Minimal resection interposition arthroplasty of the first metatarsophalangeal joint

BackgroundInterposition arthroplasty of the first metatarsophalangeal (MTP) joint is a viable alternative to fusion in patients with advanced hallux rigidus. The purpose of this study is to evaluate the midterm results of a modification of the technique.MethodsCase series of 18 interposition arthroplasties were performed on 13 female patients with Grade III–IV hallux rigidus. The technique included cheilectomy, bunionectomy when needed, minimal resection of the base of the proximal phalanx and interposition of a fascia lata allograft in the first metatarsophalangeal joint. Mean follow up was nine years (range 75–136 months). Patients were evaluated according to the AOFAS score, the ability to tip toe and their subjective satisfaction.ResultsThere was a significant difference between preoperative (mean 43.2, range 15–83) and postoperative (mean 77.3, range 40–100) AOFAS scores (p < 0.001). The patients were able to tip toe on 12 of the 18 operated feet and 9 of the 13 patients were satisfied from the operation. All dissatisfied patients had a coexistent hallux valgus deformity.ConclusionsThe technique had satisfactory midterm outcomes in older patients with advanced hallux rigidus without hallux valgus. Advantages of the method are the preservation of tip toe function in most patients and a technically easy conversion to fusion when needed.     

Interposition arthroplasty with bovine collagenous membrane for hallux rigidus: A long-term results retrospective study

BackgroundHallux rigidus (HR) is a degenerative arthritis of the first metatarsophalangeal joint (MTP1) with progressive loss of range of movement (ROM). Interposition arthroplasty (IA) is a technique widely used for the treatment of HR;however, few studies reported long-term clinical results. This study aims to report the clinical results of IA using a bovine pericardium collagen matrix for HR with a minimum 10-years follow-up.MethodsThirty patients (31 feet) who underwent IA using a bovine pericardium collagen matrix from 2001 to 2009 were retrospectively evaluated with a mean follow up of 154.1 ± 28.6 (range 124–218) months. All HR ranged from grade II to grade III, according to Regnauld classification. All patients were clinically assessed with the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal- Interphalangeal Scale, a pain Visual Analog Scale, and the Foot and Ankle Disability Index. Scores before and after treatment, respectively achieved from clinical records and clinical evaluation at final follow-up were compared.ResultsAt final follow-up, an improvement of all the considered scores (p < 0.01) was recorded. The overall rate of unsatisfying results was 16.1 %. Two (6.4 %) patients complained discomfort due to first ray shortening and 3 (9.7 %) cases of persistent metatarsal pain. There was one (3.2 %) case of Complex Regional Pain Syndrome (CPRS). No revision surgeries, infection, or other adverse events were reported.Conclusion: Interposition arthroplasty using bovine collagenous membrane is a reliable solution for high-grade HR with durable results over 10 years in more than 80 % of patients.     

Prosthetic replacement arthroplasty as a salvage operation for failed procedures of the first metatarsophalangeal joint: A small series and literature review

BackgroundA number of complications have been associated with Keller resection arthroplasty and arthrodesis of the first metatarsophalangeal joint for hallux rigidus. Salvage may be by arthrodesis (conversion to or revision). However, the optimal alignment is technically difficult to achieve and even if the fusion is successful, the procedure may still result in transfer metatarsalgia.ObjectiveTo assess the viability of prosthetic replacement arthroplasty as a salvage procedure for the first metatarsophalangeal joint.MethodsFour patients were identified who had undergone prosthetic replacement arthroplasty (one titanium hemiarthroplasty and three Moje prostheses) as a salvage procedure for failed surgery to the first metatarsophalangeal joint. Mean follow-up was 29.3 months (range 15–46). Patients were assessed with the American Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal–Interphalangeal Score, subjective patient satisfaction and current radiographs.ResultsAll patients who had a Moje press-fit ceramic arthroplasty reported subjective improvement of pain and function and achieved arcs of movement of between 20° and 50°. Mean AOFAS score was 63 (range 57–73). Radiographs revealed lucency around the prostheses in some patients.ConclusionsWe feel that the Moje arthroplasty as a salvage procedure is a viable alternative to that of arthrodesis, especially if preservation of movement is desired.     

Treatment of first metatarsophalangeal joint arthritis using hemiarthroplasty with a synthetic cartilage implant or arthrodesis: A comparison of operative and recovery time

Background

First metatarsophalangeal joint (MTPJ1) hemiarthroplasty using a novel synthetic cartilage implant was as effective and safe as MTPJ1 arthrodesis in a randomized clinical trial. We retrospectively evaluated operative time and recovery period for implant hemiarthroplasty (n = 152) and MTPJ1 arthrodesis (n = 50).

How is quality of life after total hip replacement related to the reconstructed anatomy? A study with low-dose stereoradiography

PurposeThe purpose of this study was to evaluate the relationships between the three-dimensional anatomy of operated hip in standing position using low-dose stereo-radiography imaging system and postoperative hip disability and osteoarthritis outcome score (HOOS) after total hip arthroplasty (THA).Material and methodsA total of 123 patients who underwent THA during a one-year period were included. There were 50 men and 73 women with a mean age of 67.3 ± 13.6 (SD) years (range: 19–89 years). All patients underwent pre- and postoperative low-dose stereo-radiography examination and completed a HOOS form (score from 0 to 100, 100 for full satisfaction). We recorded 16 anatomical parameters before THA, and 15 after THA. After binary transformation of HOOS score using 70 as threshold value, outcome was assessed using logistic or generalised linear models.ResultsA total of 103 patients (103/123; 83.7%) had a HOOS score ≥ 70 and were considered as the satisfied group. A significant difference in pelvic incidence (the angle between a line perpendicular to the sacral plate at its midpoint and a line connecting the same point to the centre of the bicoxofemoral axis) was found between the satisfied 56.4 ± 10.4 (SD)° (range: 31–85°) and the unsatisfied group 48.7 ± 8.9 (SD)° (range: 40–65) (P = 0.006). The relative variation of offset (distance from the centre of rotation of the femoral head to a line bisecting the long axis of the femur) compared to the contralateral hip was ?7% in the satisfied group and 7.2% in the unsatisfied group (P = 0.01).ConclusionPelvic incidence, a parameter independent of the reconstructed anatomy, probably influences the quality of life of patients with THA, via pelvic compensatory capabilities. A loss of femoral offset negatively influences the satisfaction of patients.