Salvage of first metatarsophalangeal joint arthroplasty complications

Category: Bunion Introduction/Purpose: First Metatarsophalangeal joint (MTPJ) osteoarthritis is a common forefoot disease. It leads to joint surface destruction and erosions limiting function and causing pain. The disease can be classified to mobile and non mobile or traumatic and atraumatic disease. The gold standard for treatment of stage III and IV remains MTPJ arthrodesis. In this case series we demonstrate MTPJ arthroplasty in mobile MTPJ with stable first interphalangeal joint (IPJ) can achieve short and medium-term results that are comparable to arthrodesis with high satisfaction rate. Methods: Retrospective analysis of 48 MTPJ arthroplasties performed by single surgeon in the period between 2011 to 2016. Patient were included if they had mobile first MTPJ osteoarthritis in the absence of IPJ hypermobility. The Surgical procedure included resurfacing the 1st metatarsal head using Arthrosurface® Hemicap implant and Extensor Digitorum Brevis (EDB) graft on the phalangeal surface of the joint. Radiological parameters collected using weight bearing x-rays prior to surgery, immediate radiological correction after surgery, 6 month and 2 years radiological analysis following the index surgery. Physiotherapy data were collected by senior physiotherapist prospectively during the time of postoperative rehabilitations and it included AOFAS and VAS scores. Results: 48 patients underwent 1st MTP joint arthroplasty using Arthrosurface® Hemicap implant for the metatarsal head with EDB graft on the phalangeal aspect. 44 patients had primary OA of the 1st MTP joint, 4 were conversion of MTPJ arthrodesis to arthroplasty and 3 were treated for non-union of MTP joint arthrodesis. Average postoperative ROM in the sagittal plane was 30 degrees and no valgus deformity in the coronal plane. 3 Patients (0.68%) had residual pain following the surgery due to soft tissue impingement and required further surgical intervention. 1 patient remained dissatisfied after the revision surgery. Conclusion: In short to medium-term follow up, the first MTP joint arthroplasty with Arthrosurface® implant and EDB graft provides an excellent functional outcome in the management of moderate to severe OA. In some selected cases this can be an option for treatment of patient with failed arthrodesis or patients requiring the reversal of the arthrodesis due to other issues.

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Metatarsus Primus Elevatus Resolution After First Metatarsophalangeal Joint Arthroplasty

Journal of the American Podiatric Medical Association ◽

10.7547/16-176 ◽

2018 ◽

Vol 108 (3) ◽

pp. 200-204 ◽

Cited By ~ 2

Author(s):

Patrick J. Sanchez ◽

John F. Grady ◽

Robin C. Lenz ◽

Sarah J. Park ◽

Jake G. Ruff

Keyword(s):

Sagittal Plane ◽

Metatarsophalangeal Joint ◽

Joint Arthroplasty ◽

Joint Motion ◽

First Metatarsophalangeal Joint ◽

Metatarsal Angle ◽

Second Metatarsal ◽

Before And After ◽

Declination Angle ◽

Common Etiology

Background: Hallux limitus (HL) is the second-most common pathology associated with the first metatarsophalangeal joint. A common etiology believed to be associated with HL is metatarsus primus elevatus (MPE), although causation has been unsubstantiated by evidence. Historically, correction of MPE is surgically addressed with an osteotomy. However, some believe MPE is a secondary manifestation of HL due to retrograde pressure and lack of dorsiflexion at the first metatarsophalangeal joint. This study sought to determine whether MPE resolves spontaneously after first metatarsophalangeal joint arthroplasty and reinstitution of normal joint dorsiflexion. Methods: Twenty-seven weightbearing lateral radiographs from patients with HL were reviewed before and after nonimplant first metatarsophalangeal joint arthroplasty. Radiographs were taken preoperatively and at postoperative visits 1 (mean, 2 weeks) and 2 (mean, 10 weeks). Measurements included first to second metatarsal elevation, Seiberg Index, first to fifth metatarsal distance, sagittal plane first to second metatarsal angle, Meary's angle, metatarsal declination angle, and hallux equinus angle. Results: Statistically significant improvement was seen at both postoperative visits in all of the previously mentioned measurements except first to fifth metatarsal distance, which was reduced but was not statistically significant. Conclusions: Metatarsus primus elevatus was reduced significantly after first metatarsophalangeal joint arthroplasty. Resolution occurred rapidly and was maintained at the final postoperative visit. This could be due to MPE being a manifestation of HL and not a cause. Based on the results of this study, osteotomies may be unnecessary to surgically address MPE because it can spontaneously correct after reinstitution of first metatarsophalangeal joint motion.

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Salvage arthrodesis for failed first metatarsophalangeal joint arthroplasty: A network meta-analysis

Foot and Ankle Surgery ◽

10.1016/j.fas.2019.07.014 ◽

2020 ◽

Vol 26 (6) ◽

pp. 614-623

Author(s):

David Weijia Mao ◽

Charles Zheng ◽

Nurun Nisa Amatullah ◽

Carmen Kam ◽

Charles Kon Kam King

Keyword(s):

Meta Analysis ◽

Metatarsophalangeal Joint ◽

Joint Arthroplasty ◽

First Metatarsophalangeal Joint

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Clinical Efficacy of the First Metatarsophalangeal Joint Arthroplasty as a Curative Procedure for Hallux Interphalangeal Joint Wounds in Patients with Diabetes

Diabetes Care ◽

10.2337/diacare.26.12.3284 ◽

2003 ◽

Vol 26 (12) ◽

pp. 3284-3287 ◽

Cited By ~ 70

Author(s):

D. G. Armstrong ◽

L. A. Lavery ◽

J. R. Vazquez ◽

B. Short ◽

H. R. Kimbriel ◽

...

Keyword(s):

Clinical Efficacy ◽

Metatarsophalangeal Joint ◽

Joint Arthroplasty ◽

Interphalangeal Joint ◽

First Metatarsophalangeal Joint ◽

Patients With Diabetes

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Correlation analysis of the x-ray and functional parameters from the results of chevron (Austin) osteotomy for hallux valgus

Vrač skoroj pomoŝi (Emergency Doctor) ◽

10.33920/med-02-2005-07 ◽

2020 ◽

pp. 54-63

Author(s):

Ruslan Khairutdinov ◽

Timur Minasov ◽

Ekaterina Yakupova ◽

Elvina Mukhametzyanova

Keyword(s):

Hallux Valgus ◽

Rating Scale ◽

Metatarsophalangeal Joint ◽

Valgus Deformity ◽

First Metatarsophalangeal Joint ◽

Chevron Osteotomy ◽

Hallux Valgus Deformity ◽

Valgus Angle ◽

The Right ◽

Bone Structures

Hallux valgus is characterized by the appearance and growth of a painful “lump” in the region of the first metatarsophalangeal joint, the development of forefoot corns, and inability to choose the right shoes, which leads to a significant decrease in the quality of life of these patients. Corrective osteotomies that preserve the metatarsophalangeal joint, for example Austin (Chevron) osteotomy, are usually used for hallux valgus deformity of the I, II degrees. Radiography with the study of the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA) is a research method that shows the true correlation between bone structures. The correlation between the radiological and functional indicators of osteotomy allows us to determine possible recommendations for indications for surgical treatment of Hallux valgus. Correlation shows that the largest correction of hallux valgus in older patients occurs due to a small adjustment of the angle of DMMA and HVA. IMA had the best correction after Austin osteotomy among patients of a younger age, then the HVA, and the DMMA had minimum correction according to the AOFAS rating scale (Kitaoka). The revealed correlations allow us to determine the correct tactics for the treatment of hallux valgus by identifying the benefits of Austin osteotomy.

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