scholarly journals Silastic replacement of the first metatarsophalangeal joint: historical evolution, modern concepts and a systematic review of the literature

2019 ◽  
Vol 4 (3) ◽  
pp. 77-84 ◽  
Author(s):  
Haroon Majeed
Keyword(s):  
Patient Satisfaction ◽  
Metatarsophalangeal Joint ◽  
Historical Evolution ◽  
First Metatarsophalangeal Joint ◽  
Average Patient ◽  
Radiological Changes ◽  
End Stage ◽  
First And Second Generation

Silastic implants for the first metatarsophalangeal joint (MTPJ) have been in use for over 50 years. Initial reports were associated with high failure rates leading to development of new designs that are currently in use. The aim of this article is to review the historical evolution and the outcomes of silastic implants for the treatment of end-stage OA of the first MTPJ. Databases were searched for studies reporting the outcomes of silastic implants for the first MTPJ. Various relevant search terminologies were used. Studies reporting the outcomes of metallic implants or arthrodesis were excluded. The literature search revealed 522 studies, of which 28 were included. Eight studies used single-stemmed implants and 20 used double-stemmed implants for their patients. Twenty-eight studies had a total of 2354 feet with silastic replacements in 1884 patients (1968 to 2003) with an average age of 53 years and the average follow-up was 85.3 months. There were a total of 5.3% (124 feet) failed prostheses. Improvement in pain was reported in 76.6% (1804 feet) with an average patient satisfaction rate of 84%. Radiological changes around the implants were found to be significantly higher with single-stemmed implants (30.3%) compared to the double-stemmed implants (14.7%) (p < 0.05). Significantly more single-stemmed implants failed (11%) than the double-stemmed implants (3.6%) (p < 0.05). Despite the initial reports of failed implants and complications, first- and second-generation silastic implants were associated with high patient satisfaction and pain improvement. Current literature lacks long-term outcomes of implants currently in use. Cite this article: EFORT Open Rev 2019;4:77-84. DOI: 10.1302/2058-5241.4.180055

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

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.

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

Silastic first metatarsophalangeal joint arthroplasty for the treatment of end-stage hallux rigidus

2020 ◽  
Vol 102-B (2) ◽  
pp. 220-226 ◽  
Author(s):  
Timothy M. Clough ◽  
Joseph Ring
Keyword(s):  
Metatarsophalangeal Joint ◽  
Visual Analogue Score ◽  
Patient Reported Outcome Measures ◽  
Hallux Rigidus ◽  
First Metatarsophalangeal Joint ◽  
Patient Reported ◽  
Silastic Implant ◽  
The Mean ◽  
End Stage

Aims Arthroplasty for end-stage hallux rigidus (HR) is controversial. Arthrodesis remains the gold standard for surgical treatment, although is not without its complications, with rates of up to 10% for nonunion, 14% for reoperation and 10% for metatarsalgia. The aim of this study was to analyze the outcome of a double-stemmed silastic implant (Wright-Medical, Memphis, Tennessee, USA) for patients with end-stage HR. Methods We conducted a retrospective review of 108 consecutive implants in 76 patients, between January 2005 and December 2016, with a minimum follow-up of two years. The mean age of the patients at the time of surgery was 61.6 years (42 to 84). There were 104 females and four males. Clinical, radiological, patient reported outcome measures (PROMS) data, a visual analogue score (VAS) for pain, and satisfaction scores were collected. Results The survivorship at a mean follow-up of 5.3 years (2.1 to 14.1) was 97.2%. The mean Manchester Oxford Foot and Ankle Questionnaire (MOXFQ) scores improved from 78.1 to 11.0, and VAS scores for pain from 7/10 to 1.3/10. The rate of satisfaction was 90.6%. Three implants (2.8%) required revision; one for infection, one-month postoperatively, and two for stem breakage at 10.4 and 13.3 years postoperatively. There was a 1.9% reoperation rate other than revision, 23.1% of patients developed a minor complication, and 21.1% of patients had non-progressive and asymptomatic cysts on radiological review. Conclusion We report a 97.2% survivorship at a mean follow-up of 5.3 years with this implant. We did not find progressive osteolysis, as has been previously reported. These results suggest that this double-stemmed silastic implant provides a predictable and reliable alternative with comparable outcomes to arthrodesis for the treatment of end-stage HR. Cite this article: Bone Joint J 2020;102-B(2):220–226.

scholarly journals Endometrial ablation for women with heavy menstrual bleeding: A systematic review and network meta-analysis

2021 ◽  
Author(s):  
Chung Shen Chean ◽  
Yuen Wei Liao ◽  
Jessica Potts ◽  
Steven Toh ◽  
Syafira Shaman ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Second Generation ◽  
Meta Analysis ◽  
Endometrial Ablation ◽  
Heavy Menstrual Bleeding ◽  
Menstrual Bleeding ◽  
Bipolar Radiofrequency ◽  
First And Second Generation

Background: Endometrial ablation (EA) is a less invasive treatment alternative to hysterectomy for heavy menstrual bleeding, but which ablation technique works best remains unknown. Objectives: A systematic review and network meta-analysis to evaluate the efficacy of different first and second generation EA techniques. Search strategy: A systematic search of online databases from inception. Selection criteria: Randomised controlled trials of EA techniques. Data Collection and Analysis: Primary outcomes (amenorrhoea rate and patient satisfaction rate at short (up to 12 months), intermediate (between 12 months and 5 years), and long term (5 years or more) follow-up) and secondary outcomes (re-intervention rate) were compared between first and second generation EA techniques. Treatment effects of different second generation EA techniques were compared. Main results: Comparing first versus second generation EA, there was no significant difference in amenorrhoea rates at short (OR 1.27, 95%CI 0.83-1.95), intermediate (OR 0.79, 95%CI 0.48-1.30), or long term (OR 1.39, 95%CI 0.94-2.07) follow-up. This was the same with patient satisfaction rates at short (OR 0.76, 95%CI 0.53-1.09), intermediate (OR 0.76, 95%CI 0.47-1.23), and long term (OR 0.68, 95%CI 0.31-1.51) follow-up. No difference in re-intervention rates was demonstrated. Highest amenorrhoea rate was achieved with bipolar radiofrequency, followed by hydrothermablation, microwave and thermal balloon ablation. Conclusions: Second generation EA seem to be as effective as first generation techniques in achieving amenorrhoea, high patient satisfaction and low re-intervention rate. Bipolar radiofrequency ablation seems to be the best amongst second generation EA in achieving amenorrhoea. Funding: None Keywords: ‘endometrial ablation’, ‘menorrhagia’, ‘heavy menstrual bleeding’

Cone Arthrodesis of the First Metatarsophalangeal Joint

Foot & Ankle ◽  
1984 ◽  
Vol 4 (5) ◽  
pp. 244-248 ◽  
Author(s):  
J. E. Johansson ◽  
T. W. Barrington
Keyword(s):  
Average Length ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
Hallux Rigidus ◽  
Long Term Results ◽  
First Metatarsophalangeal Joint ◽  
Hallux Valgus Deformity ◽  
Metatarsophalangeal Joints

The reliability and effectiveness of the treatment of hallux rigidus and sympomatic arthritis of the first metatarsophalangeal joint by the technique of cone arthrodesis are discussed. The authors reviewed the long-term results of cone arthrodesis in 51 patients with 60 operated feet. The average age was 55 years (range, 28 to 75 years) and the average length of follow-up was 39 months (range, 1 to 12 years). On questioning the patients regarding function, cosmesis, and pain, 41 of 51 patients were happy, eight of 51 patients were satisfied, and two of 51 were unhappy with their feet. No patient complained of persistent or recurrent hallux valgus deformity. Radiologically and clinically 58 of 60 first metatarsophalangeal joints were solidly fused. Two patients had a fibrous ankylosis which was functional and painless. Function with respect to gait and ability to walk on tiptoe and run was normal in all patients. In summary, the authors feel that this procedure is a reliable, effective treatment of painful arthritis of this joint.

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

2002 ◽  
Vol 92 (10) ◽  
pp. 543-554 ◽  
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)

scholarly journals Adjacent Joint Arthrodesis Risk After First Metatarsophalangeal Joint Arthrodesis: A 10 Year FollowUp Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0041
Author(s):  
Kar Teoh ◽  
Gianluca Gonzi
Keyword(s):  
Telephone Survey ◽  
Metatarsophalangeal Joint ◽  
Ankle Arthrodesis ◽  
Demographic Information ◽  
First Metatarsophalangeal Joint ◽  
Secondary Osteoarthritis ◽  
Clinical Workstation ◽  
End Stage ◽  
Time Of Operation

Category: Midfoot/Forefoot Introduction/Purpose: Arthrodesis remains the gold standard for end stage symptomatic first metatarsophalangeal (MTP) joint osteoarthritis. Based on several ankle arthrodesis studies, it is well known that adjacent joints are put under more stress leading to secondary osteoarthritis. However, the direct association between first MTPJ arthrodesis and the progression of adjacent joint arthrosis remains unclear. The purpose of this study was to determine the progression of interphalangeal (IPJ) and 1st tarsometarsal joint (1st TMT) degeneration following first MTP joint arthrodesis. Methods: All patients treated with first MTP joint arthrodesis from 2003 to 2008 were identified from our regional centre. Data was obtained from our institution’s electronic clinical workstation which included demographic information, radiographs and clinical letters. A telephone survey with a predetermined written script was carried out in patients as we were not able to obtain ethics to perform repeat radiographs. Results: A total of 166 first MTPJ arthrodesis were included with at least 10 year follow-up. We excluded patients who have moved out of region. There was a 3:1 female to male ratio, with an average age at time of operation being 63 (27- 83). 25% of the patients reported adjacent joint pain (15% at IPJ, 10% at 1st TMTJ) at final follow up. 3 (1.8%) patients required arthrodesis of adjacent joints (1 at IPJ, 2 at 1st TMTJ). Conclusion: This study improves the understanding of biomechanical impact on the foot following 1st MTPJ fusion and is helpful in the consenting process.

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

The Foot ◽  
2003 ◽  
Vol 13 (3) ◽  
pp. 151-155 ◽  
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

scholarly journals Interpositional Arthroplasty of the First Metatarsophalangeal Joint with Bioresorbable Pldla Implant in the Treatment of Hallux Rigidus and Arthritic Hallux Valgus: A 9-Year Case Series Follow-Up

2019 ◽  
pp. 145749691989359
Author(s):  
N. Partio ◽  
V. T. Ponkilainen ◽  
V. Rinkinen ◽  
P. Honkanen ◽  
H. Haapasalo ◽  
...  
Keyword(s):  
Lactic Acid ◽  
Hallux Valgus ◽  
Analogue Scale ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
First Metatarsophalangeal Joint ◽  
Interpositional Arthroplasty ◽  
The Mean ◽  
End Stage

Background and Aims: The interpositional arthroplasty was developed to retain foot function and to relieve pain due to the arthritis of the first metatarsophalangeal joint. The bioabsorbable poly-L-D-lactic acid RegJoint® interpositional implant provides temporary support to the joint, and the implant is subsequently replaced by the patient’s own tissue. In this study, we retrospectively examined the results of the poly-L-D-lactic acid interpositional arthroplasty in a 9-year follow-up study among patients with hallux valgus with end-stage arthrosis or hallux rigidus. Material and Methods: Eighteen patients and 21 joints underwent interpositional arthroplasty using the poly-L-D-lactic acid implant between February 1997 and October 2002 at Tampere University Hospital. Of these, 15 (83.3%) (21 joints) patients were compliant with clinical examination and radiographic examination in long-term (average 9.4 years) follow-up. The mean age of the patients was 48.3 (from 28 to 67) years at the time of the operation. Six patients underwent the operation due to arthritic hallux valgus and nine patients due to hallux rigidus. Results: The mean Ankle Society Hallux Metatarsophalangeal–Interphalangeal Scale and visual analogue scale (VAS) for pain scores improved after the operation in all patients. The decrease of pain (visual analogue scale) after the operation was statistically significant (77.5 vs 10.0; p < 0.001). Postoperative complications were observed in 3 (14.3%) joints of two hallux rigidus patients. For these patients, surgery had only temporarily relieved the pain, and they underwent reoperation with arthrodesis. Conclusion: In conclusion, interpositional arthroplasty using a poly-L-D-lactic acid implant yielded good results. This study indicates that the poly-L-D-lactic acid interpositional implant may be a good alternative for arthrodesis for treatment of end-stage degeneration of the first metatarsophalangeal joint.

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