Risk Analysis of Nonunion After First Metatarsophalangeal Joint Arthrodesis

2020 ◽  
pp. 193864001989982
Author(s):  
Carla Weber ◽  
Daiwei Yao ◽  
Michael Schwarze ◽  
Karolina Andersson ◽  
Vlatka Andric ◽  
...  
Keyword(s):  
Metatarsophalangeal Joint ◽  
Patient Characteristics ◽  
Hallux Rigidus ◽  
Male Gender ◽  
Great Toe ◽  
Therapeutic Level ◽  
Data Set ◽  
First Metatarsophalangeal Joint ◽  
Factors Influencing ◽  
Radiological Data

Objective: The standard therapy for a symptomatic hallux rigidus is still the arthrodesis of the first metatarsophalangeal (MTP) joint. A nonunion of the arthrodesis is a possible postoperative complication. This study aimed to evaluate the incidence of nonunion associated with first MTP joint arthrodesis and identify risk factors influencing this. Methods: This retrospective study included 197 patients who were treated with an isolated first MTP joint arthrodesis. The severity of MTP-related osteoarthritis was assessed clinically and radiologically prior to surgery according to the Waizy classification. Patient characteristics and radiological parameters were evaluated postoperatively. Results: A full clinical and radiological data set was collected from 153 out of 197 patients. We identified 14 cases of nonunion and found that nonunion was associated with higher incidence of male gender (P = .29), comorbidity (P = .035), higher grade of osteoarthritis (P = .01), and increased postoperative great toe dorsiflexion (P = .022). Conclusions: Arthrodesis of the first MTP joint is a safe operative treatment, as demonstrated by a nonunion rate of 9.2%. Negative influencing factors were the presence of preexisting diseases, higher grades of osteoarthritis, and a relative increased dorsiflexion position of the great toe after surgery. These factors should be considered during pre-, intra-, and postoperative planning. Levels of Evidence: Therapeutic, Level IV: Retrospective

Silastic Ball Spacer Arthroplasty in the Management of Hallux Valgus and Hallux Rigidus

Foot & Ankle ◽  
1989 ◽  
Vol 10 (2) ◽  
pp. 61-64 ◽  
Author(s):  
N. S. Broughton ◽  
A. Doran ◽  
B. F. Meggitt
Keyword(s):  
Hallux Valgus ◽  
Young Patients ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
New Bone Formation ◽  
Great Toe ◽  
First Metatarsophalangeal Joint ◽  
Proximal Migration ◽  
Original Concept

Sixty-two feet in 39 patients who were treated by insertion of a silastic ball spacer prosthesis into the first metatarsophalangeal joint for hallux valgus or hallux rigidus have been reviewed with a follow-up time of between 2 and 6 years. Twenty-one results (34%) were excellent, 27 (43%) were fair, 13 (21%) were poor, and one was revised. Seventeen feet (27%) had some metatarsalgia at followup. Results were disappointing in the young patients; in 19 cases of hallux valgus under the age of 45, 8 were either poor or had been revised. The original concept of the silastic ball spacer was to maintain great toe length and prevent proximal migration of the sesamoids. However 60% of these feet showed settling of the prosthesis or new bone formation around the prosthesis and 54% had more than 2 mm proximal migration of the sesamoid bones. The symptomatic results in these patients were similar to those in whom great toe length had been successfully maintained. The silastic ball spacer infrequently achieves its aims, however maintenance of hallux length does not seem to be important in the symptomatic result.

The Modified Oblique Keller Procedure: A Technique for Dorsal Approach Interposition Arthroplasty Sparing the Flexor Tendons

2003 ◽  
Vol 24 (7) ◽  
pp. 521-522 ◽  
Author(s):  
Kenneth J. Mroczek ◽  
Stuart D. Miller
Keyword(s):  
Soft Tissues ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Resection Arthroplasty ◽  
Joint Capsule ◽  
Great Toe ◽  
Interposition Arthroplasty ◽  
Dorsal Approach ◽  
First Metatarsophalangeal Joint ◽  
Satisfactory Outcome

A first metatarsophalangeal joint resection arthroplasty that combines a modest metatarsal cheilectomy with an oblique resection of the phalanx base (preserving the flexor hallucis brevis attachment) combined with interposition arthroplasty of the dorsal joint capsule sewn to the plantar soft tissues is presented. Numerous surgical procedures have been described for the treatment of hallux rigidus, including dorsal cheilectomy, resection arthroplasty, joint replacement, and arthrodesis. The Keller procedure has been abandoned by many because of shortening of the great toe and loss of push-off power. The modified oblique Keller technique described here allows for intraoperative transition from cheilectomy to resection arthroplasty with what appears to be a satisfactory outcome, maintaining plantarflexion power and hallux length.

scholarly journals Treatment of End-Stage Hallux Rigidus and Impact of Arthrodesis versus Arthroplasty on Patient Reported Outcomes

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Monique Chambers ◽  
MaCalus Hogan ◽  
Dukens LaBaze
Keyword(s):  
Patient Reported Outcomes ◽  
Surgical Intervention ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
First Metatarsophalangeal Joint ◽  
Significant Difference ◽  
Patient Reported ◽  
Outcome Scores ◽  
Vas Scores ◽  
End Stage

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is a degenerative disease of the first metatarsophalangeal joint. Severe, end-stage hallux rigidus can become debilitating with surgical intervention becoming necessary once conservative measures and shoe modifications have failed. Joint salvage procedures include metatarsal phalangeal (MTP) arthrodesis and MTP arthroplasty. The purpose of this study was to assess for differences in patient reported outcomes in two cohorts who underwent fusion or joint reconstruction. Methods: This study was a retrospective review of prospectively collected data of 385 patients from an academic medical institution. Patients who underwent surgical intervention from July 2015 to November 2016 were identified based on CPT codes for MTP arthrodesis (28750) and arthroplasty (28293). We extracted outcome scores including SF12-M, SF12-P, FAAM, and VAS scores. Exclusion criteria included poly-trauma, revision procedures, and lack of pre and post-operative outcome scores. Mann- Whitney t-test was performed using GraphPad Prism version 7.0b for Mac to compare procedure groups, with significance define by a p-value of 0.05. Results: A total of eighteen patients met the inclusion criteria, with 6 who underwent arthroplasty and 12 arthrodesis. The average age was 63.7 amongst the cohort, with a total of 16 female and 2 males. Patients who underwent arthrodesis had better outcomes across all parameters. When comparing preoperative and postoperative scores, arthrodesis patients showed greater improvement of SF12-M (arthrodesis 9 vs arthroplasty -2, p=0.05), and SF12-P (9 vs -16, respectively p=0.05) scores. Arthroplasty patients were more likely to have a decrease in their SF-12 scores. VAS scores and FAAM scores showed no statistical difference between the two cohorts. Postoperative VAS scores were worse in 33% of arthroplasty patients despite surgical intervention, compared to 10% of arthrodesis patients. Conclusion: Our results suggests that both procedures provide a statistically significant difference in pain with several patients having a Global Rate of Change that is “very much better”. However, fusion of the metatarsophalangeal joint results in improved pain and functional outcomes for patients with severe hallux rigidus. These findings are consistent with current reports in the literature, which are mostly case series reports. Larger studies are needed to provide appropriate power and better support the findings of this study.

Arthrodesis of First Metatarsophalangeal Joint by Plate and Screws for Treatment of Hallux Rigidus (Systematic Review and Meta-Analysis)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ossama Abdelraoof El Shazly ◽  
Mohamed Mokhtar Abdellah ◽  
Mostafa Abdelnabee Abouzaid
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Superficial Infection ◽  
First Metatarsophalangeal Joint ◽  
Non Union ◽  
Meta Analyses

Abstract Background With continued loss of dorsiflexion of the 1st MTP, degenerative changes occur within the joint with severe restriction of movement and increase in pain, which leads to the condition known as hallux rigidus. The amount of dorsiflexion may be reduced to 0-10 degrees with pain on both active and passive motion. Objectives Systematically reviewing available evidence from published articles to assess the effectiveness of arthrodesis of first metatarsophalangeal joint by plate and screws in hallux rigidus. The assessment also would encompass safety, side effects, and complications of this mode of treatment. Materials and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results Previous results for arthrodesis have been favourable with a union rate of almost 96%. In the present systematic review and meta-analysis, the overall effect estimates showed that the union rates after plate and screw arthrodesis for 1st MTPJ was 96.2% (95% CI 94 – 98.4%). In addition, the overall effect estimates showed that the non-union rates after plate and screw arthrodesis for 1st MTPJ was 4.2% (95% CI 2.4 – 6.1%). Moreover, the overall effect estimates showed that the satisfaction rates after plate and screw arthrodesis for 1st MTPJ was 94.5% (95% CI 90 – 99%). In the present study, the overall effect estimates showed that the overall complications rate after plate and screw arthrodesis for 1st MTPJ was 7.2% (95% CI 2.5 – 12%). The overall effect estimates showed that the malunion rates after plate and screw arthrodesis for 1st MTPJ was 2.7% (95% CI 0 – 6.4%). Additionally, the overall effect estimates showed that the hardware removal and superficial infection rates after plate and screw arthrodesis for 1st MTPJ were 2% and 2.9%, respectively. Conclusion Our analysis showed that plate and screws fixation is effective techniques that can be used for first MTPJ arthrodesis in patients with hallux rigidus. We found that the screw and plate fixation has a significantly lower rate of nonunion compared with the screw alone, as reported by the literature. However, owing to the small group sizes and methodologic shortcomings, we were unable to identify the clinically superior fixation technique for first MTPJ arthrodesis arthrodesis.

Arthrodesis versus arthroplasty of the first metatarsophalangeal joint in the treatment of hallux rigidus – comparative study

2017 ◽  
Vol 103 (7) ◽  
pp. S72
Author(s):  
Marta-Sofia-Santos Silva ◽  
Luís Barros ◽  
João Esteves ◽  
Pedro Serrano ◽  
Pedro Neves ◽  
...  
Keyword(s):  
Comparative Study ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
First Metatarsophalangeal Joint

scholarly journals Treatment of hallux rigidus with percutaneous arthrodesis

2018 ◽  
Vol 12 (2) ◽  
pp. 90-95
Author(s):  
Vitor Baltazar Nogueira ◽  
Miguel Viana Pereira Filho ◽  
Mauro Cesar Mattos e Dinato ◽  
Márcio De Faria Freitas ◽  
Rodrigo Gonçalves Pagnano
Keyword(s):  
Medical Records ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Conventional Technique ◽  
Hallux Rigidus ◽  
Time Level ◽  
First Metatarsophalangeal Joint ◽  
The Mean ◽  
Pain Improvement ◽  
Consolidation Time

Objective: The objective of this study was to describe the percutaneous arthrodesis technique with single medial portal of the first metatarsophalangeal joint and to evaluate the results of a series of nine cases (10 feet) with a diagnosis of hallux rigidus subjected to this technique, comparing the results with literature data regarding the conventional technique. Methods: This was a retrospective, observational study performed by analysis of medical records and radiographs of nine patients undergoing percutaneous arthrodesis of the hallux metatarsophalangeal joint. Gender, age, consolidation time, level of postoperative pain and degree of patient satisfaction were evaluated. Results: Eight patients were female, and one patient was male. The mean age was 68.7 years, the mean consolidation time was 8 weeks, the consolidation ratio was 70%, there was pain improvement in the postoperative period, and all patients considered themselves satisfied with the surgery. Conclusion: Percutaneous arthrodesis of the metatarsophalangeal hallux joint potentially yields results similar to those of the conventional method demonstrated in the literature but uses smaller incisions.Level of Evidence IV, Therapeutic Studies, Case Series.

Foot Orthotics with Morton's Extension doesn't Affects the Forces inside First Metatarsophalangeal Joint in Osteoarthritis Pathology.

2021 ◽  
Author(s):  
Ruben Sanchez-Gomez ◽  
Juan Manuel Lopez-Alcorocho ◽  
Carlos Romero-Morales ◽  
Alvaro Gomez-Carrion ◽  
Ignacio Zaragoza-García ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Control Group ◽  
Case Group ◽  
First Metatarsophalangeal Joint ◽  
Group A ◽  
Applied Forces ◽  
Pulling Force

Abstract Study designCase-control studyBackgroundRigid Morton’s extension (ME) are a kind of orthotics that have been used as conservative treatments of hallux rigidus (HR) named osteoarthritis, but only their effects on first metatarsophalangeal joint (MPJ) mobility and position in healthy subjects have been studied, but not on its applied forces neither in HR subjects.ObjectivesThis study sought to understand how ME orthotics with three different thicknesses could influence the kinetic first MPJ, measured dorsally using the Jack maneuver and comparing subjects with normal first MPJ mobility versus those with HR. We aimed to clarify whether tension values were different between healthy and HR subjects.Methods Fifty-eight healthy subjects were selected, of which 30 were included in the case group according to HR criteria, and 28 were included in the control group. A digital algometer was used to assess the pulled tension values (kgf) of the first MPJ during the Jack maneuver (2-mm, 4-mm, and 8-mm ME thicknesses) versus the first MPJ in the weight-bearing resting position (WRP).ResultsThe pulled tension values were reliable (ICC > 0.963). There were no statistically significant differences between the pulled tension values for the different WRP and ME conditions in the case (p = 0.969) or control (p = 0.718) groups. ConclusionsDifferent ME thicknesses had no influence on the pulled tension applied during the simulated dorsiflexion Jack maneuver.Clinical Relevance This research aims to highlight the importance of the force effects of ME when treating hallux rigidus conservatively. Our results indicate that the tension values of the first MPJ during Jack maneuver had no significant pulling force effects on ME in healthy and hallux rigidus subjects, which suggests that its prescription can be made without danger of joint overload.

The Simple Bunion: Anatomy at the Metatarsophalangeal Joint of the Great Toe

Foot & Ankle ◽  
1984 ◽  
Vol 4 (5) ◽  
pp. 229-240 ◽  
Author(s):  
Richard Alvarez ◽  
Ray J. Haddad ◽  
Nathaniel Gould ◽  
Saul Trevino
Keyword(s):  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Great Toe ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Valgus Deformity ◽  
Sesamoid Bones ◽  
Proper Interpretation

The pathomechanics for the development of the hallux valgus deformity takes place at the first metatarsophalangeal joint-the sesamoid complex. The sesamoid complex consists of seven muscles, eight ligaments, and two sesamoid bones. When the first metatarsal escapes the complex and drifts medially, the sesamoids remain twisted in situ, several of the ligaments “fail,” and others contract. The authors propose reduction of the metatarsus primus varus by first metatarsal osteotomy and appropriate ligament releases and plications to restore alignment. A detailed understanding of the pathomechanics is essential for proper interpretation of the problems and anticipated lasting surgeries.

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

2017 ◽  
Vol 11 (1) ◽  
pp. 22-31 ◽  
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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