Long-Term Follow-Up of the Cheilectomy for Degenerative Joint Disease of the First Metatarsophalangeal Joint

A retrospective study was performed describing the clinical presentations, radiographic findings, and surgical outcomes of 17 dogs (18 elbows) following medial coronoidectomy for the treatment of elbow joint incongruity as a sole disease entity. Complete resolution of lameness was achieved in 100% of the cases. The mean radiographic arthrosis grade progressed in 70% of the cases. Results of this study indicate that resolution of clinical lameness may be achieved with medial coronoidectomy in dogs with elbow incongruity; however, progression of degenerative joint disease with unknown, long-term clinical significance can be expected after surgery.

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Rate of Development of Hallucal Interphalangeal Degenerative Joint Disease After First Metatarsophalangeal Joint Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00259 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0025

Author(s):

Christopher Hyer ◽

Nisha Shah ◽

Marcus Richardson

Keyword(s):

Surgical Procedures ◽

Weight Bearing ◽

Subsequent Development ◽

Metatarsophalangeal Joint ◽

Degenerative Joint Disease ◽

Joint Disease ◽

Inclusion Criteria ◽

First Metatarsophalangeal Joint ◽

Post Surgery

Category: Midfoot/Forefoot Introduction/Purpose: The first metatarsophalangeal joint (MTPJ) is an integral part of the foot during the gait cycle. Arthrodesis of this joint is gold standard, especially in patients with rheumatoid arthritis. The development of IPJ arthritis after an arthrodesis of the MTPJ has been established in the literature; however, the significance of this has not. The purpose of this study was to determine the rate of IPJ degenerative joint disease (DJD) in patients who underwent first MTPJ fusion by evaluating the degree of IPJ arthritic degeneration through 2 years post-surgery and to compare radiographic parameters over time among patients with and without DJD in order to determine whether non-fusion (less than 50% fusion) or the hallucal position was associated with the subsequent development of DJD. Methods: Retrospective clinical and radiographic review of patients who had undergone a first metatarsophalangeal joint arthrodesis was performed. Inclusion criteria were adult patients 18 and older who underwent first MPJ arthrodesis between January 2012 and January 2015 with internal fixation of any type. Patients were excluded if they were under 18 years of age, underwent concomitant procedures that would affect postoperative weight bearing course, suspected or diagnosed with osteomyelitis of the foot, had prior surgical procedures of the MTPJ or IPJ joints, or concomitant hallucal IPJ arthritis or preexisting IPJ fusion. Postoperative radiographs were obtained immediately following surgery and at approximately 6 weeks, 3 months, 6 months, 12 months, and 24 months. Results: Ultimately, 103 patients met all the inclusion criteria and none of the exclusion criteria. Four of the 103 patients (3.9%) had undergone bilateral procedures, thus providing 107 surgical procedures. Demographic characteristics can be found on Table 1. The hallux abductus (HA) angle and hallux abductus interphalangeus (HAI) angle were measured preoperatively and postoperatively (Fig. 1-2). The average postoperative follow-up radiograph was taken at 22.9 weeks. The HA angle average preoperatively was 31.4 degrees, which decreased to 11.8 degrees postoperatively. The HAI angle average preoperatively measured 10.8 degrees and increased to 11.9 degrees postoperatively. No patients had symptomatic hallux IPJ postoperatively within the study period. However, 7 patients needed hardware removal and second surgery at an average of 36.3 weeks due to hardware pain and nonunion. Conclusion: Arthrodesis is often the treatment of choice for first MTPJ pathology, which is commonly arthritis or hallux valgus. We found the incidence of IPJ arthritis to be lower than the reported literature and unchanged over the postoperative period. Furthermore, no patients reported symptomatic hallux IPJ within the study period. Also, we found the HA angle had decreased in the patients postoperatively; however, there was a mixed trend with HAI increasing after first MTPJ fusion. The significance of this trend is unclear, but the increase of the HAI could possibly cause further pain and deterioration of the joint in the future.

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Rate of Development of Hallucal Interphalangeal Degenerative Joint Disease After First Metatarsophalangeal Joint Arthrodesis: A Retrospective Radiographic Analysis

Foot & Ankle Specialist ◽

10.1177/1938640018803767 ◽

2018 ◽

Vol 12 (4) ◽

pp. 357-362

Author(s):

Nisha N. Shah ◽

Marcus P. Richardson ◽

Anson K. Chu ◽

Christopher F. Hyer

Keyword(s):

Metatarsophalangeal Joint ◽

Degenerative Joint Disease ◽

Interphalangeal Joint ◽

Joint Disease ◽

Radiographic Analysis ◽

First Metatarsophalangeal Joint ◽

Rate Of Development ◽

Significant Difference ◽

Retrospective Comparative Study

The development of hallux interphalangeal joint (IPJ) arthritis after an arthrodesis of the first metatarsophalangeal joint has been established in the literature. However, the significance has not been well reported. A retrospective, radiographic review of patients who had undergone a first metatarsophalangeal joint arthrodesis was performed. The Coughlin classification for degree of arthritic degeneration, hallux abductus angle, and hallux interphalangeus angle were measured in 107 radiographs of 103 patients preoperatively and postoperatively. Postoperative angles were measured immediately following surgery at approximately 6 weeks, 3 months, 6 months, 12 months, and 24 months. We found that the hallux abductus angle had decreased in the patients postoperatively; however, the hallux abductus interphalangeus angle increased on average after first metatarsophalangeal fusion. The majority of patients started with a Coughlin classification I of the hallux IPJ, which remained unchanged over the postoperative period, with no statistically significant difference in IPJ degeneration in the patients with or without fusion of the first metatarsophalangeal joint. In addition, no patients had a symptomatic hallux IPJ postoperatively within our limited study period. Further prospective studies would be beneficial with longer follow-up times to assess IPJ degeneration following first metatarsophalangeal joint fusions. Levels of Evidence: Level III: Retrospective, comparative study

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Long-term Follow-up of the Green-Watermann Osteotomy for Hallux Limitus

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-92-10-543 ◽

2002 ◽

Vol 92 (10) ◽

pp. 543-554 ◽

Cited By ~ 27

Author(s):

Jason B. Dickerson ◽

Richard Green ◽

Donald R. Green

Keyword(s):

Clinical Evaluation ◽

Average Length ◽

Metatarsophalangeal Joint ◽

First Metatarsophalangeal Joint ◽

Hallux Limitus ◽

Before And After ◽

Chief Complaints ◽

Long Term Follow Up

The authors undertook a retrospective analysis of the long-term efficacy of the Green-Watermann procedure for the treatment of painful hallux limitus or rigidus. Questionnaires were sent to 80 consecutive patients who had such procedures performed between 1990 and 1999. Medical records and radiographs were reviewed for the 32 patients who completed the questionnaires, representing 40 Green-Watermann procedures. Twenty-four patients were able to return for clinical evaluation. The average length of follow-up was 4 years (range, 1 to 10 years). The questionnaires addressed pain before and after surgery, function after surgery, complications, and overall impression and satisfaction. Nearly all of the patients (30 of 32; 94%) reported that surgery had significantly relieved their hallux joint pain, and a slightly smaller proportion (28 of 32; 88%) felt that their chief complaints were at least 70% improved. Clinical evaluation revealed adequate range of motion at the first metatarsophalangeal joint. It is concluded that the Green-Watermann procedure is an effective treatment approach for hallux limitus and rigidus, resulting in a significant reduction in pain, an increase in function, and a high degree of patient satisfaction. (J Am Podiatr Med Assoc 92(10): 543-554, 2002)

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Long-term follow-up of silastic joint replacement of the first metatarsophalangeal joint

The Foot ◽

10.1016/s0958-2592(03)00041-5 ◽

2003 ◽

Vol 13 (3) ◽

pp. 151-155 ◽

Cited By ~ 13

Author(s):

R Bommireddy ◽

S.K Singh ◽

P Sharma ◽

M El Kadafi ◽

D Rajan ◽

...

Keyword(s):

Joint Replacement ◽

Metatarsophalangeal Joint ◽

First Metatarsophalangeal Joint ◽

Long Term Follow Up

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Arthrodesis of the First Metatarsophalangeal Joint for Hallux Valgus in Rheumatoid Arthritis

Foot & Ankle International ◽

10.1177/107110079701800203 ◽

1997 ◽

Vol 18 (2) ◽

pp. 65-67 ◽

Cited By ~ 11

Author(s):

Roger A. Mann ◽

Francesca M. Thompson

Keyword(s):

Rheumatoid Arthritis ◽

Metatarsophalangeal Joint ◽

Fusion Rate ◽

Degenerative Joint Disease ◽

Joint Disease ◽

First Metatarsophalangeal Joint ◽

Total Reconstruction ◽

The One ◽

Metatarsophalangeal Joints

We reviewed the results of reconstruction of the fore part of the foot in rheumatoid patients by arthrodesis of the first metatarsophalangeal joint. The follow-up averaged 4.1 years (range, 2.0 to 7.25 years). Eighteen feet in eleven women were operated on. Twelve feet underwent total reconstruction of the fore part: arthrodesis of the first metatarsophalangeal joint and excision of all of the lesser metatarsophalangeal joints. Six feet underwent subtotal reconstruction, which included arthrodesis of the first metatarsophalangeal joint. The results were classified as excellent in fourteen feet, good in two, and fair in two. There were no poor results. Metatarsophalangeal bone fusion was achieved in all but one foot (fusion rate, 94 per cent). The one fibrous ankylosis was painless, with satisfactory function. Interphalangeal degenerative joint disease was a radiographic but not a clinical sequela. Arthrodesis of the first metatarsophalangeal joint provided stability that permanently corrected deformity, permitted the patients to wear ordinary shoes, and, in combination with excisional arthroplasty of involved lesser metatarsophalangeal joints, relieved disabling pain in the fore part of the foot.

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Long-term follow-up of Keller arthroplasty with irradiated costochondral implants

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-88-1-1 ◽

1998 ◽

Vol 88 (1) ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

JT Harlan ◽

FD Goldman

Keyword(s):

Metatarsophalangeal Joint ◽

Degenerative Disease ◽

First Metatarsophalangeal Joint ◽

Reasonable Alternative ◽

Long Term Follow Up ◽

Graft Implantation

The authors present results of long-term follow-up of seven patients whose degenerative disease of the first metatarsophalangeal joint was treated with irradiated chondral graft implantation arthroplasty. In appropriate candidates, this procedure is a reasonable alternative to Keller arthroplasty alone, arthrodesis, and nonbiologic implant arthroplasty.

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Intermediate to Long Term Clinical and Radiographic Outcomes of Triple Arthrodesis: A 422 Case Retrospective Review

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00250 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0025

Author(s):

Jesse King ◽

Karl Henrikson ◽

Thomas Harper ◽

Mike Anderson ◽

Chris Stauch ◽

...

Keyword(s):

Infection Rate ◽

Degenerative Joint Disease ◽

Joint Disease ◽

Triple Arthrodesis ◽

Non Union ◽

Radiographic Outcomes ◽

Diabetic Status ◽

Radiographic Data

Category: Ankle Arthritis, Hindfoot Introduction/Purpose: Triple arthrodesis is a commonly performed surgical treatment for hindfoot arthritis and deformity. No study has clearly delineated correlates of both clinical and radiographic outcomes in a sample size this large. The purpose of this study is to explore predictive and demographic outcome measures with long-term followup after triple arthrodesis. Methods: With IRB approval, an institutional radiology database was queried for patients undergoing triple arthrodesis between 2004 and 2016, by a single surgeon at a single institution. A total of 465 cases were identified. Pre- and post-operative clinical and radiographic data was collected retrospectively. Demographic and predictive data included: age, Body Mass Index (BMI), American Society of Anesthesiologists Score (ASA), Charleston Comorbidity Index (CCI), diabetic status, osteoporosis, hypothyroidism, and neuromuscular disease status. Clinical outcomes including infection rate, reoperation rate and clinical nonunion were recorded. Unintended return to the operating room defined clinical failure. Radiographic data including non-union rate, pre- and post- operative ankle degenerative joint disease was also recorded. Statistical analysis was then performed to evaluate the relationship between predictive measures and various outcomes including reoperation, infection, and non-union rates. 23 cases were lost to follow-up. Results: A total of 442 feet (397 patients) were analyzed. The average age was 54 years (14 to 85) with the majority of cases being female (60%). Average follow up was 593 days (40 to 4079). Overall failure rate was 13.7% with clinical nonunion rate of 4.5%. Infection rate was 5.9%. Mortality rate was 0% at 2 years post-operatively. Predictors of failure included: increased BMI, elevated ASA, history of diabetes, underlying neuromuscular disorder (Figure 1). We found no significant difference between pre and post-operative degenerative joint disease rates in the midfoot (9.4%, 12.5%) and ankle (11.7%,13.7%), respectively. Conclusion: Triple arthrodesis is a highly effective procedure for treating hindfoot arthritis. Certain predictive measures including BMI, ASA score, diabetic status and underlying neuromuscular disorders significantly correlate with radiographic union. Additionally, diabetic status significantly correlates with infection status postoperatively. An understanding of these predictive measures may help surgeons in their preoperative planning to improve their clinical and radiographic success rates.

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Long-term Results of Hemiarthroplasty for Osteoarthritis of the First Metatarsophalangeal Joint

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000118 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Stefan Beekhuizen ◽

Ron Onstenk

Keyword(s):

Patient Satisfaction ◽

Scale Score ◽

Operative Treatment ◽

Primary Outcome ◽

Metatarsophalangeal Joint ◽

Long Term Results ◽

First Metatarsophalangeal Joint ◽

Satisfaction Rates

Category: Big toe, MTP-1 joint osteoarthritis Introduction/Purpose: Osteoarthritis of the first metatarsophalangeal joint is the second most common disorder affecting the hallux. If non-operative treatment is not efficacious, operative treatment should be considered. Arthrodesis is considered standard care for grade III and IV osteoarthritis of the first metatarsophalangeal joint. If preservation of joint mobility is preferred, implant arthroplasty could be considered. Total arthroplasty is less recommendable because of high failure rates. However, recent studies showed similar short term results after arthrodesis and hemi joint replacement with greater satisfaction rates, as well as low postoperative pain, after hemiarthroplasty. In our study we mainly focussed on long-term subjective results like patient satisfaction as well as patient recommendation for the performed procedure including our primary outcome; the postoperative AOFAS HMI score. Methods: We therefore evaluated primary arthrodesis and hemiarthroplasty as treatment for arthritis of the first metatarsophalangeal joint. All 102 patients operated between January 2005 and December 2011 were asked to participate in our study, sixty-seven patients responded and were included. Forty-seven arthrodesis were performed in 40 patients using different fixation techniques and thirty-one hemiarthroplasties were performed in 27 patients using the BiopPro® First MPJ implant. Both procedures performed for stage 3 or 4 osteoarthritis and patients had been followed for at least five years, the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) scale score was measured as primary outcome. Secondary outcomes addressed satisfaction rates, recommendation of the performed procedure, number of unplanned surgical repeat procedures, return to daily activities (work as well as sports), and influence of smoking and diabetes mellitus on postoperative results. Finally, financial costs for both procedures were calculated. Results: The 47 primary arthrodeses and 31 hemiarthroplasties performed between January 2005 and December 2011 were evaluated. After a mean follow-up of 8.3 years (range 5-11.8) the mean AOFAS-HMI scale score after arthrodesis and after hemiarthroplasty were 72.8±14.5 and 89.7±6.6 respectively (p =.001). Patients were significantly more pleased after hemiarthroplasty (p<.001) and this procedure was better recommended (p<.001). The number of unplanned repeat surgical procedures did not differ between the two groups. No differences were found in postoperative work resumption, but patients returned to sports significantly sooner after hemiarthroplasty (p=.002). No association was found between smoking and the total AOFAS-HMI score. Overall costs, the sum of procedure costs as wel as additional costs, were quite similar for both procedures. Conclusion: Higher postoperative AOFAS HMI scores after a long-term follow-up (mean 8.3 years, range 5-11.8 years) were found after hemiarthroplasty compared to arthrodesis of the MTP-1 joint. Also greater patient satisfaction and better recommendation is seen after hemiarthroplasty. However return to work showed no differences, a significantly faster return to sports was seen after hemiarthoplasty. Based on these long-term results we could recommend hemiarthroplasty in future patient with osteoarthritis of the MTP-1 joint, with modest preference for the younger, more active patients.

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Evaluation of Metatarsal Head Resurfacing Hemiarthroplasty in the Surgical Treatment of Hallux Rigidus: A Retrospective Study and Mid- to Long-Term Follow-up

Foot & Ankle Specialist ◽

10.1177/1938640017695864 ◽

2017 ◽

Vol 11 (1) ◽

pp. 22-31 ◽

Cited By ~ 1

Author(s):

Musa Uğur Mermerkaya ◽

Erkan Alkan ◽

Mehmet Ayvaz

Keyword(s):

Surgical Treatment ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Treatment Method ◽

Hallux Rigidus ◽

Retrospective Case ◽

First Metatarsophalangeal Joint

Background. The aim of this study was to evaluate the mid- to long-term outcomes of metatarsal head resurfacing hemiarthroplasty in the surgical treatment of advanced-stage hallux rigidus. Methods. We performed a retrospective review of 57 consecutive patients (25 [43.9%] males, 32 [56.1%] females; mean age, 61.0 ± 6.4 years) who underwent first metatarsal head resurfacing hemiarthroplasty (HemiCAP) for hallux rigidus between August 2007 and September 2010. Sixty-five implantations were performed in 57 patients; 8 patients underwent bilateral procedures. All patients were clinically rated prior to surgery and at the final follow-up visit using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and first metatarsophalangeal joint range of motion (MTPJ ROM). Results. The median follow-up duration was 81 (range = 8-98) months. The median preoperative AOFAS score was 34 (range = 22-59) points, which had increased to 83 (range = 26-97) points at the final follow-up visit (P < .001). The median preoperative first MTPJ ROM was 25° (range = 15° to 40°), which had increased to 75° (range = 30° to 85°) at the final follow-up visit (P < .001). Conclusions. First MTPJ hemiarthroplasty is an effective treatment method that recovers toe function and first MTPJ ROM, and provides good mid- to long-term functional outcomes. Levels of Evidence: Level IV: Retrospective case series

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