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

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.

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.

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.

scholarly journals Symptomatic Medial Bone Excrescence in the Distal Phalanx of the Hallux after the First Metatarsophalangeal Joint Arthrodesis: A Case Report and Radiographic Reviews

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yuji Maenohara ◽  
Ryutaro Takeda ◽  
Song Ho Chang ◽  
Yasunori Omata ◽  
Sakae Tanaka ◽  
...  
Keyword(s):  
Case Report ◽  
Metatarsophalangeal Joint ◽  
Distal Phalanx ◽  
First Metatarsophalangeal Joint ◽  
First Case ◽  
Significant Difference ◽  
Before And After ◽  
One Year ◽  
Common Manifestation

Medial bone excrescence at the base of the distal phalanx of the hallux is a common manifestation which is rarely painful. In this case report, we described the first case of the excrescence becoming symptomatic one year after a metatarsophalangeal (MTP) joint arthrodesis of the great toe in a 74-year-old female. The medial bony excrescence which was obscure preoperatively became obvious postoperatively in the anteroposterior foot radiographs. The patient was successfully treated by an excision of the excrescence. In order to clarify the pathology of the excrescence, we reviewed the radiographs with respect to the excrescence before and after hallux surgeries including 97 metatarsal osteotomies and 33 MTP joint arthrodesis. The width of the excrescence measured in the anteroposterior foot radiographs displayed substantial increment one month after the hallux surgeries (osteotomy group: 0.9 ± 0.7 vs. 1.5 ± 0.7   mm , p < 0.01 ; arthrodesis group: 1.3 ± 0.8 vs. 1.8 ± 1.0   mm , p < 0.01 ). However, there was no significant difference in the width of the excrescence between one month after surgery and at the most recent follow-up of around 20 months in average after the surgery (osteotomy group: 1.5 ± 0.7 vs. 1.4 ± 0.7   mm , p = 0.62 ; arthrodesis group: 1.8 ± 1.0 vs. 1.8 ± 0.7   mm , p = 0.37 ). The present case and our radiographic review suggested that the postoperative medial bony excrescence was not the result of change of position of the preexisting excrescence. The correction of pronation deformity through hallux surgeries could emphasize the medial bony excrescence and cause symptomatic irritation upon shoe contact.

scholarly journals A systematic review of injectable corticosteroid for osteoarthritis of the first metatarsophalangeal joint 

2020 ◽  
Author(s):  
Ian Reilly ◽  
Gillian Bromley ◽  
George Flanagan
Keyword(s):  
Systematic Review ◽  
Steroid Injection ◽  
Corticosteroid Injection ◽  
Metatarsophalangeal Joint ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
First Metatarsophalangeal Joint ◽  
Frequency Of Use ◽  
Good Quality Research ◽  
Evidenced Based

Abstract Intra articular steroid injection is a common treatment modality for relief of pain and inflammation associated with degenerative joint disease. Use of injectable steroid preparations is widely accepted as safe and effective for the treatment of osteoarthritis of the 1st metatarsophalangeal joint. Despite the frequency of use, literature specific to pathology of the 1st metatarsophalangeal joint is sparse. The aim of this systematic review was to determine if good quality research exists to enable clinicians to adopt an evidenced based approach to corticosteroid injection of the 1st metatarsophalangeal joint. Despite the frequency of use, this review found no high quality studies that support the use of intra articular corticosteroid injection of the 1st metatarsophalangeal joint in osteoarthritis.

scholarly journals First metatarsophalangeal fusion with dorsal plate: clinical outcomes

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Giuseppe Restuccia ◽  
Fabio Cosseddu ◽  
Andrea del Chiaro ◽  
Matteo Ceccoli ◽  
Alessandro Lippi ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Wound Dehiscence ◽  
Dorsal Plate ◽  
First Metatarsophalangeal Joint ◽  
Low Profile ◽  
Significant Difference ◽  
The Stability ◽  
Dorsal Plating

Abstract Background First metatarsophalangeal joint (MTPJ) fusion is the most effective technique for the treatment of MTPJ primary arthritis, severe hallux valgus and failure of primary corrective surgery of these conditions. It can be achieved through different techniques. We evaluated the outcomes in a cohort of patients treated with dorsal plate arthrodesis. Materials and methods We treated 30 feet for 28 patients; the mean follow-up was 35 months. For each foot, we collected radiological and clinical assessment, with the visual analogue scale (VAS) for pain and the Manchester and Oxford Foot questionnaire (MOFQ). The technique consisted in a cup and cone arthrodesis with the application of a low profile dorsal plate. Patients were allowed for immediate weight bearing. Results Consolidation was achieved in all cases; in 29 cases, radiographic union was recorded within 6 months from surgery, in one case after 9 months. Comparison between the preoperative and postoperative of VAS and MOXFQ values showed a statistically significant difference (p < 0.05). Only one case developed wound dehiscence as complication. Conclusions Even if there is still a debate regarding the best system for MTPJ fusion, we believe cup and cone fusion with dorsal plating is an effective method. Moreover, the stability of the osteosynthesis obtained allows for immediate post-operative weight bearing, making patients able to return soon to their normal life. Trial registration We present a retrospective study; all patients enrolled were retrospectively registered.

scholarly journals Efficacy of intra-articular injection of combined platelet-rich plasma and hyaluronic acid in knee degenerative joint disease (182)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0030
Author(s):  
Pietro Randelli ◽  
FILIPPO RANDELLI ◽  
Fabio Sciancalepore ◽  
Chiara Fossati ◽  
Stefano Pasqualotto ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Conservative Treatment ◽  
Current Literature ◽  
Platelet Rich Plasma ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Knee Oa ◽  
Significant Difference ◽  
Early Oa

Objectives: Osteoarthritis (OA) of the knee is a debilitating disease whose prevalence has increased across the world with aging population. Platelet-Rich Plasma (PRP) and Hyaluronic Acid (HA) injections appear to be two of the main strategies for conservative treatment of early knee OA. The effectiveness of both treatments, however, is still under debate because contrasting results have been described in the current literature. Some pre-clinical studies evaluated the association of PRP and HA with encouraging results, highlighting the possibility of a synergistic effect between the two compounds and suggesting a possible use through combined intra-articular injections. The aim of this prospective randomized controlled double-blind clinical trial is to evaluate the efficacy of intra-articular injections of PRP and HA for the treatment of early stages of knee degenerative joint disease in improving joint function and reducing pain, compared to the intra-articular injections of PRP and HA alone. Methods: Patients with knee early OA were prospectively enrolled and then double-blinded randomly divided into three groups of fifty-eight subjects each: HA alone, PRP alone and PRP+HA group. Patients received three intra-articular injections with two-week interval period among each dose. Patients clinical outcome was evaluated through five questionnaires [The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Tegner Activity, Visual Analogue Scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) Subjective Knee Form] before the treatment (T0) and after 3, 6 and 12 months from the first injection. Patients’use of paracetamol and supplementary analgesia for knee pain during the study was collected. Results: One hundred and seventy-four patients were enrolled in this study (age, 30-80 years; 108 females and 66 males) and 162 completed the 12-month follow-up. All patients showed significant clinical improvement after treatment. The analysis of covariance (ANCOVA) did not show statistically significant differences among the three groups for all the variables analysed at 6 and 12 months of follow-up (p>0.05).No significant differences were found in terms of adverse events (p=0.49) among the three groups of patients (p=0.92).The demand for paracetamol and supplementary analgesics was generally low and there were no significant differences among the groups (p=0.23 and p=0.56, respectively). Conclusions: Injections treatments for early knee OA are an important conservative therapeutic strategy. To date, the current literature presents many contrasting studies about the effectiveness of PRP or HA, but only a few consider the combined use of PRP and HA as attractive therapeutic option. Our study has not shown any significant difference in clinical and functional outcomes among the three experimental groups, suggesting a substantial equivalence of these three treatments. Thus, cost-effectiveness is in favor of HA injections in the conservative treatment of early OA.

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.

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