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

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 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 Five-year Outcomes of a Synthetic Cartilage Implant for the First Metatarsophalangeal Joint in Advanced Hallux Rigidus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0005
Author(s):  
Mark Glazebrook ◽  
Chris Blundell ◽  
Dishan Singh ◽  
Gwyneth de Vries ◽  
Ian Le ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Data Entry ◽  
Metatarsophalangeal Joint ◽  
Well Being ◽  
Hallux Rigidus ◽  
Implant Removal ◽  
First Metatarsophalangeal Joint ◽  
Surgical Interventions ◽  
Safety Outcomes

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is the most common arthritic condition of the foot. A prospective, randomized, non-inferiority clinical trial of first metatarsophalangeal joint (MTPJ) hemiarthroplasty with a synthetic polyvinyl alcohol hydrogel implant, for moderate to severe hallux rigidus, demonstrated maintenance of MTPJ active dorsiflexion motion and excellent pain relief; additionally, the trial showed functional outcomes and safety equivalent to first MTPJ arthrodesis at 24 months (Baumhauer et al. 2016; FAI:37(5):457-469). Recognizing that many hemiarthroplasty and total toe implants have initially good results that deteriorate over time, the purpose of this study was to prospectively assess the safety and efficacy outcomes for the synthetic cartilage implant population and to determine if the excellent outcomes were maintained at >5 years. Methods: One hundred and fifty-two patients underwent implant hemiarthroplasty in the original trial; 14 underwent implant removal and conversion to fusion and 3 were lost to follow-up during the first 24 months, leaving 135 eligible for this study. One hundred patients were evaluated at 5+ years; 5 could not be reached for follow-up. Thirty are pending consent, follow-up, and/or data entry; their status will be available for inclusion at the conference presentation. Patients completed a pain visual analogue scale (VAS) and Foot and Ankle Ability Measure (FAAM) Sports and Activities of Daily Living (ADL) scores, preoperatively and at 2, 6, 12, 26, 52, 104 and 260 weeks postoperatively. Minimal clinically important differences are: =30% difference for pain VAS, 9 points for FAAM Sports, and 8 points for FAAM ADL. Great toe active dorsiflexion, weight-bearing radiographs, secondary procedures, and safety parameters were evaluated. Results: Of 100 synthetic cartilage implant hemiarthroplasty patients available at mean 5.8 years follow-up (SD ±0.7; range: 4.4- 7.4), 5 underwent implant removal and conversion to fusion in years 2-5 (Figure 1), and 2 underwent subsequent surgical interventions during the pivotal trial and were censored, leaving 93 patients for evaluation. Pain and function outcomes observed at 5.8 years were similar to those at 2 years (Figure 1). VAS Pain and FAAM Sports Scores were maintained or improved at 5.8 years follow-up, but these differences were not clinically significant. Joint motion was maintained at 5.8 years. No evidence of avascular necrosis, device migration or fragmentation was observed upon independent radiographic review. Eighty-six percent of patients agreed their overall well-being had improved, and 92% would have the procedure again. Conclusion: Clinical and safety outcomes of patients having undergone synthetic cartilage implant hemiarthroplasty for the surgical treatment of hallux rigidus were previously demonstrated to be non-inferior to the gold standard treatment, MTPJ fusion, at 2 years. Prospectively determined outcomes for 100/135 of these implant hemiarthroplasty patients at 5.8 years are similar to those reported at 2 years. Longer-term results demonstrate that clinical and safety outcomes for synthetic cartilage implant hemiarthroplasty are durable, and that the implant remains a viable treatment option to decrease pain, improve function and maintain motion for advanced hallux rigidus.

scholarly journals Total Joint Replacement of the First Metatarsophalangeal Joint with Roto-Glide as Alternative to Arthrodesis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0035
Author(s):  
Martinus Richter ◽  
Stefan Zech ◽  
Stefan Meissner ◽  
Issam Naef
Keyword(s):  
Joint Replacement ◽  
Total Joint Replacement ◽  
Weight Bearing ◽  
Treatment Options ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Degenerative Changes ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal

Category: Midfoot/Forefoot Introduction/Purpose: Total joint replacement (TJR) and arthrodesis (A) are treatment options for severe osteoarthritis of the first metatarsophalangeal joint (MTP1). The aim of this study was to compare outcome (clinical and pedographic) of TJR (Roto- Glide) and A of MTP1. Methods: All patients that completed follow-up of at least 24 months after TJR and A of MTP1 before November 5, 2018 were included in the study. Preoperatively and at follow-up, radiographs and/or weight-bearing computed tomographies (WBCT) were obtained. Degenerative changes were classified in four degrees. Standard dynamic pedography was performed (percentage force at first metatarsal head/first toe from force of entire foot). Visual-Analogue-Scale Foot and Ankle (VAS FA) and MTP1 range of motion for dorsi-/plantarflexion (ROM) were registered and compared pre-operatively and follow-up. From November 24, 2011 until October 31, 2016, 25 TJR and 49 A were performed that completed follow-up. Results: Parameters (average values if not stated otherwise) for TJR/A were preoperatively: age 59/60 years; 7(28%)/14(29%) male; height 168/169 cm; weight 71/72 kg; degree degenerative changes 3.3/3.1; ROM 19.4/0/9.8°//20.3/0/9.2°; percentage force first metatarsal/first toe 7.9/14.6//8.5/15.3; VAS FA 45.9/46.2. Six wound healing delays were registered (TJR 2, A 4) as only complications. Follow-up time on average 45.7/46.2 and range 25.0-80.3/24.1-81.1 months. VAS FA at follow-up was 73.4/70.2.; percentage force first metatarsal/first toe 15.8/5.8//12.3/10.8; ROM 35.6/0/10.5°//10.5/0/0. Parameters did not differ between TJR and A (each p>.05) except higher force percentage first toe and lower ROM for A at follow-up (each p<.05). VAS FA and pedography parameters improved for TJR and A between preoperatively and follow-up, ROM increased for TJR and decreased for A (each p<.05). Conclusion: TJR and A were performed in similar patient cohorts regarding demographic parameter, degree of degenerative changes, ROM, pathological pedographic pattern, and VAS FA. TJR and A improved pathological pedographic pattern and VAS FA at minimum follow-up of 24 months. TJR additionally improved ROM and showed better pedographic pattern (and not different to physiological pattern) than A. Survival rate of TJR was 100% up to 6 years. In this study, TJR was a valuable alternative to A for treatment of severe MTP1 osteoarthritis.

Retrograde placement of a novel 3.5 mm titanium interlocking nail for supracondylar and diaphyseal femoral fractures in cats

2007 ◽  
Vol 20 (03) ◽  
pp. 211-218 ◽  
Author(s):  
A. Klein ◽  
J. Pink ◽  
A. Hidalgo ◽  
P. Moissonnier ◽  
P. Fayolle ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Femoral Fractures ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Autogenous Bone ◽  
Intercondylar Notch ◽  
Fracture Characteristics ◽  
Interlocking Nail ◽  
Stifle Joint

SummaryTwenty-four simple or comminuted supracondylar and diaphyseal femoral fractures in cats, which had been treated by retrograde insertion of a new 3.5 mm titanium interlocking nail (IN) from the intercondylar notch, were evaluated between June 2000 and October 2004 at the Ecole Nationale Vétérinaire d'Alfort. Patient data (species, breed, weight, and age), fracture characteristics, details of the surgery, post-operative complications and radiographic follow-up were recorded. The mean body weight was 3.75 kg and the cats ranged in age between four and 66 months (mean 29 months). The IN had a diameter of 3.5 mm and a length of 100, 109 or 119 mm, and were all fixed in a static position (two screws in seven cats, three screws in 10 cats and four screws in seven cats). Cerclage wires were used in seven cats and an autogenous bone graft was used in two cats. Screw or nail breakage were not recorded. Nineteen fractures healed without any complications, three cats died during the post-operative period from unknown causes, and two cats showed delayed bone healing. Twenty cats were considered to have an excellent limb function at one month. One cat with a sciatic injury was non-weight bearing for several months. Radiographic signs of degenerative joint disease of the stifle joint were not observed except in the cat with the sciatic nerve injury. The results of this study suggest that this new 3.5 mm titanium IN can be introduced from the intercondylar notch and be used in static fixation mode to stabilize supracondylar and diaphyseal femoral fractures in cats.

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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