scholarly journals First Metatarsal Phalangeal Joint Arthrodesis without the Use of Hardware after Failed Arthroplasty: A Case Report

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peter Adamson ◽  
Cory Janney ◽  
Jie Chen ◽  
Vinod Panchbhavi
Keyword(s):  
Case Report ◽  
Bone Loss ◽  
Screw Fixation ◽  
Hallux Rigidus ◽  
Allograft Bone ◽  
Salvage Procedure ◽  
High Failure Rate ◽  
Unique Case ◽  
First Metatarsal ◽  
First Ray

Introduction: First metatarsal phalangeal joint (MTPJ) arthroplasty has a high failure rate due to aseptic loosening, which leads to bone loss. The salvage procedure is conversion to an arthrodesis, but bone loss can make obtaining screw fixation difficult. Herein, we report a unique case of revision first-metatarsal arthrodesis without the use of hardware after a failed arthroplasty. Case Report: A 60-year-old women presented to us with first MTPJ pain in the setting of failed arthroplasty. We performed an arthrodesis; however, intraoperatively, hardware fixation could not be obtained due to bone loss. We utilized allograft bone struts to maintain first ray length and to hold the correct hallux position during arthrodesis maturation. Conclusion: Bone loss is a frequently encountered problem in revision surgery to a first MTPJ arthrodesis. An arthrodesis can be obtained without the use of hardware in scenarios where bone loss precludes screw fixation. Keywords: Hallux rigidus, revision, bone loss, arthrodesis

scholarly journals Cue Ball Arthroplasty With Humeroradial Total Elbow Arthroplasty (TEA) Revision: An Approach to Managing Infection and Severe Ulnar Bone Loss in TEA

2020 ◽  
Vol 4 ◽  
pp. 247154922096159
Author(s):  
Daniel E Gerow ◽  
Emily H Tan ◽  
H Brent Bamberger
Keyword(s):  
Case Report ◽  
Bone Loss ◽  
Distal Humerus ◽  
Deep Infection ◽  
Salvage Procedure ◽  
Joint Infections ◽  
Surgical Complexity ◽  
Periprosthetic Bone Loss ◽  
Antibiotic Spacer ◽  
Cement Arthroplasty

Total elbow arthroplasties (TEA) have become more prevalent as indications expand. However, TEA complications remain a treatment conundrum. One such complication, periprosthetic joint infections (PJIs) have been reported to occur in up to 12% of all TEA procedures. Irrigation and debridement with retention of hardware and antibiotic suppression has a high failure rate. Two stage revisions of TEA, while more morbid, is an effective approach with previous studies showing a 79% eradication rate. These cases are often associated with periprosthetic bone loss, adding to the surgical complexity. In our case report, we present the case of a 59 year old diabetic male with a primary TEA secondary to a distal humerus fracture who developed a deep infection and was successfully treated with explantation, cue ball antibiotic cement arthroplasty, and humeroradial revision. This case report will discuss the cue ball antibiotic spacer technique and humeroradial revision as a salvage procedure in TEA revisions in the setting of extensive ulnar bone loss.

Average 4-Year Outcomes of Distal Oblique First Metatarsal Osteotomy for Stage 1 to 3 Hallux Rigidus

2021 ◽  
pp. 107110072110522
Author(s):  
Maurise Saur ◽  
Julien Lucas y Hernandes ◽  
Pierre Barouk ◽  
Lorena Bejarano-Pineda ◽  
Carlos Maynou ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Hallux Rigidus ◽  
Aofas Score ◽  
First Metatarsal ◽  
Subjective Satisfaction ◽  
First Ray ◽  
Shortening Rate ◽  
Stage 1

Background: Hallux rigidus is the second most frequent pathology of the first ray. Surgical options for degenerative metatarsophalangeal joint disease are either joint destructive or conservative procedures. The hypothesis was that oblique distal shortening osteotomy of the first metatarsal is an effective conservative technique for the management of stage 1 to 3 hallux rigidus. Methods: We conducted a retrospective cohort study of 87 feet with Coughlin and Shurnas’s stage 1-3 hallux rigidus, operated between 2009 and 2019. The cohort consisted in 72 patients (87 feet) with an average age of 57±9 (30/79) years; 22 of 87 (25.3%) feet had the first metatarsal surgery performed in isolation; 65 of 87 (74.7%) had concomitant forefoot procedures, including 31 of 87 (35.6%) with Akin phalangeal osteotomies and 34 of 87 (39.1%) with Moberg phalangeal osteotomies. We evaluated the American Orthopaedic Foot & Ankle Society (AOFAS) Scale, subjective satisfaction, joint amplitudes, shortening rate, and occurrence of postoperative complications with a mean follow-up of 51 months (16/134). Results: The AOFAS score increased from 54.2±11.3 (25/70) preoperatively to 92.2±7.8 (62/100) postoperatively ( P < .001). Patients reported excellent or good outcome in 95.4% of cases. The 40-point self-reported pain subscale score improved from 19.6 (± 10.0) to 37.4 (± 5.4), P < .001. The overall range of motion increased from 61±21 (20/110) degrees to 69±17 (35/120) degrees ( P < .001). The mean first metatarsal shortening rate (SRpo) was 9.6%. Neither the Coughlin grade, the metatarsal index, or the SRpo influenced the AOFAS score. At 6-month follow-up, 15 patients had transfer metatarsalgia compared with 5 at last follow-up without requiring another surgical procedure. The risk was not significantly different according to Coughlin's stage, preoperative metatarsal index, or SRpo. Conclusion: Oblique distal osteotomy of the first metatarsal for stage 1-3 hallux rigidus, often in combination with other first ray procedures, performed well during our follow-up time period, with a high subjective satisfaction rate and few complications. Level of Evidence: Level III, retrospective cohort study.

Result of Arthrodesis of the Hallux Metatarsophalangeal Joint Using Bone Graft for Restoration of Length

2000 ◽  
Vol 21 (4) ◽  
pp. 297-306 ◽  
Author(s):  
Mark S. Myerson ◽  
Lew C. Schon ◽  
Francis X. McGuigan ◽  
Ali Oznur
Keyword(s):  
Bone Loss ◽  
Bone Graft ◽  
Total Joint Replacement ◽  
Metatarsophalangeal Joint ◽  
Technical Difficulty ◽  
Deep Infection ◽  
High Rate ◽  
Metatarsal Osteotomy ◽  
First Metatarsal ◽  
First Ray

We treated 24 patients (18 women, six men; average age, 46.4 years; (range, 28 to 66 years) with fusion of the hallux metatarsophalangeal (MTP) joint using bone graft for the restoration of the length of the first ray. This procedure was performed after bone loss subsequent to previous surgeries for the correction of hallux valgus and hallux rigidus with: silastic arthroplasty (11), bunionectomy and distal metatarsal osteotomy (six), Keller resection arthroplasty (five), and total joint replacement (two). The indication for performing the arthrodesis with bone graft was a short first metatarsal, and associated metatarsalgia of the lesser metatarsals in addition to a painful MTP joint with or without deformity. This bone loss was associated with avascular necrosis of the first metatarsal (nine patients) and with osteomyelitis (seven patients). Of the 24 patients, 14 underwent additional concurrent surgery for correction of hammer toes (10), excision of a Morton's neuroma (two), and lesser metatarsal osteotomy (two). All patients were examined clinically and radiographically at a mean interval of 62.7 months after surgery (range, 26 to 108 months). The patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux and MTP 100-point outcome scale. Arthrodesis occurred in 19/24 patients (79.1%) at a mean of 13.3 weeks (range, 11 to 16 weeks), and the first ray was lengthened by a mean of 13 mm (range, 0 to 29 mm). Of the five nonunions, two were asymptomatic, and three were subsequently revised successfully, with arthrodesis occurring at a mean of 10.7 weeks. Complications included one deep infection requiring intravenous antibiotics for treatment of osteomyelitis and two minor superficial wound infections. The mean AOFAS score improved from 39 points (range, 22 to 60 points) to 79 points (range, 64 to 90 points). All patients were satisfied with the final outcome of treatment and stated that they would undergo the surgical procedure again. We concluded that arthrodesis of the hallux MTP joint with bone graft to restore bone loss and length of the first ray may be a worthwhile procedure despite the technical difficulty and the high rate of nonunion.

scholarly journals Reconstruction of First Metatarsal Bone Loss Following Osteomyelitis by a Modified Masquelet Technique: A Case Report

2020 ◽  
Vol 10 (9) ◽  
Author(s):  
Abhinav D Jogani ◽  
Vinayak Garje ◽  
Prakash K George ◽  
Tushar Rathod ◽  
Shubhanshu M Bhaladhare ◽  
...  
Keyword(s):  
Case Report ◽  
Bone Loss ◽  
Metatarsal Bone ◽  
First Metatarsal ◽  
Masquelet Technique

Mobility of the First Ray in Various Foot Disorders

2012 ◽  
Vol 33 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Justin Greisberg ◽  
Lisa Sperber ◽  
Daniel E. Prince
Keyword(s):  
Hallux Valgus ◽  
Hallux Rigidus ◽  
Stress Fractures ◽  
Consecutive Series ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Posterior Tibial ◽  
First Ray ◽  
Made In

Background: Instability of the first ray has been proposed by Morton and others to be a major cause of several foot disorders, including hallux valgus, transfer metatarsalgia, lesser metatarsal stress fractures, and second metatarsophalangeal diseases. However, there are few studies to support these theories. In this study, we have used a simple device to measure first ray elevation and translation in a consecutive series of foot and ankle patients. We propose that mobility of the first ray will be increased in patients with hallux valgus, metatarsalgia, hallux rigidus, lesser metatarsal stress fractures, posterior tibial tendinitis, and interdigital neuromas. Methods: Measurements of first ray translation and elevation were made in 345 feet in 315 patients. One or more pathologic diagnoses were recorded for each foot, and data was analyzed by a statistician. Results: First ray mobility was increased in females compared to males. Patients with hallux valgus and metatarsalgia had greater mobility than other patients. Those feet with low arches showed greater mobility than those with high arches. Patients with hallux rigidus showed decreased mobility. We failed to find any differences for patients with stress fractures, posterior tibial tendinitis, or neuromas, but some of these groups may have had insufficient power. Conclusion: First ray translation and elevation are two different measures of medial column instability. Although they are distinct measures, they closely paralleled each other in this series. An association was found between increased first metatarsal elevation and several foot disorders. Although such an association does not prove causation, and it is likely other factors may play a role in many patients, this data does link instability of the first ray to some diseases. The decreased mobility seen in patients with hallux rigidus may offer new insights into the etiology of that disorder. Level of Evidence: III, Comparative Study

scholarly journals Management of a failed metatarso-phalangeal joint fusion utilizing a hemicup prosthesis

2014 ◽  
Vol 4 (2) ◽  
Author(s):  
Nicola Stadler ◽  
Stefan Hofstätter ◽  
Klemens Trieb
Keyword(s):  
Case Report ◽  
Metatarsophalangeal Joint ◽  
Treatment Method ◽  
Hallux Rigidus ◽  
Salvage Procedure ◽  
Operative Techniques ◽  
First Metatarsophalangeal Joint ◽  
First Report ◽  
Joint Fusion

We report a case of a 65-year-old man with a painful nonunion of the first metatarsophalangeal joint (MTPJ). It is one of the main severe complications of this surgery. Its prevalence is described between 5% and 10% across different operative techniques. The implantation of hemicup-prosthesis has been successfully used for the hallux rigidus treatment with very promising results. In our case report, we introduce a treatment method of converting a pseudoarthrosis of the first MTPJ, made of two crossing screws into a hemicup-prosthesis as a salvage procedure. This is to our best knowledge the first report using this device for treatment of pseudoarthrosis of the first MTPJ.

An unique case of celiac disease with hypocoagulation and secondary hyperparathyreodism in elderly patient - a case report

2017 ◽  
Author(s):  
Gocha Barbakadze ◽  
Lali Tigishvili ◽  
Levan Ramishvili ◽  
Nani Tsikarishvili ◽  
Koba Burnadze
Keyword(s):  
Elderly Patient ◽  
Celiac Disease ◽  
Case Report ◽  
Unique Case
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