Use of Titanium Grommets in Silicone Implant Arthroplasty of the Hallux Metatarsophalangeal Joint

1996 ◽  
Vol 17 (3) ◽  
pp. 145-151 ◽  
Author(s):  
E. James Sebold ◽  
Andrea Cracchiolo
Keyword(s):  
Rheumatoid Arthritis ◽  
Metatarsophalangeal Joint ◽  
Degenerative Joint Disease ◽  
Silicone Implant ◽  
Joint Disease ◽  
Silicone Implants ◽  
Postoperative Complaints ◽  
Lost To Follow Up ◽  
Metatarsophalangeal Joints

Double-stem silicone implants protected by titanium grommets were placed in the hallux metatarsophalangeal joints of 32 patients (47 feet). All patients had a painful destroyed joint and most were women. Three patients (six feet) were lost to follow-up. Nineteen patients had a diagnosis of rheumatoid arthritis (25 feet) and 10 had degenerative joint disease (16 feet). The average age for the group was 57 years and the average follow-up was 51 months (range, 34–76 months). Twenty patients (30 feet) were completely satisfied with their result. Eight patients (10 feet), all with rheumatoid arthritis, had some minor postoperative complaints, usually involving the lateral toes. Two patients (three feet) in this group had no pain, but would have preferred more hallux motion. One patient with rheumatoid arthritis (one foot) had a poor result due to implant removal for deep sepsis. Radiographic analysis of these patients showed no evidence of implant fracture and the implant composite appeared to be well tolerated by the surrounding bone in which it was placed. When compared with another, similar group of patients in whom grommets were not used, this implant appeared to be much more stable, as there was significantly less evidence of radiolucency seen around those implants protected by the grommets. It appears that the titanium grommets may protect the silicone implant and may help provide a longer life for the silicone implant.

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

1997 ◽  
Vol 18 (2) ◽  
pp. 65-67 ◽  
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.

Silicone Synovitis

1994 ◽  
Vol 19 (4) ◽  
pp. 479-484 ◽  
Author(s):  
M. LANZETTA ◽  
T. J. HERBERT ◽  
W. B. CONOLLY
Keyword(s):  
Rheumatoid Arthritis ◽  
Effective Treatment ◽  
Revision Surgery ◽  
Joint Arthroplasty ◽  
Silicone Implant ◽  
Joint Disease ◽  
Silicone Implants ◽  
True Incidence ◽  
Radiological Changes

Silicone implant arthroplasty is, arguably, the most effective treatment for the majority of patients with symptomatic arthritis in the hand and wrist. In 1985 the problem of silicone synovitis was first brought to our attention. Since that time there have been numerous reports on this condition leading to a worldwide trend against the use of silicone implants. However, the true incidence and effects of silicone synovitis have not been clearly defined. For this reason, we have undertaken a survey of all patients who have undergone silicone implant arthroplasty in the wrist and hand in our Unit between 1975 and 1990. Patients with rheumatoid arthritis and those undergoing MP or IP joint arthroplasty were excluded. Of the 289 implant arthroplasties remaining, we have been able to review personally 229 implants with a mean follow-up of 3.8 years (range 1–15). Although 40% of cases showed significant radiological changes, only 11 patients (4.8%) developed symptoms requiring treatment. Of these, two were managed conservatively whilst the rest underwent revision surgery, all with entirely satisfactory results. We conclude that silicone implant arthroplasty remains the treatment of choice for patients with painful joint disease in the hand and wrist.

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

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.

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

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

Silicone Implant Arthroplasty for Second Metatarsophalangeal Joint Disorders with and without Hallux Valgus Deformities

Foot & Ankle ◽  
1988 ◽  
Vol 9 (1) ◽  
pp. 10-18 ◽  
Author(s):  
Andrea Cracchiolo ◽  
Harold B. Kitaoka ◽  
Edward O. Leventen
Keyword(s):  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Degenerative Joint Disease ◽  
Silicone Implant ◽  
Joint Disease ◽  
Hallux Valgus Deformity ◽  
Second Metatarsal ◽  
Second Toe

Subluxation or dislocation of the second metatarsophalangeal joint (MTPJ) is usually associated with a hammertoe deformity and, frequently, with a significant hallux valgus deformity. Although the joint itself may be painful, there is also pain in the hammertoe deformity, especially when the patient is wearing closed shoes. A painful intractable plantar keratosis is usually present. We reviewed all of our patients with second MTPJ subluxation or dislocation, in whom a double-stem silicone implant had been used to relocate the joint. In 31 feet of 28 patients, 32 implants were used. All but six feet with advanced degenerative joint disease secondary to Freiberg's infraction had severe associated forefoot pathology that necessitated surgical correction. Several feet had previous bunion operations as well as operations on the second toe. In addition to the second toe, we performed hallux valgus corrections in 23 feet, seven of which were revision procedures. At an average follow-up time of 37 months, good results were seen in 20 feet (63%), good results with reservations in eight feet (25%), and failure in four feet (12%). Transfer metatarsalgia was the most frequent complication. The implants remained stable, and in only one was there a suspected fracture. More optimum results might have been achieved had there been better correction of the hallux valgus deformities, more frequent correction of the hammertoe deformity, and less resection of the second metatarsal head. These patients with pathology usually involving both the first and second MTPJ are difficult to treat, therefore. Their results are less predictable and not as favorable as those achieved for patients with isolated similar deformities.

Keller Arthroplasty in Combination with Resection Arthroplasty of the Lesser Metatarsophalangeal Joints in Rheumatoid Arthritis

Foot & Ankle ◽  
1988 ◽  
Vol 9 (2) ◽  
pp. 75-80 ◽  
Author(s):  
Scott R. McGarvey ◽  
Kenneth A. Johnson
Keyword(s):  
Rheumatoid Arthritis ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
Resection Arthroplasty ◽  
Rheumatoid Disease ◽  
First Metatarsophalangeal Joint ◽  
Hallux Valgus Deformity ◽  
Metatarsophalangeal Joints

We reviewed the results of the Keller arthroplasty in combination with resection arthroplasty of the forefoot in patients with rheumatoid arthritis. Of the 29 patients (49 feet) in the series, 20 had involvement of both feet and nine had involvement of a single foot. The average age of the patients was 55.4 years, and the average follow-up period was 4.9 years. All feet had resection of the lesser metatarsal heads, resection of the base of the proximal phalanges of the lesser toe, and a Keller arthroplasty of the first metatarsophalangeal joint. The results were satisfactory in 16 feet, satisfactory with some reservations in 21 feet, satisfactory with major reservations in seven feet, and unsatisfactory in five feet. For 40 of the 49 feet (82%), the patients stated that they would repeat the procedure, knowing the results achieved. The major causes of patient reservations and lack of satisfaction were return of the hallux valgus deformity and pain (53%), forefoot instability (27%), and continuing metatarsalgia (20%). Resection arthroplasty of the lesser metatarsophalangeal joints of the forefoot in rheumatoid disease is a satisfactory procedure. When used in combination with Keller resection arthroplasty of the first metatarsophalangeal joint, however, an increased number of unsatisfactory results occur, attributable to returning pain and deformity of that joint.

Unusual Involvement of the Feet in Hemochromatosis

Foot & Ankle ◽  
1984 ◽  
Vol 4 (4) ◽  
pp. 212-215 ◽  
Author(s):  
Nancy D. Baker ◽  
Melvin H. Jahss ◽  
Gerald H. Leventhal
Keyword(s):  
Rheumatoid Arthritis ◽  
Metatarsophalangeal Joint ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
First Metatarsophalangeal Joint ◽  
Metacarpophalangeal Joints ◽  
Bilateral Involvement

The arthropathy of hemochromatosis mimics aspects of both rheumatoid arthritis and degenerative joint disease. The negative latex fixation, involvement of weightbearing and non-weightbearing joints, as well as the peculiar involvement of the second and third metacarpophalangeal joints serve to distinguish this rare arthropathy from other inflammatory and degenerative arthritides. The purpose of this paper is to present a case of hemochromatosis arthritis with unusual bilateral involvement of the naviculocuneiform and tarsometatarsal joints. Only two cases of hemochromatosis of the foot have been previously reported, and those had involvement limited to the first metatarsophalangeal joint.

Pulmonary Manifestations of Rheumatoid Arthritis

2021 ◽  
Vol 36 (2) ◽  
pp. 97-103
Author(s):  
Keith J. Christensen ◽  
Mark A. Malesker ◽  
Nikhil Jagan ◽  
Douglas R Moore
Keyword(s):  
Rheumatoid Arthritis ◽  
Needle Biopsy ◽  
Pulmonary Toxicity ◽  
Pharmacy Practice ◽  
Pulmonary Function Testing ◽  
Therapeutic Outcomes ◽  
Pulmonary Manifestations ◽  
Lost To Follow Up ◽  
Function Testing

Objective To describe the case of an 88-year-old male with rheumatoid arthritis who developed pulmonary manifestations. Treatment for his RA previously included various biologics, while at the time of pulmonary consultation included meloxicam, methotrexate, and abatacept. Following chest scans, bronchoscopy, needle biopsy, pulmonary function testing, and a thoracentesis, the diagnosis of pleural effusion and nodules associated with rheumatoid arthritis was determined. The patient was recommended to follow-up with the pulmonologist but was lost to follow-up because of nonpulmonary and nonrheumatoid arthritis complications. Settings Ambulatory clinic pharmacy practice, Community pharmacy, Consultant pharmacy practice. Practice Considerations Drugs used to treat rheumatoid arthritis may produce pulmonary toxicity similar to what is seen with the disease itself. Drug therapy may require modification if identified as an offending agent causing pulmonary manifestations. If fibrosing interstitial lung disease develops, the addition of nintedanib may need to be considered. Conclusion In order for pharmacists to better assist providers and patients and improve therapeutic outcomes, it is important for pharmacists to understand that pulmonary manifestations are common in patients having rheumatoid arthritis as well as with drugs used to treat rheumatoid arthritis.

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