outcome measure data (PROMS) and visual analogue scale (VAS) scores were collected pre- and post-operatively. Results Findings showed 99.1% survivorship following a silastic joint arthroplasty with a mean follow-up of four years (six months to seven years). The MOXFQ (Manchester Oxford Foot Questionnaire) score improved from a mean of 81 (59.8-100) to 13 (0-57). The mean VAS scores improved from 7.2 (5-10) to 1.5 (0-7) postoperatively. Five patients were lost to follow-up. Two patients developed deep infection and one required revision. The other patient with infection was lost to follow-up. In total 10 patients (8.9%) developed complications, out of which eight patients responded to simple treatments. Conclusion Results have shown good to excellent outcomes following a silastic arthroplasty of the first MTPJ for the treatment of end-stage hallux rigidus. The survivorship at a mean follow-up of four years was 99.1% and the patient satisfaction rate was 90.1%. As historically reported, we did not see any soft tissue reaction or progressive osteolysis in any of our patients. It provides comparable and predictable outcomes to joint fusion for end-stage arthritis.
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Affiliation(s)
- Mohit Sethi
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
| | - Natalie Limaye
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
| | - Elizabeth Alderton
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
| | - Rajiv Limaye
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
| | - Ameet Kulkarni
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, GBR
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Alvarez PM, Gallagher J, Curatolo C, Pettit D, Martin KD. Dorsal Cheilectomy Using Great Toe Metatarsophalangeal Joint Arthroscopy for the Treatment of Hallux Rigidus. Arthrosc Tech 2023; 12:e603-e608. [PMID: 37323788 PMCID: PMC10265193 DOI: 10.1016/j.eats.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023] Open
Abstract
Great toe metatarsophalangeal joint (MTPJ) arthroscopy has been described in the literature for more than 50 years for treatment of a multitude of first MTPJ pathologies, including hallux rigidus, hallux valgus, and osteochondritis dissecans, among others. Despite this, the use of great toe MTPJ arthroscopy has not become widely used for treatment of these conditions as the result of reported difficulties with adequate visualization of the joint surface and manipulation of surrounding soft-tissue structures with the instruments available. We propose a simple technique with illustrations of the operating room setup and procedural steps to perform a dorsal cheilectomy in those with early-stage hallux rigidus using great toe MTPJ arthroscopy and a minimally invasive surgical burr in a way that is reproducible by foot and ankle surgeons.
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Affiliation(s)
- Paul M. Alvarez
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - James Gallagher
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Christian Curatolo
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - David Pettit
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Kevin D. Martin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
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Arzac Ulla I. Tratamiento del hallux valgus rigidus con osteotomía tipo Mitchell modificada. Descripción de la técnica quirúrgica y evaluación funcional a mediano plazo. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2023. [DOI: 10.15417/issn.1852-7434.2023.88.1.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Objetivo: Describir la técnica quirúrgica de Mitchell modificada para el tratamiento del hallux valgus rigidus grado 2, y evaluar los resultados a mediano plazo.
Materiales y Métodos: Estudio prospectivo observacional. Entre agosto de 2015 y enero de 2019, 21 pacientes (23 pies) con hallux valgus rigidus grado 2 fueron sometidos a una osteotomía tipo Mitchell modificada.
Resultados: Se comunican los resultados sobre la base de la edad, el sexo, el seguimiento posoperatorio, el puntaje de la AOFAS, el pie afectado, la pérdida de reducción, el colapso de la cabeza del metatarsiano, el dolor residual y la necesidad de plantillado para el alta. El puntaje de la AOFAS a los 18 meses fue de 94,78. Los pacientes retornaron a su actividad laboral, en promedio, a los 16.6 días y a sus actividades previas, a los 3.43 meses.
Conclusión: Presentamos una técnica quirúrgica que combina los beneficios de la osteotomía de Chevron y la de Mitchell, con excelentes resultados clínicos y funcionales.
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Retrospective Comparison of Two Different Fixation Methods for First Metatarsophalangeal Joint Arthrodesis. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1091385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background and Purpose: Arthrosis of the first MTP joint is a common condition. Among the available arthrodesis methods, plate/screw and screw methods are the current treatment methods of choice. In this study, we investigate whether there is a difference between these two methods.
Methods: Thirty-four toes of 32 patients with advanced arthrosis were included in the study. Eighteen toes were fixed with plates/screws and 16 with cross-screws. In the radiological evaluations, malunion and nonunion were examined. Clinical evaluation was made according to AOFAS-HMI scoring.
Results: The mean age of the patients was 57.74 years and the mean follow-up period was 22.21 months. There was no statistically significant difference in clinical scores or union times between the two groups. As complications, superficial skin problems developed in 2 (5.9%) cases, deep infection in 3 (8.8%) cases, and nonunion in 3 (8.8%) cases. There was no statistically significant difference between the two groups in this regard.
Conclusion: Plate/screw and cross-screw techniques give similar clinical and radiological results in cases of arthrodesis of the first MTP joint. The cross-screw technique, which can be performed more easily and has lower costs, should be the first choice.
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Emami Razavi SZ, Azadvari M, Fateh HR, Ghahvechi Akbari M, Kazemi S, Rezaee E. Short-term Efficacy of Ultrasonographic Guidance for Intra-articular Corticosteroid Injection in Hallux Rigidus: A Single-Blind Randomized Controlled Trial. Foot Ankle Int 2021; 42:1410-1418. [PMID: 34111992 DOI: 10.1177/10711007211015988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Multiple considerations should be taken before standardizing a clinical procedure such as efficacy, safety, or the cost. The aim of this study was to compare the effects of landmark-guided vs ultrasonography-guided intra-articular injection of corticosteroid into the first metatarsophalangeal joint cavity to reduce pain and dysfunction in patients with hallux rigidus. METHODS We carried out a single-blind randomized controlled trial with 2 parallel arms in an outpatient clinic affiliated with a medical university. In total, 50 participants (35 women) with the mean (SD) age of 49.8 (10.3) years were randomly allocated to landmark-guided or ultrasonography-guided groups (each n = 25). Each patient received a single intra-articular injection of 40-mg methylprednisolone plus 1 mL lidocaine into the affected first metatarsophalangeal joint. The primary outcome was joint pain and the secondary outcome was the American Orthopaedic Foot & Ankle Society score. We measured the outcomes at baseline and 2 and 6 weeks after the intervention. RESULTS Six weeks after the injections, there were no statistically significant differences between the study groups in pain reduction and increase in the American Orthopaedic Foot & Ankle Society scores (P = .131 and .241, respectively). We did not find any complications for the injections in both groups. There were statistically significant changes within each group in pain and the scores for the landmark (P < .001, and P = .007), and ultrasonography groups (both P < .001). CONCLUSION Landmark guidance is as effective as ultrasonographic guidance for intra-articular injection in patients with hallux rigidus. A single intra-articular injection of 40 mg methylprednisolone plus 1 mL lidocaine is an efficient and safe therapeutic measure for decreasing joint pain and maintaining its function, at least for 6 weeks. LEVEL OF EVIDENCE Level I, high-quality prospective randomized study.
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Affiliation(s)
| | - Mohaddeseh Azadvari
- Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid R Fateh
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shahrbanoo Kazemi
- Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Rezaee
- Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Lunati M, Mahmoud K, Kadakia R, Coleman M, Bariteau J. Complications Associated with the Surgical Management of Hallux Rigidus. Orthop Clin North Am 2021; 52:291-296. [PMID: 34053574 DOI: 10.1016/j.ocl.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hallux rigidus is the most common arthritic pathology of the foot. This review article discusses the pathophysiology and common clinical presentation of hallux rigidus. Furthermore, we discuss multiple classification systems that categorize the arthritic process and guide management. Surgical interventions include cheilectomy, Moberg osteotomy, synthetic cartilage implants, interpositional arthroplasty, and arthrodesis. The common complications are reviewed, and the rates of these complications highlighted. Surgical options for hallux rigidus globally have successful outcomes with low rates of complications when done on appropriate patients.
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Affiliation(s)
- Matthew Lunati
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Karim Mahmoud
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Rishin Kadakia
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Michelle Coleman
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Jason Bariteau
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA.
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8
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Fung J, Sherman A, Stachura S, Eckles R, Doucette J, Chusid E. Nonoperative Management of Hallux Limitus Using a Novel Forefoot Orthosis. J Foot Ankle Surg 2021; 59:1192-1196. [PMID: 32736972 DOI: 10.1053/j.jfas.2019.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 02/03/2023]
Abstract
Hallux limitus is among the most common arthritides of the foot and ankle, with increasing incidence in the aging population. Despite its prevalence and disease burden, treatment of the condition remains poorly understood. Many patients will fail initial conservative management, whereas controversy exists surrounding indications for and outcomes of surgery. The present study sought to examine the impact of a novel forefoot orthosis on foot function, pain, and plantar pressure distributions in patients with symptomatic hallux limitus. Nineteen adult patients completed a questionnaire consisting of the 23-item Foot Function Index and a 10-point visual analogue scale measuring pain. Standing pedobarographic maps were generated using a foot scanning system. Participants were instructed to wear the orthosis in athletic shoes for 4 weeks. Eighteen participants (94.7%) experienced improvements in foot function and pain, with 12 (63.2%) reporting complete resolution of pain at the end of the 4-week trial. Mean Foot Function Index scores improved significantly from 43.0% at baseline to 11.0% with the orthosis (p < .001). Similarly, mean visual analogue scale pain scores decreased significantly from 4.87 to 1.18 (p < .001). Pedobarographic analysis while wearing the orthosis demonstrated increased ability of participants to bear weight on the arthritic hallux metatarsophalangeal joint and restoration of physiologic stance. Compared to existing products, the device was well tolerated and did not require footwear modifications or impede normal gait. Overall, the orthosis offers an appealing solution to patients dissatisfied with existing treatment options as well as those who may be averse to or ineligible for surgery.
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Affiliation(s)
- Jonathan Fung
- Podiatrist, New York College of Podiatric Medicine, New York, NY
| | - Alain Sherman
- Medical Student, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Sara Stachura
- Podiatrist, New York College of Podiatric Medicine, New York, NY
| | - Robert Eckles
- Dean of Clinical and Graduate Medical Education, New York College of Podiatric Medicine, New York, NY
| | - John Doucette
- Associate Professor of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eileen Chusid
- Dean and Associate Professor of Pre-Clinical Sciences, New York College of Podiatric Medicine, New York, NY
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9
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Lee JY, Tay KS, Rikhraj IS. Distal oblique osteotomy versus cheilectomy for moderate-advanced hallux rigidus: A 2-year propensity-score-matched study. Foot Ankle Surg 2021; 27:443-449. [PMID: 32631778 DOI: 10.1016/j.fas.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/10/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The surgical treatment of moderate-advanced hallux rigidus is controversial. Cheilectomy is widely used but has recurrence rates of up to 30%. Dorsal oblique metatarsal osteotomy (DOO) has also shown good results, however, there is no study comparing outcomes of the DOO against cheilectomy. METHODS This was a retrospective propensity score matched study based on registry data from a single tertiary institution. Between 2007 and 2017, all patients who had undergone dorsal cheilectomy or DOO for hallux rigidus were included. Patients with previous foot surgery, revision surgeries, and concomitant surgical procedures were excluded. Clinical outcomes, complication rates, revision rates and patient satisfaction were assessed at 2 years postoperatively. RESULTS There were 44 patients (34 cheilectomy, 10 DOO). After propensity score matching, 17 cheilectomy and all 10 DOO cases were selected for comparison. Patients in both groups had a significant improvement in visual analogue pain scores (VAS) and AOFAS 1st toe scores 2-years post-operatively (P<0.001) with high levels of post-operative satisfaction (85.1%). Overall there were no statistically significant differences in post-operative scores, improvement in scores, complication rates, revision rates, and levels of patient satisfaction between groups. CONCLUSIONS Both the DOO and cheilectomy give similarly good outcomes for moderate-advanced hallux rigidus. Further studies are needed to elucidate differences in indications for each procedure.
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Affiliation(s)
- Jia Ying Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, Singapore 169608, Singapore.
| | - Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, Singapore 169608, Singapore.
| | - Inderjeet Singh Rikhraj
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Rd, Singapore 169608, Singapore.
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10
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Adamson P, Janney C, Chen J, Panchbhavi V. First Metatarsal Phalangeal Joint Arthrodesis without the Use of Hardware after Failed Arthroplasty: A Case Report. J Orthop Case Rep 2021; 11:63-66. [PMID: 34141673 PMCID: PMC8180337 DOI: 10.13107/jocr.2021.v11.i02.2028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction First metatarsal phalangeal joint (MTPJ) arthroplasty has a high failure rate due to aseptic loosening, which leads to bone loss. The salvage procedure is conversion to an arthrodesis, but bone loss can make obtaining screw fixation difficult. Herein, we report a unique case of revision first-metatarsal arthrodesis without the use of hardware after a failed arthroplasty. Case Report A 60-year-old women presented to us with first MTPJ pain in the setting of failed arthroplasty. We performed an arthrodesis; however, intraoperatively, hardware fixation could not be obtained due to bone loss. We utilized allograft bone struts to maintain first ray length and to hold the correct hallux position during arthrodesis maturation. Conclusion Bone loss is a frequently encountered problem in revision surgery to a first MTPJ arthrodesis. An arthrodesis can be obtained without the use of hardware in scenarios where bone loss precludes screw fixation.
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Affiliation(s)
- Peter Adamson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd Route 0165, Galveston, TX 77555-0165
| | - Cory Janney
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134
| | - Jie Chen
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd Route 0165, Galveston, TX 77555-0165
| | - Vinod Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd Route 0165, Galveston, TX 77555-0165
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Colò G, Fusini F, Samaila EM, Rava A, Felli L, Alessio-Mazzola M, Magnan B. The efficacy of shoe modifications and foot orthoses in treating patients with hallux rigidus: a comprehensive review of literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020016. [PMID: 33559617 PMCID: PMC7944704 DOI: 10.23750/abm.v91i14-s.10969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023]
Abstract
Hallux rigidus (HR) is a degenerative disease of the first metatarsophalangeal (MTP1) joint and affects about 2.5% of people older than 50 years. The real etiology of this condition remains under debate. Clinical symptoms, physical exam, and instrumental evidence are important in assessing and grading the disease. The anatomy of the first metatarsal is unique and its configuration may play a significant role in the HR development. The first approach in the early stages of the disease usually begins with shoe modifications and foot orthoses, designed to limit irritation from the dorsal osteophytes, reducing motion and the mechanical stresses on the joint. To prevent or delay the development of HR, shoes should be sufficiently long, comfortable, with high toe box and broad toe-boxed, and should bear an allowed space for the orthotic device. The ideal orthotic appears to require a 3-mm thickness with a correct stiffness, and also increasing and extending the medial metatarsal arch just proximal to the metatarsal head, raising the first metatarsal and allowing the proximal phalanx to rest in a more plantarflexed position, decompressing the dorsal aspect of the joint. The increased foot pronation moment with medial column overload, when present, should be corrected. In addition, the maximum follow-up found by the analyzed studies was of 14.4 years, so the Authors cannot conclude how long conservative care can keep a patient free from pain and able to perform normal daily activities. However, the use of shoe modifications and foot orthoses may be considered a safe treatment and then should be always offered to patients, before any surgical management. (www.actabiomedica.it)
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Affiliation(s)
- Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy.
| | - Federico Fusini
- Department of Orthopaedics and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Via S. Rocchetto, 99, 12084 Mondovì (CN), Italy.
| | - Elena Manuela Samaila
- Department of Orthopedics and Trauma Surgery, University of Verona, Surgical Center "P. Confortini", P.le A. Stefani 1, 37126, Verona (VR), Italy.
| | - Alessandro Rava
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, via Zuretti 29, 10121, Turin, Italy.
| | - Lamberto Felli
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), University of Genoa, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Mattia Alessio-Mazzola
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), University of Genoa, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Bruno Magnan
- Department of Orthopedics and Trauma Surgery, University of Verona, Surgical Center "P. Confortini", P.le A. Stefani 1, 37126, Verona (VR), Italy.
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Lunati MP, Manz WJ, Maidman SD, Kukowski NR, Mignemi D, Bariteau JT. Effect of Age on Complication Rates and Outcomes Following First Metatarsophalangeal Arthrodesis for Hallux Rigidus. Foot Ankle Int 2020; 41:1347-1354. [PMID: 32791854 DOI: 10.1177/1071100720942140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux rigidus is one of the most common toe pathologies in patients greater than 50 years old. Although metatarsophalangeal (MTP) arthrodesis is used to improve pain and function, older patients are often considered to be higher-risk operative candidates. There are minimal data on outcomes of MTP fusion and no studies comparing outcomes between geriatric and younger patients. METHODS This is a single-center, prospective study of all patients who underwent MTP fusion between August 1, 2015, and July 1, 2018. Patient-reported outcomes were assessed using the Short Form Health Survey (SF-36), Life-Space Assessment survey (LSA), and visual analog scale (VAS) for pain administered preoperatively as well as 6 months and 1 year postoperatively. Baseline characteristics and operative outcomes were collected from the electronic medical record. Clinical and patient-reported outcomes were compared between patients <65 years old and ≥65 years old. Of 143 included patients, 79 were in the younger group (mean of 56.5 years) and 64 were in the older group (mean of 72.0 years). RESULTS Compared with the younger group, the older group was more predominantly female (95.3% older group, 77.2% younger group, P = .002). More patients in the older group had hypertension (73.4% older group, 50.6% younger group, P = .005) and coronary artery disease (9.4% older group, 0.0% younger group, P = .005). Both age groups had similar rates of postoperative wound complications requiring operative irrigation and debridement, deep vein thrombosis, deformity recurrence, and revision surgery. No differences were detected in SF-36, LSA, and VAS surveys administered at baseline, 6 months postoperation, or 1 year postoperation between younger and older patients. CONCLUSION Despite more comorbidities, older patients had similar rates of postoperative complications and reported similar outcomes for pain, function, and mobility following MTP fusion. These findings support increased implementation of MTP fusion surgery for older patients with hallux rigidus. LEVEL OF EVIDENCE Level II, prospective cohort.
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Affiliation(s)
- Matthew P Lunati
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Wesley J Manz
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Nathan R Kukowski
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Jason T Bariteau
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Sansone V, Maiorano E, Melato M, Martinelli N, Pascale V. Novel treatment for hallux rigidus using a temporary metal interpositional device. Foot Ankle Surg 2020; 26:630-636. [PMID: 31439504 DOI: 10.1016/j.fas.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this prospective study is to evaluate the results of a consecutive series of patients suffering from grade II-III hallux rigidus who underwent a mobility preserving surgical technique consisting of resection arthroplasty with implantation of a temporary metal spacer. METHODS Thirty consecutive patients, 18 female and 12 male with a diagnosis of a grade II-III hallux rigidus, not responding to conservative treatment, underwent a minimal resection arthroplasty followed by the implantation of a temporary metal interpositional device by the same surgeon. All spacers were removed after 6 months through a minimal incision under regional anaesthesia. Patients were clinically and radiographically evaluated at 3, 6, 12 months, and 5 years after spacer removal. RESULTS The clinical AOFAS scores improved already at first follow-up and continued to improve over time with a statistically significant change until the first year. At 3, 6, and 12 months follow-ups, the number of patients with severely limited ROM (i.e. under 30°, that means grade II-III according to Coughlin and Shaurnas classification) significantly decreased. There were only two minor complications, so defined as both of which resolved spontaneously and did not affect the procedure's effectiveness. CONCLUSIONS We observed good to excellent results with the use of this mobility preserving surgical technique for the treatment of symptomatic grades II and III hallux rigidus. The never before published procedure is easy to perform and inexpensive. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Valerio Sansone
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Emanuele Maiorano
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Marco Melato
- Department of Orthopaedic, Hospital SS. Antonio and Biagio and Cesare Arrigo Alessandria, Italy
| | - Nicoló Martinelli
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy.
| | - Valerio Pascale
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
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14
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Maes DJA, De Vil J, Kalmar AF, Lootens T. Clinical and Radiological Outcomes of Hallux Rigidus Treated With Cheilectomy and a Moberg-Akin Osteotomy. Foot Ankle Int 2020; 41:294-302. [PMID: 31910662 DOI: 10.1177/1071100719897264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to evaluate the clinical and radiological outcome after cheilectomy and proximal phalangeal biplanar osteotomy for patients with mild and advanced stages of hallux rigidus. METHODS A total of 105 feet (grades 0-4) were treated with cheilectomy and a Moberg-Akin osteotomy of the proximal phalanx. All patients were clinically assessed preoperatively and followed up for 12 months by range of motion, visual analog scale (VAS) pain score, American Orthopaedic Foot & Ankle Society (AOFAS) score, Short Form 36 (SF-36) score, and weightbearing radiographs. RESULTS This operative procedure resulted in a statistically significant positive effect on mobility of the first metatarsophalangeal joint (P = .001), VAS pain score (P < .001), AOFAS score (P < .001), and SF-36 score (P < .001). CONCLUSION Cheilectomy and biplanar osteotomy of the proximal phalanx was an effective procedure for hallux rigidus with a positive effect on clinical and radiological outcome. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Danielle J A Maes
- Departement of Orthopaedic Surgery, Maria Middelares Hospital, Ghent, Belgium
| | - Jeroen De Vil
- Departement of Orthopaedic Surgery, Maria Middelares Hospital, Ghent, Belgium
| | - Alain F Kalmar
- Departement of Anesthesia and Intensive Care Medicine, Maria Middelares Hospital, Ghent, Belgium
| | - Tom Lootens
- Departement of Orthopaedic Surgery, Maria Middelares Hospital, Ghent, Belgium
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Massimi S, Caravelli S, Fuiano M, Pungetti C, Mosca M, Zaffagnini S. Management of high-grade hallux rigidus: a narrative review of the literature. Musculoskelet Surg 2020; 104:237-243. [PMID: 32030657 DOI: 10.1007/s12306-020-00646-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/02/2020] [Indexed: 01/13/2023]
Abstract
Hallux rigidus is a disease characterized by an osteoarthritic degeneration of the first metatarsophalangeal joint. Aetiology of hallux rigidus is not clear in the literature. History of trauma is considered one of the most common causes of unilateral hallux rigidus. Also, repetitive microtraumas or inflammatory and metabolic causes such as gout, rheumatoid arthritis and seronegative arthropathy can cause degeneration of the joint. The aim of this literature narrative overview is to summarize and expose the great amount of management concepts and information, including the well-codified main operative procedures to treat of hallux rigidus. This may provide current information for med-school students, researchers and physicians. A comprehensive literature search using PubMed database has been performed. The management for hallux rigidus can involve a variety of therapeutic interventions, conservative or operative. High-grade hallux rigidus represents a complex disease characterized by several clinical and pathological findings, and to achieve optimal results, surgical treatment should be chosen between several surgical techniques depending on the degree of arthritis and other different clinical conditions.
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Affiliation(s)
- S Massimi
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - S Caravelli
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - M Fuiano
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - C Pungetti
- Department of Orthopaedic Surgery, Ospedale Maggiore "Pizzardi", Bologna, Italy
| | - M Mosca
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - S Zaffagnini
- 2nd Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
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Majeed H. Silastic replacement of the first metatarsophalangeal joint: historical evolution, modern concepts and a systematic review of the literature. EFORT Open Rev 2019; 4:77-84. [PMID: 30993009 PMCID: PMC6440300 DOI: 10.1302/2058-5241.4.180055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Silastic implants for the first metatarsophalangeal joint (MTPJ) have been in use for over 50 years. Initial reports were associated with high failure rates leading to development of new designs that are currently in use.The aim of this article is to review the historical evolution and the outcomes of silastic implants for the treatment of end-stage OA of the first MTPJ. Databases were searched for studies reporting the outcomes of silastic implants for the first MTPJ. Various relevant search terminologies were used. Studies reporting the outcomes of metallic implants or arthrodesis were excluded.The literature search revealed 522 studies, of which 28 were included. Eight studies used single-stemmed implants and 20 used double-stemmed implants for their patients. Twenty-eight studies had a total of 2354 feet with silastic replacements in 1884 patients (1968 to 2003) with an average age of 53 years and the average follow-up was 85.3 months. There were a total of 5.3% (124 feet) failed prostheses. Improvement in pain was reported in 76.6% (1804 feet) with an average patient satisfaction rate of 84%. Radiological changes around the implants were found to be significantly higher with single-stemmed implants (30.3%) compared to the double-stemmed implants (14.7%) (p < 0.05).Significantly more single-stemmed implants failed (11%) than the double-stemmed implants (3.6%) (p < 0.05). Despite the initial reports of failed implants and complications, first- and second-generation silastic implants were associated with high patient satisfaction and pain improvement. Current literature lacks long-term outcomes of implants currently in use. Cite this article: EFORT Open Rev 2019;4:77-84. DOI: 10.1302/2058-5241.4.180055.
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Affiliation(s)
- Haroon Majeed
- Manchester University Foundation NHS Trust, Manchester, United Kingdom
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17
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Beekhuizen SR, Voskuijl T, Onstenk R. Long-Term Results of Hemiarthroplasty Compared With Arthrodesis for Osteoarthritis of the First Metatarsophalangeal Joint. J Foot Ankle Surg 2018; 57:445-450. [PMID: 29366661 DOI: 10.1053/j.jfas.2017.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 02/03/2023]
Abstract
If operative treatment is opted for grade 3 and 4 osteoarthritis of the first metatarsophalangeal joint, arthrodesis is considered the standard of care. However, if preservation of joint mobility is preferred, implant arthroplasty could be favored. Previous studies have suggested hemiarthroplasty might result in less pain, better function, and greater patient satisfaction compared with arthrodesis. However, these studies only evaluated short-term results (range 2.2 to 6.6 years). The aim of our study was to determine whether patients treated with hemiarthroplasty would show better postoperative outcomes compared with those treated with arthrodesis after ≥5 years after surgery. The American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal interphalangeal (AOFAS-HMI) scale score was used as the primary outcome measure. Secondary outcomes addressed satisfaction rates, patient procedure recommendation, and number of unplanned repeat surgical procedures. We also addressed the influence of the procedures on daily activities (work and sports), the influence of smoking on the postoperative results, and the costs for both procedures. A total of 47 primary arthrodeses and 31 hemiarthroplasties performed between January 2005 and December 2011 were evaluated. After a mean follow-up period of 8.3 (range 5 to 11.8) years, the mean AOFAS-HMI scale score after arthrodesis and hemiarthroplasty was 72.8 ± 14.5 and 89.7 ± 6.6, respectively (p = .001). The patients were significantly more pleased after hemiarthroplasty (p < .001), and this procedure was recommended more often (p < .001). The number of unplanned repeat surgical procedures did not differ between the 2 groups. Patients resumed sports activities significantly sooner after hemiarthroplasty (p = .002). The overall crude costs were similar for both procedures. Our results have shown more favorable postoperative outcomes for hemiarthroplasty compared with arthrodesis as operative treatment of osteoarthritis of the first metatarsophalangeal joint after a mean follow-up period of 8.3 years.
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Affiliation(s)
- Stefan R Beekhuizen
- Orthopaedic Resident, Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands.
| | - Timothy Voskuijl
- Orthopaedic Resident, Orthopaedic Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Ron Onstenk
- Orthopaedic Surgeon, Orthopaedic Surgery, Green Heart Hospital, Gouda, The Netherlands
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Couqueberg Y, Augoyard R, Augoyard M, Berry-Kromer V, Bouby C, Girod L. A Statistical Study of Metatarsal Anatomy: Toward the Design of Wide-Range Prosthetic Solutions. Foot Ankle Spec 2018; 11:277-287. [PMID: 29199479 DOI: 10.1177/1938640017744639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED The aim of the study is to provide some characteristic parameters of the anatomy of metatarsals from computed tomography (CT) scans. These data are important for more anatomical metatarsal head resurfacing prosthesis conception. Measures were performed on 20 CT scans from 17 patients with a mean age of 44.35 ± 15.75 years old. The panel was composed of 40% male and 50% left feet. Measurements were divided in 2 distinct categories: linear measurements with length of metatarsal, head radius and head, and diaphysis and base thicknesses, and cross-sectional area measurements, including cortical and cancellous bone area at 10%, 25%, 50%, 60%, 75%, and 90% of the metatarsal's length. The results included the mean and SD found for each measured value. This study is the first step toward a better understanding of the metatarsal's anatomy, so as to design a more anatomical range of metatarsal head resurfacing implants. LEVELS OF EVIDENCE Level IV.
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Affiliation(s)
- Yohann Couqueberg
- Université de Lorraine and CNRS, LEMTA, UMR 7563, Vandoeuvre-lès-Nancy, France (YC, VB-K, CB).,NOVASTEP, Espace Performance III, Bâtiment P, Saint-Grégoire, France (YC, LG).,Clinique Saint-Charles, Lyon, France (RA, MA)
| | - Romain Augoyard
- Université de Lorraine and CNRS, LEMTA, UMR 7563, Vandoeuvre-lès-Nancy, France (YC, VB-K, CB).,NOVASTEP, Espace Performance III, Bâtiment P, Saint-Grégoire, France (YC, LG).,Clinique Saint-Charles, Lyon, France (RA, MA)
| | - Marc Augoyard
- Université de Lorraine and CNRS, LEMTA, UMR 7563, Vandoeuvre-lès-Nancy, France (YC, VB-K, CB).,NOVASTEP, Espace Performance III, Bâtiment P, Saint-Grégoire, France (YC, LG).,Clinique Saint-Charles, Lyon, France (RA, MA)
| | - Valérie Berry-Kromer
- Université de Lorraine and CNRS, LEMTA, UMR 7563, Vandoeuvre-lès-Nancy, France (YC, VB-K, CB).,NOVASTEP, Espace Performance III, Bâtiment P, Saint-Grégoire, France (YC, LG).,Clinique Saint-Charles, Lyon, France (RA, MA)
| | - Céline Bouby
- Université de Lorraine and CNRS, LEMTA, UMR 7563, Vandoeuvre-lès-Nancy, France (YC, VB-K, CB).,NOVASTEP, Espace Performance III, Bâtiment P, Saint-Grégoire, France (YC, LG).,Clinique Saint-Charles, Lyon, France (RA, MA)
| | - Loïc Girod
- Université de Lorraine and CNRS, LEMTA, UMR 7563, Vandoeuvre-lès-Nancy, France (YC, VB-K, CB).,NOVASTEP, Espace Performance III, Bâtiment P, Saint-Grégoire, France (YC, LG).,Clinique Saint-Charles, Lyon, France (RA, MA)
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20
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Baumhauer JF, Singh D, Glazebrook M, Blundell CM, De Vries G, Le ILD, Nielsen D, Pedersen ME, Sakellariou A, Solan M, Wansbrough G, Younger ASE, Daniels TR. Correlation of Hallux Rigidus Grade With Motion, VAS Pain, Intraoperative Cartilage Loss, and Treatment Success for First MTP Joint Arthrodesis and Synthetic Cartilage Implant. Foot Ankle Int 2017; 38:1175-1182. [PMID: 28992721 DOI: 10.1177/1071100717735289] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Grading systems are used to assess severity of any condition and as an aid in guiding treatment. This study examined the relationship of baseline motion, pain, and observed intraoperative cartilage loss with hallux rigidus grade. METHODS A prospective, randomized study examining outcomes of arthrodesis compared to synthetic cartilage implant was performed. Patients underwent preoperative clinical examination, radiographic assessment, hallux rigidus grade assignment, and intraoperative assessment of cartilage loss. Visual analog scale (VAS) score for pain was obtained preoperatively and at 24 months. Correlation was made between active peak dorsiflexion, VAS pain, cartilage loss, and hallux rigidus grade. Fisher's exact test was used to assess grade impact on clinical success ( P < .05). RESULTS In 202 patients, 59 (29%), 110 (55%), and 33 (16%) were classified as Coughlin grades 2, 3, and 4, respectively. There was no correlation between grade and active peak dorsiflexion (-0.069, P = .327) or VAS pain (-0.078, P = .271). Rank correlations between grade and cartilage loss were significant, but correlations were small. When stratified by grade, composite success rates between the 2 treatments were nearly identical. CONCLUSIONS Irrespective of the grade, positive outcomes were demonstrated for both fusion and synthetic cartilage implant. Clinical symptoms and signs should be used to guide treatment, rather than a grade consisting of radiographic, symptoms, and range of motion factors. LEVEL OF EVIDENCE Level II, randomized clinical trial.
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Affiliation(s)
- Judith F Baumhauer
- 1 Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Dishan Singh
- 2 Stanmore Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Mark Glazebrook
- 3 Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
| | | | - Gwyneth De Vries
- 5 Dalhousie University and Memorial University of Newfoundland, Fredericton, New Brunswick, Canada
| | - Ian L D Le
- 6 University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Matthew Solan
- 10 Royal Surrey County Hospital, Guildford, Surrey, UK
| | | | - Alastair S E Younger
- 12 Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy R Daniels
- 13 Division of Orthopaedic Surgery, St Michael's Hospital, Toronto, Ontario, Canada
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Abstract
INTRODUCTION Classification systems for hallux rigidus imply that, as radiographic changes progress, symptoms will concurrently increase in severity. However, symptom intensity and radiographic severity can be discordant for many patients. We studied the correlation between hallux rigidus grades and the Foot and Ankle Ability Measure (FAAM) scores to better understand this relationship. METHODS We retrospectively reviewed weight-bearing radiographs of the foot and FAAM Activities of Daily Living (ADL) questionnaires for 84 patients with hallux rigidus. The Spearman rank coefficient was used to correlate clinical-radiographic hallux rigidus grade with FAAM ADL scores. RESULTS In 84 patients, the clinical-radiographic grade for hallux rigidus showed no relationship with FAAM ADL score (r = -0.10; P = 0.36) but did show moderate correlation with patient age (r = 0.63; P < 0.001). DISCUSSION Advancing radiographic changes in hallux rigidus did not correspond with patient symptoms as measured via FAAM ADL scores. CONCLUSION The reliability and validity of current grading criteria for hallux rigidus may require further exploration. LEVEL OF EVIDENCE Level III.
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Lam A, Chan JJ, Surace MF, Vulcano E. Hallux rigidus: How do I approach it? World J Orthop 2017; 8:364-371. [PMID: 28567339 PMCID: PMC5434342 DOI: 10.5312/wjo.v8.i5.364] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/20/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
Hallux rigidus is a degenerative disease of the first metatarsalphalangeal (MTP) joint and affects 2.5% of people over age 50. Dorsal osteophytes and narrowed joint space leads to debilitating pain and limited range of motion. Altered gait mechanics often ensued as 119% of the body force transmit through the 1st MTP joint during gait cycle. Precise etiology remains under debate with trauma being often cited in the literature. Hallux valgus interphalangeus, female gender, inflammatory and metabolic conditions have all been identified as associative factors. Clinical symptoms, physical exam and radiographic evidence are important in assessing and grading the disease. Non-operative managements including nonsteroidal antiinflammatory drugs, intra-articular injections, shoe modification, activity modification and physical therapy, should always be attempted for all hallux rigidus patients. The goal of surgery is to relieve pain, maintain stability of the first MTP joint, and improve function and quality of life. Operative treatments can be divided into joint-sparing vs joint-sacrificing. Cheilectomy and moberg osteotomy are examples of joint-sparing techniques that have demonstrated great success in early stages of hallux rigidus. Arthrodesis is a joint-sacrificing procedure that has been the gold standard for advanced hallux rigidus. Other newer procedures such as implant arthroplasty, interpositional arthroplasty and arthroscopy, have demonstrated promising early patient outcomes. However, future studies are still needed to validate its long-term efficacy and safety. The choice of procedure should be based on the condition of the joint, patient’s goal and expectations, and surgeon’s experience with the technique.
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Nüesch C, Mündermann A, Horisberger M. Mid-term functional outcome of a total arthroplasty of the first metatarsophalangeal joint. Clin Biomech (Bristol, Avon) 2017; 41:9-13. [PMID: 27846395 DOI: 10.1016/j.clinbiomech.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Arthroplasty of the first metatarsophalangeal joint is an alternative treatment option for end-stage hallux rigidus to the current gold standard of arthrodesis. The aim of this study was to investigate the mid-term functional outcome of an anatomically shaped prosthesis for the first metatarsophalangeal joint using pedobarography. METHODS Ten patients (12 affected feet; age at surgery: 62.1 (SD: 7.2) years) were investigated preoperatively and 52 (SD: 3) months postoperatively using pedobarography (EMED, novel GmbH, Munich, Germany). Two patients were excluded at follow-up because their prosthesis was converted to an arthrodesis. Peak force and plantar pressure under the five metatarsal heads and the hallux were analyzed and correlated with the clinical outcome (pain, American Orthopaedic Foot and Ankle Society forefoot score and radiographic maximum first metatarsophalangeal dorsiflexion). Differences between pre- and postoperative data were analyzed using paired t-tests (alpha=0.05). FINDINGS Postoperatively, forefoot peak forces under the fourth (+40.9%; P=0.018) and fifth metatarsal (+54.9%; P=0.037) and plantar pressures under the fifth metatarsal (+38.7%; P=0.027) increased significantly, while peak plantar pressures and forces under the hindfoot, medial forefoot and hallux did not change. While maximum passive dorsiflexion was not significantly greater at the 4-year follow-up compared to preoperatively, overall greater passive dorsiflexion was associated with higher first metatarsal peak pressure. INTERPRETATION Despite of patients reporting less pain, the functional results indicate an altered and potentially non-physiological postoperative gait pattern with a lateralization of the load during walking, especially in patients with limited passive dorsiflexion.
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Affiliation(s)
- Corina Nüesch
- University of Basel, University Hospital, Orthopaedics and Traumatology, Switzerland; University of Basel, Department of Biomedical Engineering, Switzerland.
| | - Annegret Mündermann
- University of Basel, University Hospital, Orthopaedics and Traumatology, Switzerland; University of Basel, Department of Biomedical Engineering, Switzerland
| | - Monika Horisberger
- University of Basel, University Hospital, Orthopaedics and Traumatology, Switzerland
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Long-term outcome of first metatarsophalangeal joint fusion in the treatment of severe hallux rigidus. INTERNATIONAL ORTHOPAEDICS 2016; 40:2401-2408. [PMID: 27542800 DOI: 10.1007/s00264-016-3277-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 08/03/2016] [Indexed: 12/30/2022]
Abstract
AIMS This study was aimed to study the arthrodesis of the first metatarsophalangeal joint using an oblique interfragmentary lag screw and dorsal plate as an effective option for the treatment of hallux rigidus. Few researchers have studied the outcome of this surgical method over a long follow-up period. PATIENTS AND METHODS We performed a retrospective review of 60 patients status post arthrodesis of the first metatarsophalangeal joint. The mean age was 68.5 years and average follow-up lasted for 47.3 months. Patients' satisfaction and functional outcomes were evaluated with the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale, the foot and ankle questionnaire, the Functional Foot Index, and dynamic pedobarography. RESULTS Fusion rate of 93.3 % was recorded; 6.7 % of the cases ended up with a painless pseudarthrosis and required no additional surgery. Pedobarographic measurements demonstrated first ray weight bearing function restoration. More physiological foot plantar pressure patterns were observed. Concerning the postoperative outcomes, 71.7 % of the patients were very satisfied and 18.3 % were satisfied. The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale increased post-operatively from 40.9 to 79.3. CONCLUSION The arthrodesis of the metatarsophalangeal joint using transarticular screw and dorsal nonlocked plate is an effective method for the treatment of severe hallux rigidus with fair patient satisfaction rate and functional outcome.
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Bitterman A, Mathew C, Patel M, Gurtowski JP. Antibiotic Spacer Arthroplasty for Revision MTP Arthrodesis: A Novel Means to Build the Implant: A Case Report. Cureus 2016; 8:e537. [PMID: 27114892 PMCID: PMC4841614 DOI: 10.7759/cureus.537] [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: 12/02/2022] Open
Abstract
Metatarsophalangeal (MTP) joint osteoarthritis (OA), also known as hallux rigidus (HR), is the most common degenerative arthropathy of the foot and is often the result of trauma. There are multiple methods of addressing the patient’s pain and limited function. Arthrodesis is the gold standard to manage severe MTP arthritis with a highly significant union rate. With various techniques of arthrodesis available, ranging from cannulated screw fixation, Kirschner wires, as well as plate and screw fixation, the orthopedic surgeon has multiple modalities to address this ailment; however, when these fail due to infection, the armament is limited. Through the idea of articulating antibiotic spacers in other regions of the body such as the knee and hip, we present a novel technique to the creation of an antibiotic spacer in the setting of a failed infected MTP arthrodesis.
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Affiliation(s)
| | - Cristin Mathew
- Orthopaedics, North Shore Long Island Jewish Health Systems
| | - Milap Patel
- Orthopaedics, North Shore Long Island Jewish Health Systems
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26
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Marsland D, Konan S, Eleftheriou K, Calder J, Elliot RR. Fusion of the First Metatarsophalangeal Joint: Precontoured or Straight Plate? J Foot Ankle Surg 2016; 55:509-12. [PMID: 26968232 DOI: 10.1053/j.jfas.2016.01.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Indexed: 02/03/2023]
Abstract
Precontoured, low-profile plates with fixed dorsiflexion angles are becoming increasingly popular for first metatarsophalangeal joint fusion. We have concerns that the routine use of a precontoured plate can lead to excessive clinical dorsiflexion. The aim of our study was to investigate the relationship between the first metatarsophalangeal joint dorsiflexion intramedullary angle and the angle formed at the dorsal cortices where the plate is applied. We hypothesized that the dorsal cortical angle was significantly less dorsiflexed than the intramedullary angle. We measured both angles on lateral weightbearing radiographs of 40 consecutive individuals presenting with forefoot symptoms. The results demonstrated that the mean dorsal cortical angle was significantly smaller (mean 0.2° plantarflexion) compared with the intramedullary angle (mean 10.6° dorsiflexion; p < .001). The interobserver and intraobserver reliability of both the intramedullary and the dorsal cortical measurements was very good. In conclusion, the dorsal cortical angle is, on average, 10.8° smaller than the intramedullary angle, with a mean angle of almost 0°. This finding should be considered when selecting plates for first metatarsophalangeal joint fusion.
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Affiliation(s)
- Daniel Marsland
- Specialist Registrar, Trauma and Orthopaedics, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom.
| | - Sujith Konan
- Specialist Registrar, Trauma and Orthopaedics, Chelsea and Westminster Hospital National Health Service Trust, London, United Kingdom
| | | | - James Calder
- Specialist Registrar, Trauma and Orthopaedics, Chelsea and Westminster Hospital National Health Service Trust, London, United Kingdom; Consultant Trauma and Orthopaedic Surgeon, Imperial College School of Medicine and Fortius Clinic, London, United Kingdom
| | - Robin R Elliot
- Consultant Trauma and Orthopaedic Surgeon, Hampshire Hospitals National Health Service Foundation Trust, Basingstoke, United Kingdom
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Abstract
BACKGROUND There is a clear call for improved patient-centered outcomes. The Foot and Ankle Outcome Score (FAOS) is a region-specific patient-reported measure that has been validated for a number of foot and ankle diagnoses, but not hallux rigidus. QUESTIONS/PURPOSES The aim of this study was to validate the FAOS in patients with hallux rigidus. METHODS From 2007 to 2013, 211 patients with hallux rigidus (HR) were included in the study. For the construct validity portion of the study, 125 patients completed a Short-Form 12 (SF-12) and FAOS survey. Forty additional HR patients were prospectively given questionnaires to assess the relevance of each FAOS question as it pertained to their HR. Reliability was assessed in 36 HR patients via administration of a second FAOS an average 1 month following the first. In 55 patients, preoperative and postoperative FAOS scores were compared to determine responsiveness. RESULTS All FAOS subscales demonstrated moderate correlation coefficients with the physical functioning, role physical, bodily pain, and physical health component scores of the SF-12, with all subscales demonstrating poor correlation with the SF-12 mental health-related domains. Content validity was high for all FAOS scores, with the exception of the daily activities subscale. All subscales achieved acceptable test-retest reliability with correlation coefficients of ≥0.72. Furthermore, all subscales were rated as responsive to change in postoperative patients (p < 0.001). CONCLUSION This study demonstrates the acceptable construct and content validity, reliability, and responsiveness of the FAOS for hallux rigidus. Due to its broad applicability and proven validation across multiple foot and ankle pathologies, the FAOS represents a patient-centered outcome measure that can be reliably used for the assessment of patients with hallux rigidus.
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Ceccarini P, Ceccarini A, Rinonapoli G, Caraffa A. Outcome of Distal First Metatarsal Osteotomy Shortening in Hallux Rigidus Grades II and III. Foot Ankle Int 2015; 36:1469-74. [PMID: 26187719 DOI: 10.1177/1071100715595503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Existing techniques for operative treatment of hallux rigidus commonly combine skeletal and soft tissue interventions to obtain long-lasting relief of pain. To date, operative treatments include implant arthroplasty, cheilectomy, various osteotomies, nonimplant arthroplasty, and arthrodesis. We assessed a technique that respects the anatomy and joint function and used a shortening osteotomy of the head of the first metatarsal. METHODS We evaluated a series of 40 consecutive patients affected by grade II and III hallux rigidus, aged 32 to 79 years, who had undergone surgery from January 2010 to January 2014. All patients were evaluated clinically and radiographically, preoperatively and postoperatively, and underwent a final follow-up at a mean of 35.4 (range = 12-51) months. For the clinical evaluation, the American Orthopaedic Foot & Ankle Society (AOFAS) clinical rating scale for the hallux metatarsophalangeal-interphalangeal joints was used. RESULTS A patient survey revealed excellent and good overall satisfaction in 90% of the sample. Postoperative results included a significant increase (P < .001) in the median global AOFAS score, from 39 (range = 25-60) to 84 (range = 78-94). CONCLUSIONS The technique of a shortening osteotomy of the first metatarsal head appeared to be useful for the correction of stiffness, pain relief, and an improvement in range of motion. Other advantages were that it preserved the integrity of the metatarsophalangeal joint and led to a rapid functional recovery. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Paolo Ceccarini
- Department of Orthopaedics and Traumatology, S.M. Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Alfredo Ceccarini
- Department of Orthopaedics and Traumatology, S.M. Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Giuseppe Rinonapoli
- Department of Orthopaedics and Traumatology, S.M. Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Auro Caraffa
- Department of Orthopaedics and Traumatology, S.M. Misericordia Hospital, University of Perugia, Perugia, Italy
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Delman C, Kreulen C, Sullivan M, Giza E. Proximal Phalanx Hemiarthroplasty for the Treatment of Advanced Hallux Rigidus. Foot Ankle Clin 2015; 20:503-12. [PMID: 26320563 DOI: 10.1016/j.fcl.2015.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Multiple treatment options exist for the management of late-stage hallux rigidus. The goals of treatment are pain reduction and restoration of function. Arthrodesis remains the treatment of choice, but recent advances support the use of first metatarsophalangeal hemiarthroplasty as a viable and successful option in properly selected patients in whom preservation of motion and function are desirable.
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Affiliation(s)
- Connor Delman
- Department of Orthopaedics, University of California, Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA
| | - Chris Kreulen
- Department of Orthopaedics, University of California, Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA
| | - Martin Sullivan
- Foot & Ankle Clinic, St. Vincents Clinic, Suite 901E, 438 Victoria Street Darlinghurst, Sydney, Australia
| | - Eric Giza
- Department of Orthopaedics, University of California, Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA.
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Abstract
Hallux rigidus is the most commonly occurring arthritic condition of the foot and is marked by pain, limited motion in the sagittal plane of the first metatarsophalangeal joint and varying degrees of functional impairment. In conjunction with clinical findings, radiographic grading helps guide therapeutic choices. Nonsurgical management with anti-inflammatory medications, corticosteroid injections, or shoewear and activity modifications can be successful in appropriately selected patients. Patients with more severe disease or refractory to conservative management may benefit from surgical intervention. Operative options range from joint-preserving procedures (eg, cheilectomy with or without associated osteotomies) to joint-altering procedures (eg, arthroplasty or arthrodesis).
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Affiliation(s)
- Kamran S Hamid
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Selene G Parekh
- Department of Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Duke University School of Medicine, 3609 Southwest Durham Drive, Durham, NC 27707, USA.
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Voskuijl T, Onstenk R. Operative Treatment for Osteoarthritis of the First Metatarsophalangeal Joint: Arthrodesis Versus Hemiarthroplasty. J Foot Ankle Surg 2015; 54:1085-8. [PMID: 26277243 DOI: 10.1053/j.jfas.2015.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Indexed: 02/03/2023]
Abstract
Controversy remains whether hemiarthroplasty or arthrodesis results in better postoperative outcomes for patients who request surgery for advanced osteoarthritis of the first metatarsophalangeal joint. Therefore, we tested the primary null hypothesis that the 2 treatment groups would not differ in the postoperative American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal interphalangeal scale scores after a follow-up period of ≥1 year. Secondary analyses addressed the satisfaction rates, percentage of patients who would recommend the procedure, and unplanned repeat operation rates. A total of 58 primary arthrodeses and 36 hemiarthroplasties performed from January 2005 to December 2010 were evaluated at ≥1 year postoperatively. At a mean average of 4 (range 1 to 7) years after surgery, the mean American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal interphalangeal scale score was 77.5 ± 18.5 in the arthrodesis group and 77.8 ± 12.0 in the arthroplasty group (p = .93). The number of repeat operations did not differ between these 2 groups, and patients treated with hemiarthroplasty reported greater mean satisfaction (p = .04). These results showed that the symptom intensity and magnitude of disability were similar at ≥1 year after arthrodesis or hemiarthroplasty for osteoarthritis of the first metatarsophalangeal joint, although the patients were subjectively more pleased with the results after hemiarthroplasty.
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Affiliation(s)
- Timothy Voskuijl
- Resident, Orthopaedic Surgery, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - Ron Onstenk
- Orthopaedic Surgeon, Groene Hart Ziekenhuis, Gouda, The Netherlands.
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Abstract
UNLABELLED Arthroscopy of the hallux metatarsophalangeal (MTP) joint is an evolving technique for hallux rigidus and other disorders of the hallux MTP joint. Purported advantages of this minimally invasive procedure include rapid rehabilitation and the ability to identify and address other intra-articular and sesamoid pathologies without additional dissection. Larger, prospective, and comparative outcomes studies are needed to optimize the treatment algorithm. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Kenneth J Hunt
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA
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33
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Proposed global treatment algorithm for Hallux rigidus according to evidence-based medicine. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014. [DOI: 10.1016/j.recote.2014.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Cheilectomy is commonly performed for osteoarthritis of the first metatarsophalangeal joint and generally has a successful outcome and high rate of patient satisfaction over the short to medium term. Despite the relatively good results achieved in most cases, a proportion of patients have ongoing pain after cheilectomy. This article outlines the potential causes of ongoing pain, including progression of osteoarthritis, neuralgic symptoms, and transfer metatarsalgia. Management strategies for treating the ongoing symptoms are discussed.
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Lewis JT, Hanselman AE, Lalli TAJ, Daigre JL, Santrock RD. Effect of Dorsal Plate Positioning on Dorsiflexion Angle in Arthrodesis of the First Metatarsophalangeal Joint: A Cadaveric Study. Foot Ankle Int 2014; 35:802-808. [PMID: 24798914 DOI: 10.1177/1071100714534419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The relationship between dorsal plate positioning and final dorsiflexion angle after first metatarsophalangeal (MTP) joint fusion has not been well established. The main purpose of this study was to investigate whether changes in dorsal plate positioning along the longitudinal axis affect fusion dorsiflexion angle, as excessive dorsiflexion angles can lead to poor clinical results. METHODS Ten cadaver foot specimens were randomly assigned to 2 groups for first MTP joint fusion: 1 group used a straight plate, and the other group used a 10-degree precontoured plate. After routine preparation, the plates were placed in an "ideal" position based on clinical and radiological examination. The plates were then moved proximally 3 mm and 6 mm from the initial site, with repeat imaging completed at each position. The radiological dorsiflexion angle was determined for each position, and the results were assessed. RESULTS Placement of both straight and precontoured plates at positions more proximal from the initial position led to significant increases in dorsiflexion angles (P = .04), although the percentage change was larger in the precontoured plate group (P = .01). While placement of the plate 3 mm proximal from the perceived "ideal" position did increase the dorsiflexion angle, the percentage of specimens with dorsiflexion angles in the suggested optimal range changed minimally. Positioning at 6 mm from the starting point, however, led to significantly increased dorsiflexion angles for both plates (P = .004). CONCLUSION Positioning the dorsal plate at more proximal locations leads to increasing dorsiflexion angles. Precontoured plates are more likely to lead to excessive dorsiflexion compared with straight plates regardless of plate position. CLINICAL RELEVANCE Fusion at excessive dorsiflexion angles can be minimized with appropriate selection and proper positioning of the dorsal fusion plate along the longitudinal axis.
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Herrera-Pérez M, Andarcia-Bañuelos C, de Bergua-Domingo J, Paul J, Barg A, Valderrabano V. [Proposed global treatment algorithm for hallux rigidus according to evidence-based medicine]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:377-86. [PMID: 25088241 DOI: 10.1016/j.recot.2014.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/30/2014] [Accepted: 05/05/2014] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Hallux rigidus is the most common arthritis of the foot and ankle. There are numerous reviews on the surgical treatment, but few publications that address the effectiveness of conservative treatment. OBJECTIVE To present a comprehensive algorithm for treatment of all grades of this disease. METHODS Literature search in the following sources: Pubmed and PEDro database (physiotherapy evidence database) until October 2013 for articles on treatment hallux rigidus to record levels of evidence. RESULTS A total of 112 articles were obtained on conservative treatment and 609 on surgical treatment. Finally, only 4 met the inclusion criteria. CONCLUSIONS The use of orthoses or footwear modifications, infiltration with hyaluronate, cheilectomy in moderate degrees and the metatarsophalangeal arthrodesis for advanced degrees, are the only procedures contrasted with grade B or moderate evidence in the treatment of hallux rigidus.
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Affiliation(s)
- M Herrera-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España; Facultad de Medicina, Universidad de La Laguna, Tenerife, España; Unidad de Tobillo y Pie, Hospital Universitario de Canarias, Tenerife, España.
| | - C Andarcia-Bañuelos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España
| | - J de Bergua-Domingo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España
| | - J Paul
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Basilea, Basilea, Suiza
| | - A Barg
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Basilea, Basilea, Suiza
| | - V Valderrabano
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Basilea, Basilea, Suiza
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Stadler N, Hofstätter S, Trieb K. Management of a failed metatarso-phalangeal joint fusion utilizing a hemicup prosthesis. Clin Pract 2014; 4:646. [PMID: 25332761 PMCID: PMC4202183 DOI: 10.4081/cp.2014.646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/25/2014] [Accepted: 08/04/2014] [Indexed: 01/04/2023] Open
Abstract
We report a case of a 65-year-old man with a painful nonunion of the first metatarsophalangeal joint (MTPJ). It is one of the main severe complications of this surgery. Its prevalence is described between 5% and 10% across different operative techniques. The implantation of hemicup-prosthesis has been successfully used for the hallux rigidus treatment with very promising results. In our case report, we introduce a treatment method of converting a pseudoarthrosis of the first MTPJ, made of two crossing screws into a hemicup-prosthesis as a salvage procedure. This is to our best knowledge the first report using this device for treatment of pseudoarthrosis of the first MTPJ.
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Affiliation(s)
- Nicola Stadler
- Department of Orthopaedic Surgery, Klinikum Wels-Grieskirchen , Austria
| | - Stefan Hofstätter
- Department of Orthopaedic Surgery, Klinikum Wels-Grieskirchen , Austria
| | - Klemens Trieb
- Department of Orthopaedic Surgery, Klinikum Wels-Grieskirchen , Austria
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38
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Abstract
Arthritis of the foot can be a difficult problem. It is initially managed with antiinflammatory medications and footwear modifications or bracing. However, a significant percentage of people with arthritis of the foot go on to require surgical intervention, which is most commonly arthrodesis.
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Affiliation(s)
| | - Jorge Bustillo
- Penn State Hershey Bone and Joint Institute, 30 Hope Drive, Building B, Suite 2400, Hershey, PA 17033-0850, USA
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Perler AD, Nwosu V, Christie D, Higgins K. End-stage osteoarthritis of the great toe/hallux rigidus: a review of the alternatives to arthrodesis: implant versus osteotomies and arthroplasty techniques. Clin Podiatr Med Surg 2013; 30:351-95. [PMID: 23827492 DOI: 10.1016/j.cpm.2013.04.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hallux rigidus is defined as end-staged arthrosis of the first metatarsophalangeal joint. Although the literature supports arthrodesis as being the gold standard for the treatment of end-staged hallux rigidus, there are several other treatments available that can either prolong the life of the remaining joint or artificially mimic the original biomechanics by replacing a portion of or the entire joint with the added advantage of preserving joint mobility. There are several new and emerging joint preservative techniques that may delay or prevent the need for a joint-destructive procedure, such as arthrodesis or arthroplasty.
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Affiliation(s)
- Adam D Perler
- Saint Vincent's Hospital System, Indianapolis, IN, USA.
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40
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Unger A, Stoica L, Olms KH, Renken F, Kasch R, Schulz A. Mittel- und langfristige Ergebnisse nach endoprothetischer Versorgung des Hallux rigidus. DER ORTHOPADE 2013; 42:561-8. [DOI: 10.1007/s00132-013-2112-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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