scholarly journals Comparison of Outcomes of Cheilectomy with and without Synthetic Hydrogel Interposition (Cartiva®)

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Samuel E. Ford ◽  
Daniel J. Scott ◽  
Shannon F. Alejandro ◽  
David D. Vier ◽  
Jacob R. Zide ◽  
...  
Keyword(s):  
Joint Space ◽  
Hallux Rigidus ◽  
Persistent Pain ◽  
Interposition Arthroplasty ◽  
Synthetic Hydrogel ◽  
Sf 36 ◽  
Joint Distraction ◽  
Surgical Treatments ◽  
Limited Motion

Category: Midfoot/Forefoot; Other Introduction/Purpose: Cheilectomy and arthrodesis are the primary surgical treatments of hallux rigidus. While cheilectomy preserves limited motion, that motion can be the source of persistent pain that later requires arthrodesis. Cheilectomy with interposition arthroplasty using a synthetic hydrogel implant (Cartiva) has been proposed as an alternative to arthrodesis. Previous studies compared Cartiva to arthrodesis, but Cartiva is really a modification of cheilectomy, meant to improve its results by distracting the bony surfaces of the first MTP joint. This study compared outcomes of cheilectomy with Cartiva to cheilectomy alone. Methods: A retrospective cohort study assessed the results at 1-year minimum follow-up, identifying patients by CPT code for cheilectomy with (28291) and without (28289) Cartiva interposition. There were forty-five patients: 26 in the Cartiva group and 19 in the cheilectomy group. Tabulated data included: age, gender; preoperative, 6-month, and final postoperative total first MTP ranges of motion (ROM); preoperative and final postoperative VAS and SF-36 scores; and reoperation information. Hallux rigidus grade was assessed by Coughlin and Shurnas criteria. First MTP joint space was measured at the medial, midline, and lateral portions of the joint on both AP and lateral radiographs before, immediately following, and at maximum postoperative follow-up (16 month mean). For analysis, medial, midline, and lateral joint measurements were averaged to generate a composite measure of radiographic joint space. Follow-up means were 23 months for all patients, 18 for Cartiva and 28 for cheilectomy. Results: Mean age was 54. Mean preoperative grade was 2.6 for Cartiva and 2.1 for cheilectomy (p=0.037). Mean preoperative ROM was 44°. At 1 year follow-up, ROM was 39° for Cartiva and 47° for cheilectomy (p=0.95). Mean VAS improved from 5.8 to 2.0 and 3.0 for Cartiva and cheilectomy, respectively, at final follow-up (p=0.002, p=0.004). Following Cartiva, two week postoperative joint space means increased: AP midline 1.4 to 2.6 mm, AP composite 1.4 to 2.2 mm, and lateral midline 1.3 to 2.7 mm (p<0.001). At final follow-up, joint space measures returned to levels similar to cheilectomy: AP midline 1.3 vs. 1.2 mm, AP composite 1.1 vs. 1.2 mm, and lateral midline 1.6 vs. 1.2 mm (p>0.3). Five patients in each group (22%) underwent revision. Conclusion:: Cartiva offers similar intermediate-term ROM preservation and pain relief as cheilectomy in a cohort with higher grade hallux rigidus. Joint distraction gained by synthetic hydrogel interposition subsides with time to levels similar to cheilectomy. Revision surgery for persistent pain is common in both groups.

scholarly journals Clinical results of capsular interposition arthroplasty for severe hallux rigidus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0052
Author(s):  
Akiyama Yui ◽  
Takaaki Hirano ◽  
Hisateru Niki
Keyword(s):  
Clinical Results ◽  
Joint Space ◽  
Hallux Rigidus ◽  
Interposition Arthroplasty ◽  
Articular Capsule ◽  
Medial Side ◽  
Grade Ii ◽  
The Mean ◽  
Mtp Joints

Category: Midfoot/Forefoot Introduction/Purpose: There is no established surgical treatment for severe hallux rigidus (HR). Hamilton suggested capsular interposition arthroplasty (CIA), performed using an articular capsule and extensor hallucis brevis as a biologic spacer, as an alternative to metatarsophalangeal (MTP) joint fixation to treat severe HR. CIA is a preservation procedure that relieves pain and maintains joint function. We present the results of CIA performed at our facility to treat severe HR. Methods: In the present study, we further divided Hattrup’s grade II HR into two subtypes on the basis of joint space narrowing of 1stMTP. We recorded the severity of patients’ condition using our modified Hattrup’s classification. In this study, we did a follow-up of 8 cases in which CIA was performed to treat severe HR. The cases were followed up for 1 year or longer. The mean age of patients at surgery was 63.8 years, and the mean follow-up period was 7.1 years. Surgery was performed using a modified Hamilton method, which involves making an incision on the dorsal instead of the medial side and a manipulating the articular capsule in a different manner. Clinical outcomes were evaluated using the Japanese Society for Surgery of the Foot standard rating system (JSSF) scale. We investigated the pre- and post-operative ROM of the MTP joints and verified the presence or absence of complications. Results: It was observed that pain had reduced significantly in all cases after surgery. Following CIA, the mean ROM at extension was noted to have improved from 27.5° to 48.8° and the mean ROM at flexion had improved from 11.9° to 21.9°. The mean JSSF scale score has improved from 59.5 to 97.5 points. No complications were observed. Conclusion: This procedure is beneficial for pain relief and acquisition or maintenance of articular ROM and is a better choice for patients desiring preservation of ROM and articular function. It is imperative that patients follow proper rehabilitation for ROM and muscular strength preservation.

scholarly journals Allograft Tendon Interposition Arthroplasty of the Hallux Metatarsophalangeal Joint: A Technique Guide and Literature Review

2018 ◽  
Vol 40 (1) ◽  
pp. 113-119 ◽  
Author(s):  
Troy S. Watson ◽  
Jordan Panicco ◽  
Amit Parekh
Keyword(s):  
Soft Tissue ◽  
Metatarsophalangeal Joint ◽  
Joint Space ◽  
Hallux Rigidus ◽  
Senior Author ◽  
Bone Tunnel ◽  
Interposition Arthroplasty ◽  
Level Of Evidence ◽  
Tissue Handling ◽  
Tendon Interposition

The “anchovy” interpositional arthroplasty technique can be used as a salvage option for failed hallux rigidus procedures. The operative technique utilized by the senior author is described. Careful soft-tissue handling, meticulous joint space and graft preparation, and interposition graft stabilization using a bone tunnel and suture anchors are unique aspects of this technique, which in the authors’ experience have contributed to improved outcomes. Current literature regarding indications and outcomes is limited and controversial. The proposed benefits of soft-tissue interposition arthroplasty of the hallux metatarsophalangeal joint for patients with prior failed implant arthroplasty are improved pain scores and preservation of range of motion. Level of Evidence: Level V, technique guide.

scholarly journals Osteochondral Defects in Hallux Rigidus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0019
Author(s):  
David Ciufo ◽  
Michelle Lawson ◽  
Benjamin Strong ◽  
Benedict DiGiovanni
Keyword(s):  
Outcome Measures ◽  
Demographic Data ◽  
Age Groups ◽  
Operative Management ◽  
Hallux Rigidus ◽  
Entire Cohort ◽  
Sf 36 ◽  
The Difference ◽  
Component Scores

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus, or 1st metatarsophalangeal (MTP) joint degeneration, is commonly encountered in foot and ankle practice. Operative management can include a dorsal cheilectomy, a motion sparing procedure to reduce impingement. Hallux rigidus affects patients across all age groups, and etiologies may include trauma, first ray hypermobility, pes planus, or hallux valgus. First MTP joint trauma may result in an osteochondral defect (OCD). Literature is sparse regarding OCD management in the 1st MTPJ, as is follow-up data on cheilectomy using validated outcome measures. We hypothesize that the presence of an OCD is associated with symptomatic hallux rigidus at a lower Coughlin and Shurnas grade. We also hypothesize that OCD treatment concurrent with cheilectomy leads to outcomes equivalent to patients treated with isolated hallux rigidus. Methods: A retrospective review of prospectively collected data was performed. All patients of a single surgeon were reviewed based on the CPT code (28289) for cheilectomy from 1/1/2011 to 12/31/2015. Demographic data, presence/drilling of an OCD on operative reports, and Coughlin grading were recorded. All patients had taken the FAAM and SF-36 preoperatively per the surgeon’s routine preoperative data collection. After approval by the institutional review board, all patients were contacted by telephone for follow-up and answered the FAAM, SF-36 and Patient Acceptable Symptom State (PASS) questionnaires. Visual analog scores (VAS), patient satisfaction, complications, and whether they would opt for surgery again were recorded.Paired T-tests were performed to evaluate improvement in FAAM activity of daily living (ADL), FAAM sport, SF-36 physical component scores (PCS), and SF-36 mental component scores (MCS). Two-tailed T-tests were performed to evaluate the difference in groups with and without OCDs. Results: Seventy-one patients met inclusion criteria. Follow-up was obtained from 28 patients (29 feet) for analysis, 10 with OCDs. Mean responder age was 53.1 years (32.6-70.9), with average 4 year follow-up (minimum 2 years). Patients with OCDs had lower Coughlin grade (p<0.01) and trended towards lower age (p=0.07), but similar improvement in FAAM sport (p=0.43), SF-36 PCS (p=0.33), and MCS (p=0.46). Patients with OCDs trended towards greater improvement in FAAM ADL (p=0.07). The entire cohort demonstrated significant improvements (p<0.01) in ADL, Sport, PCS, and MCS after cheilectomy. ADL and Sport scores met the MCID of 8 and 9 points, respectively. MCID is not well-defined for SF-36. One patient required subsequent fusion. Conclusion: Cheilectomy is an effective surgical option for improving function and pain in the setting of hallux rigidus, as measured at intermediate-term follow-up with validated patient outcome measures. Patients with a 1st MTP joint OCD become symptomatic at a younger age and with a lower radiographic grade of hallux rigidus. These patients demonstrate equivalent improvements in the FAAM sport, SF-36 PCS and MCS while trending towards greater improvement in the FAAM ADL score as those without OCDs. The presence and treatment of a 1st MTP joint OCD should be considered in younger patients with symptomatic hallux rigidus and lower radiographic severity.

scholarly journals Outcomes Following Interposition Arthroplasty of the First Metatarsophalangeal Joint for the Treatment of Hallux Rigidus: A Systematic Review

2019 ◽  
Vol 4 (2) ◽  
pp. 247301141881442 ◽  
Author(s):  
Brendan R. Emmons ◽  
Dominic S. Carreira
Keyword(s):  
Systematic Review ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Cochrane Central Register ◽  
Interposition Arthroplasty ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Number Of Patients ◽  
Long Term Follow Up

Background: Interposition arthroplasty of the first MTP joint has recently experienced renewed interest as a treatment for hallux rigidus. The purpose of this study was to systematically review the rapidly expanding literature on PRO following interposition arthroplasty of the first MTP joint. Methods: PubMed Central, Embase, and the Cochrane Central Register for Controlled Trials (CENTRAL) were searched. Inclusion criteria included length of time to follow-up, number of patients, outcome measure, and use of allogeneic or autogenous soft tissue or a synthetic matrix as interposition. Results: 20 studies were included in the review, comprising 498 patients and 539 feet with mean time to follow-up of 4.5 years. The most common substance used for interposition in the included studies was autogenous first MTPJ capsular tissue, a technique reported on in 12 (60.0%) of the included articles. In studies reporting preoperative and postoperative outcomes by way of a standardized outcome scoring system, mean group improvements exceed minimal clinically important differences in the majority of studies. Eighty-five percent of the studies included in this review were of Level IV quality evidence, and of this subset of studies, 70.6% were of a retrospective nature. Progression to further surgery was observed in 3.8% of toes. The most common complication reported was transfer metatarsalgia of 1 or more lesser toes, observed in up to 57.9% of patients in one study. Conclusion: Interposition arthroplasty appears to be a viable option for the treatment of moderate to severe hallux rigidus in patients looking to salvage motion through the first metatarsophalangeal joint. A wide array of autogenous, allogeneic, and synthetic implant materials have surfaced in recent years, but long-term follow-up and prospective, comparative study designs with low risk of bias are limited. Level of Evidence: Level IV, systematic review of Level III-IV studies

Rolled Tendon Allograft Interposition Arthroplasty for Salvage Surgery of the Hallux Metatarsophalangeal Joint

2018 ◽  
Vol 39 (4) ◽  
pp. 458-462 ◽  
Author(s):  
Danielle Thomas ◽  
David Thordarson
Keyword(s):  
Operative Procedure ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Joint Space ◽  
Hallux Rigidus ◽  
Salvage Treatment ◽  
High Rate ◽  
Interposition Arthroplasty ◽  
First Metatarsophalangeal Joint ◽  
Interpositional Arthroplasty

Background: Hallux rigidus is a common osteoarthritic disease of the first metatarsophalangeal joint (MTPJ). Few salvage treatment options exist that preserve motion for patients who have failed an initial procedure and who are not amenable to fusion, typically patients who are active or who would like to wear high heels. Allograft tendon interpositional arthroplasty is an unconventional salvage treatment option that may preserve motion and prevent bone loss. Methods: A retrospective chart review is reported of 19 patients who failed previous procedures and refused fusion who underwent allograft tendon interpositional arthroplasty of the hallux MTPJ by a single surgeon between 2012 and 2015. Outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale assessment as well as measurement of apparent joint space on anterior to posterior and lateral views. Results: The cumulative average AOFAS score for all patients was 68.5 preoperatively and 74.1 postoperatively. The average AOFAS pain subscore was 24.7 preoperatively and 26.8 postoperatively (SD = 7.7 and 13.8, respectively). Radiographically, patients had an increase in apparent joint space from pre- to postoperatively, most notable on the lateral view (0.6 to 4.7 mm; SD = 0.7 and 3.2 mm). Five patients required a second operative procedure, for an overall 26% reoperation rate. One patient underwent hallux MTPJ fusion after the interpositional arthroplasty. An additional 4 patients (21%) had symptoms requiring a steroid injection, and another 3 patients (16%) were recommended to undergo a revision procedure based on their symptoms. Conclusion: Rolled allograft tendon interposition arthroplasty performed poorly as a salvage strategy for failed previous hallux MTPJ surgery for hallux rigidus because of a high rate of complication and minimal benefits. The senior author has abandoned the technique. Level of Evidence: Level IV, retrospective case series.

Long-Term Follow-up of Capsular Interposition Arthroplasty for Hallux Rigidus

2017 ◽  
Vol 39 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Ettore Vulcano ◽  
Andy L. Chang ◽  
David Solomon ◽  
Mark Myerson
Keyword(s):  
Patient Satisfaction ◽  
Short Form ◽  
Case Series ◽  
Hallux Rigidus ◽  
Interposition Arthroplasty ◽  
Patient Satisfaction Score ◽  
Long Term Follow Up ◽  
The Mean

Background: Capsular interposition arthroplasty is a joint- and motion-sparing procedure that has been shown as an effective alternative to fusion. This study aimed to evaluate patient function and satisfaction after long-term follow-up. Methods: Sixty-four patients were treated with capsular interposition arthroplasty for hallux rigidus by the senior author performed between February 1998 and July 2011. Twenty-two patients could not be reached for follow-up and were thus excluded from the analysis. Therefore, 42 remaining patients were evaluated using the visual analog scale (VAS), Foot Function Index (FFI), Short Form 12 (SF-12), and patient satisfaction scores. The mean follow-up was 11.3 (range, 4-16) years. Results: The mean VAS for pain was 7.9 preoperatively and 1.8 postoperatively ( P = .003). The mean preoperative SF-12 physical score was 42.0 vs 64.2 postoperatively ( P = .02). The mean preoperative SF-12 mental score was 50.7, while the postoperative SF-12 mental score was 54.6 ( P = .01). The total FFI score also significantly improved, with a preoperative value of 98.3 and a postoperative mean score of 49.6 ( P = .001). The mean patient satisfaction score was 7.4 of 10. Overall, 39 of 42 patients (92.9%) stated they would have the surgery again. Four of the 42 patients (9.5%) required conversion to hallux metatarsophalangeal fusion at a mean of 6.1 years after the index procedure secondary to pain, but no other complications were reported. Conclusion: Capsular interposition arthroplasty was a safe and effective treatment for severe hallux rigidus. These longer term results demonstrate a high level of patient satisfaction. Level of Evidence: Level IV, retrospective case series.

scholarly journals Middle and Long -term Clinical Results of Dorsiflexion Osteotomy for Severe Hallux Rigidus

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Hiroko Ikezawa ◽  
Norio Usami ◽  
Eiichi Hiraishi ◽  
Yamada Takahiro
Keyword(s):  
Articular Surface ◽  
Clinical Results ◽  
Joint Space ◽  
Hallux Rigidus ◽  
Radiographic Findings ◽  
First Metatarsal ◽  
Joint Preserving Surgery ◽  
Experienced Pain

Category: Bunion Introduction/Purpose: Total arthroplasty or arthrodesis is often used as a surgical procedure for severe case of hallux rigidus. However, because these procedures involve problems such as loss of joint function, age, and postoperative motion restriction, joint-preserving surgery is desirable for achieving a better quality of life. To resolve these problems, we have performed dorsiflexion osteotomy of the first metatarsal head since 2000, yielding favorable outcomes. We report about middle to long-term follow-up for our clinical results and radiographic findings. Methods: The study involved 31 feet of 30 patients (20 male,11 female) with Grade 2 (joint space narrowed to about 1/2 or less) or Grade 3 according to the Hattrup and Johnson classification. The mean age at surgery was 61.6 years (range: 53-77). Surgical techniques: We have used dorsal approach and conducted closed wedge osteotomy of the first metatarsal bone neck. Then, the bone head was flexed dorsally to form an articular surface and fixation. PWB was permitted 3 weeks after surgery. Mean postoperative follow-up period was 4 years and 2 months (range: 3-13 years). Clinical outcomes, range of motion (ROM), and radiographic findings were investigated. Results: Clinical outcomes were rated as excellent in 24 feet, good in 7, and fair/poor in none. All patients returned to normal daily life. Stiffness while walking was noted in 10 feet. As for ROM, most patients had a 1/2 to 2/3 of the normal range. No complications such as infection, nonunion, or transfer metatarsalgia were seen in any case. An X-ray film showed joint space narrowing in about half of all cases. None of the patients experienced pain relapse requiring arthrodesis again. Conclusion: The mechanism of pain relief is Dorsiflexion osteotomy is by bone shortening, make a decreasing joint pressure and regaining of normal articular to the dorsal side so that it faces the articular surface of the proximal phalanx. The postoperative restriction of ROM may be attributable to changes in the bone alignment and in the tension of soft tissue around the joint as compared to the healthy condition. None of the patients experienced pain relapse. Our procedure appears to be useful as joint- preserving surgery for severe cases with hallux rigidus.

scholarly journals Is Interposition Arthroplasty a Viable Option for Treatment of Moderate to Severe Hallux Rigidus? A Systematic Review and Meta-analysis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0042
Author(s):  
Ashish Shah ◽  
Harshadkumar Patel ◽  
Sameer Naranje ◽  
Henry DeBell ◽  
Andrew McGee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Metatarsophalangeal Joint ◽  
Scoring Systems ◽  
Hallux Rigidus ◽  
Complication Rates ◽  
Viable Option ◽  
Interposition Arthroplasty ◽  
First Metatarsophalangeal Joint

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is a painful arthritis of the first metatarsophalangeal joint that causes progressive loss of mobility. Treatment options include activity modifications, analgesics, corticosteroids, and surgery. Arthrodesis of the MTP joint is considered the gold standard treatment for hallux rigidus, but it is often reserved for advanced. Interposition arthroplasty uses a spacer taken from an autograft, allograft, or synthetic material. For patients with severe arthritic diseases who would like to preserve MTP joint function, interposition arthroplasty may be a viable option. The purpose of this systematic review is to investigate patient outcomes after undergoing interposition arthroplasty of the MTP joint. The objectives are to determine if this technique is practical for patients who would prefer to avoid arthrodesis, and to systematically analyze post-operative improvement. Methods: The systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) guidelines. Medline, pubmed, Embase, and Cohrane Database of Systematic Reviews (CDRS) were searched for publications from 2000 to 2017. Duplicates were then removed, and titles and abstracts were reviewed to confirm the relevance f the study. Studies were included if they reported results of first MTP joint interposition arthroplasty in one of the well-known scoring systems: AOFAS, FFI, or SF-36. Studies also were also required to have a 12 month follow up. Systematic review and data extraction were performed on all selected studies. Means were recorded and placed in tables for all variables including scoring results and complication rates. A linear regression model comparing the change in preoperative to postoperative AOFAS scores between the autogenous versus allogenous interposition materials was performed. Results: Database searches produced 574 articles for review. 15 of these were included in the systematic review. Mean AOFAS score was improved from 41.35 preoperatively to 83.17 postoperatively. Mean pain, function, and alignment scores improved from preoperative values of 14.9, 24.9, and 10 to postoperative values of 33.3, 35.8, and 14.5. Mean dorsiflexion increased from 21.27 degrees (5-30) to 42.03 degrees (25-71). Mean ROM improved from 21.06 to 46.43 degrees. Eighty-seven percent of patients were satisfied to highly satisfied with their surgery and would choose surgery again. Joint space increased by 0.8 mm to 2.5 mm. The most common complications included metatarsalgia (13.9%), loss of ground contact (9.7%), osteonecrosis (5.4%), great toe weakness (4.8%), hypoesthesia (4.2%), decreased push off power (4.2%), and callous formation (4.2%). Conclusion: The management of hallux rigidus remains heavily debated. This systematic review of the current literature suggests that interposition arthroplasty is a viable short and intermediate term treatment for hallux rigidus in terms of patient satisfaction, pain scores, and AOFAS scores. Further studies with greater sample sizes, more uniform methods, and longer follow-up times are needed to further support the superiority of interposition arthroplasty.

Early Catastrophic Failure of a Synthetic Cartilage Implant for Hallux Rigidus

2020 ◽  
pp. 193864002096958
Author(s):  
Sudheer C. Reddy
Keyword(s):  
Case Report ◽  
Hallux Rigidus ◽  
Catastrophic Failure ◽  
Short Term ◽  
Levels Of Evidence ◽  
Evidence Level ◽  
Mode Of Failure ◽  
Surgical Treatments

Hallux rigidus is a common arthritic disorder of the foot. Surgical treatments are varied, from isolated cheilectomy to arthrodesis. A synthetic cartilage implant has been embraced recently as a joint-sparing alternative to arthrodesis, with good early and midterm outcomes. However, early clinical failures have been described relating to implant subsidence. This case report focuses on another mode of failure consisting of early catastrophic wear resulting in conversion to a lengthening arthrodesis at short-term follow-up. Levels of Evidence: Level V

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