Hemiarthroplasty in the Treatment of Hallux Rigidus

2008 ◽  
Vol 29 (3) ◽  
pp. 273-281 ◽  
Author(s):  
Charles Sorbie ◽  
Gerald Anthony Briden Saunders
Keyword(s):  
Perioperative Complications ◽  
Proximal Phalanx ◽  
Hallux Rigidus ◽  
Rating System ◽  
Steel Alloy ◽  
Joint Mobility ◽  
Aofas Score ◽  
Component Loosening ◽  
Small Hematoma ◽  
Cobalt Chrome

Background: Osteoarthritis of the first metatarsophalangeal (MTP) joint is a painful, disabling condition. It can interfere with the ability to run and even walk without pain. An implant of cobalt-chrome steel alloy to replace the base of the proximal phalanx is one solution. The purpose of this study is to review our results with one of these implants. Materials and Methods: A series of 23 cases of hemiarthroplasty for the treatment of hallux rigidus from June 2000 to October 2001 has been evaluated using the AOFAS rating system, and the results are presented. Results: The average preoperative AOFAS score was 57 (range, 39 to 80). The AOFAS score after hemiarthroplasty was 88 (range, 75 to 100) at last followup (34 to 72 months). There were no perioperative complications except for a small hematoma. Only one patient has required further surgery after 3 years for worsening of a preexisting tendency to hallux valgus. Conclusion: A hemiarthroplasty retained, in most cases, joint mobility, strength, and alignment while relieving pain. There was no evidence, at last followup, of component loosening or osteolysis.

Clinical and Radiological Outcomes of Hallux Rigidus Treated With Cheilectomy and a Moberg-Akin Osteotomy

2020 ◽  
Vol 41 (3) ◽  
pp. 294-302
Author(s):  
Danielle J. A. Maes ◽  
Jeroen De Vil ◽  
Alain F. Kalmar ◽  
Tom Lootens
Keyword(s):  
Pain Score ◽  
Proximal Phalanx ◽  
Hallux Rigidus ◽  
Radiological Outcome ◽  
Aofas Score ◽  
Sf 36 ◽  
Biplanar Osteotomy ◽  
Clinical And Radiological Outcome ◽  
Akin Osteotomy ◽  
Positive Effect

Background: This study aimed to evaluate the clinical and radiological outcome after cheilectomy and proximal phalangeal biplanar osteotomy for patients with mild and advanced stages of hallux rigidus. Methods: A total of 105 feet (grades 0-4) were treated with cheilectomy and a Moberg-Akin osteotomy of the proximal phalanx. All patients were clinically assessed preoperatively and followed up for 12 months by range of motion, visual analog scale (VAS) pain score, American Orthopaedic Foot & Ankle Society (AOFAS) score, Short Form 36 (SF-36) score, and weightbearing radiographs. Results: This operative procedure resulted in a statistically significant positive effect on mobility of the first metatarsophalangeal joint ( P = .001), VAS pain score ( P < .001), AOFAS score ( P < .001), and SF-36 score ( P < .001). Conclusion: Cheilectomy and biplanar osteotomy of the proximal phalanx was an effective procedure for hallux rigidus with a positive effect on clinical and radiological outcome. Level of Evidence: IV, case series.

One-year Follow-Up Results with Hydrogel Implant in Therapy of Hallux Rigidus: Case Series with 44 Patients

2021 ◽  
Author(s):  
Christoph Zanzinger ◽  
Norbert Harrasser ◽  
Oliver Gottschalk ◽  
Patrick Dolp ◽  
Florian Hinterwimmer ◽  
...  
Keyword(s):  
Learning Algorithm ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Therapy Failure ◽  
Retrospective Case ◽  
Aofas Score ◽  
Medium Level ◽  
One Year

Abstract Background The Cartiva implant (CI) is being increasingly used in the surgical therapy of hallux rigidus. Despite a growing number of studies, numerous questions regarding patient selection remain unanswered. Patients and Methods As part of a retrospective case series with prospective follow-up (average follow-up period: 12 months), a total of 44 patients (male/female = 16/28; mean age at the time of surgery: 55.4 years) with 44 CI were analysed (VAS, EFAS-, AOFAS-score). Using a correlation analysis and a machine learning algorithm, risk factors for therapy failure were investigated. Results The overall survival rate of the CI was 93% at 12 months. The VAS, EFAS and AOFAS scores showed a significant improvement in comparison to the preoperative condition. The mobility of the metatarsophalangeal joint showed no increase. Patients with a medium osteoarthritis grade and a medium level of clinical restraint showed the greatest improvement in relation to their preoperative condition. Conclusion The CI can be seen as an effective therapy for hallux rigidus. Nonetheless, realistic patient expectations must be communicated.

scholarly journals Treatment of Moderate Hallux Valgus by Percutaneous, Extra-articular Reverse-l Chevron (PERC) Osteotomy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Julien Lucas ◽  
Olivier Laffenetre
Keyword(s):  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Subjective Rating ◽  
Outpatient Basis ◽  
Range Of Movement ◽  
Aofas Score ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
The Mean

Category: Midfoot/Forefoot Introduction/Purpose: The purpose of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a Percutaneous Extra-articular Reverse-L Chevron (PERC) osteotomy. Methods: A total of 38 patients underwent 45 PERC procedures. A medial approach is used just proximal to the flare of the metatarsal head. The osteotomy is performed using a burr, the thickness of which is selected according to the planned correction and shortening. A second dorsolateral approach is then performed and the osteotomy is fixed using a self-drilling, self-tapping 3 mm diameter cannulated and headless compression screw. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. Results: The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Conclusion: Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy. Its main asset is that it maintains an excellent range of movement; other advantages relate to the procedure being performed on an outpatient basis and the absence of tourniquet use.

scholarly journals Assessment of New Measurements to Assess First Metatarsal Elevation in Hallux Rigidus Compared to Controls

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Mackenzie Jones ◽  
Austin Sanders ◽  
Rachael Da Cunha ◽  
Elizabeth Cody ◽  
Carolyn Sofka ◽  
...  
Keyword(s):  
Proximal Phalanx ◽  
Elevation Angle ◽  
Hallux Rigidus ◽  
Intrarater Reliability ◽  
First Metatarsal ◽  
Radiographic Measurements ◽  
Significant Difference ◽  
And Control ◽  
The Relationship ◽  
Research Assistants

Category: Midfoot/Forefoot Introduction/Purpose: While Metatarsus Primus Elevatus (MPE) has been implicated in the development of hallux rigidus, previous studies have presented conflicting findings regarding the relationship between an elevated first metatarsal and arthritis. This may be due to the variety of definitions for MPE and the radiographic measurement techniques that are used to assess it. The aim of this study was to examine the reliability of new radiographic measurements that take into account the elevation of the first metatarsal in relation to the proximal phalanx, rather than in relation to the second metatarsal as previously described, to assess for MPE. In addition, we aimed to determine whether the elevation of the first metatarsal was significantly different in hallux rigidus patients than in a control population. Methods: A retrospective chart review was conducted from prospectively collected registry data at the investigators’ institution to identify patients with hallux rigidus (n=65). A size matched control cohort of patients without evidence for first metatarsophalangeal (MTP) joint arthritis were identified (n=65). Patients with a previous history of foot surgery, rheumatoid arthritis, or hallux valgus were excluded. Five blinded raters of varying levels of training, including two research assistants, a senior orthopedic resident, a foot & ankle fellow, and an attending radiologist, evaluated seven radiographic measurements for their reliability in assessing for MPE in hallux rigidus and control groups. Four of the seven measurements were newly designed taking into account the relationship of the first MTP joint. Inter- and intrarater reliability were calculated using Intraclass Correlation Coefficients (ICC) and categorized by Landis and Koch reliability thresholds. The measurements between the hallux rigidus and control populations were compared using an independent t-test. Results: Six of the seven radiographic measurements were found to have substantial to almost perfect interrater reliability (ICC=0.800 to 0.953) between all levels of training, except for the Proximal Phalanx-First Metatarsal Angle which showed moderate reliability (ICC=0.527) (Table). Substantial to almost perfect intrarater reliability (ICC=0.710-0.980) was demonstrated by the research assistants. Six of the seven measurements taken by the attending radiologist demonstrated significant differences in first metatarsal elevation between the hallux rigidus and control populations with the hallux rigidus group showing increased elevation (p=0.000-0.020). Only the First Metatarsal Elevation Angle failed to show a significant difference between the populations (p=0.368). However, the First Metatarsal Elevation Angle measurements of the research assistant and the senior orthopedic resident did show a significant difference between the two populations (p<0.050). Conclusion: This study confirmed the reliability of seven radiographic measurements used to assess for MPE, including three previously established and four newly described measurements. Observers across all levels of training were able to demonstrate reliable measurements. In addition, the measurements were used to show that hallux rigidus patients are more likely to have an elevated first metatarsal compared to patients without radiographic evidence for first MTP arthritis. These measurements could be used in future work to examine how the presence of MPE relates to the etiology and progression of hallux rigidus, and how it affects the results of operative treatment.

Proximal Phalanx Hemiarthroplasty for the Treatment of Advanced Hallux Rigidus

2015 ◽  
Vol 20 (3) ◽  
pp. 503-512 ◽  
Author(s):  
Connor Delman ◽  
Chris Kreulen ◽  
Martin Sullivan ◽  
Eric Giza
Keyword(s):  
Proximal Phalanx ◽  
Hallux Rigidus

The Effects of Cheilectomy on Dorsiflexion of the First Metatarsophalangeal Joint

1997 ◽  
Vol 18 (12) ◽  
pp. 803-808 ◽  
Author(s):  
William A. Heller ◽  
Michael E. Brage
Keyword(s):  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
Surface Velocity ◽  
First Metatarsophalangeal Joint ◽  
Motion Patterns ◽  
Custom Made ◽  
Fresh Frozen ◽  
End Stage

Our purpose in this study was to determine the effects of cheilectomy on the mechanics of dorsiflexion of the first metatarsophalangeal (MTP) joint. Ten fresh-frozen cadaver feet were utilized, of which two demonstrated radiographic evidence of hallux rigidus. Each specimen was rigidly mounted on a custom-made slide tray that was articulated with a hinge mechanism designed to dorsiflex the first MTP joint. Range-of-motion measurements were made on the first MTP joint. Cheilectomy of 30% of the metatarsal head diameter was performed. Lateral radiographs with the beam centered on the MTP joint were taken with the joint at neutral, 20°, 40°, and at the limits of dorsiflexion. This process was repeated after a 50% cheilectomy was performed. The radiographs were examined for changes in joint congruence and in patterns of surface motion as the hallux moved from neutral to full dorsiflexion. Instant centers of rotation were determined by a method first described by Rouleaux. We constructed surface velocity vectors to describe patterns of motion of the first MTP joint. The mean dorsiflexion of the first MTP joint was 67.9° and increased to 78.3° after 30% cheilectomy. The increase in dorsiflexion was significantly greater in the two specimens with hallux rigidus (33%) than in the other specimens (12.1%). After both levels of cheilectomy, the proximal phalanx demonstrated pivoting at the resection site on the metatarsal head. This pivoting resulted in abnormal motion patterns across the MTP joint. Normal sliding motion predominated in early dorsiflexion, with compression peaking at the end stage of dorsiflexion, producing jamming of the articular surfaces. Cheilectomy significantly increased dorsiflexion of the MTP joint, but resulted in abnormal motion patterns. The increase in dorsiflexion resulted from pivoting of the proximal phalanx on the metatarsal head, resulting in anomalous velocity vectors and compression across the MTP joint.

scholarly journals Comparison between Hemiarthroplasty in the First Proximal Phalanx and Keller's Arthroplasty. A Finite Element Study

2018 ◽  
Vol 6 ◽  
Author(s):  
Mario Alberto Madrid Pérez ◽  
Javier Bayod López
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Hallux Rigidus ◽  
Element Analysis ◽  
Finite Element Study ◽  
First Ray ◽  
Element Study

Hallux valgus and hallux rigidus are the most common pathologies in the first ray of the foot. Arthroplasty can restore the mobility of the joint but is a destructive procedure. This paper presents three finite element analysis of the foot studying two different kinds of arthroplasty.

scholarly journals Reverse reaming distraction for acetabular reconstruction of chronic pelvic discontinuity

2020 ◽  
Author(s):  
Jing-yang Sun ◽  
Ming Ni ◽  
Hai-yang Ma ◽  
Yin-qiao Du ◽  
Jun-min Shen ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Vertical Direction ◽  
Harris Hip Score ◽  
Abduction Angle ◽  
Acetabular Reconstruction ◽  
Pelvic Discontinuity ◽  
Long Term Prognosis ◽  
Postoperative Dislocation ◽  
Component Loosening

Abstract Background: The acetabular distraction technique demonstrates encouraging radiographic and clinical outcomes in treating chronic pelvic discontinuity. The aim of this study is to describe a modified distraction technique and to show our results. Methods: This study identified 12 cases of chronic pelvic discontinuity undergoing primary or revision total hip arthroplasty (THA) with the technique of reverse reaming distraction between July 2015 and November 2018. All 12 patients had a minimum follow-up of 12 months. Radiographs were reviewed to inspect for component loosening. Clinical assessment included the Harris hip score (HHS) and an ambulatory scoring system. Results: At the time of final follow-up, no patient was revised. One patient had up to 1 cm migration of the cup in a horizontal or vertical direction and more than 20° change in the abduction angle but was asymptomatic. In the remaining 11 patients, no migration of the component was detected. Both the HHS and ambulatory score showed improvement in all patients. There were no perioperative complications. No postoperative dislocation occurred. Conclusions: Reverse reaming distraction is a feasible technique in treatment of chronic pelvic discontinuity, with encouraging results at early-term. However, ongoing follow-up is required to determine the long-term prognosis in patients receiving this technique.

scholarly journals Reverse reaming distraction for acetabular reconstruction of chronic pelvic discontinuity

2020 ◽  
Author(s):  
Jing-yang Sun ◽  
Ming Ni ◽  
Hai-yang Ma ◽  
Yin-qiao Du ◽  
Jun-min Shen ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Vertical Direction ◽  
Porous Metal ◽  
Harris Hip Score ◽  
Abduction Angle ◽  
Acetabular Reconstruction ◽  
Pelvic Discontinuity ◽  
Postoperative Dislocation ◽  
Component Loosening ◽  
Minimum Followup

Abstract Introduction The acetabular distraction technique demonstrates encouraging radiographic and clinical outcomes in treating chronic pelvic discontinuity. The aim of this study is to describe a modified distraction technique and to show our results. Methods This study identified 12 cases of chronic pelvic discontinuity undergoing primary or revision total hip arthroplasty (THA) with the technique of reverse reaming distraction between July 2015 and November 2018. All 12 patients had a minimum followup of 12 months. Radiographs were reviewed to inspect for component loosening. Clinical assessment included the Harris hip score (HHS) and an ambulatory scoring system. Results At the time of final follow-up, no patient was revised. One patient had up to 1 cm migration of the cup in a horizontal or vertical direction and more than 20° change in the abduction angle but was asymptomatic. In the remaining 11 patients, no migration of the component was detected. Both the HHS and ambulatory score showed improvement in all patients. There were no perioperative complications. No postoperative dislocation occured. Conclusions Reverse reaming distraction is a feasible technique in treatment of chronic pelvic discontinuity. Sometimes it can work with the aid of augment or cup-cage construct. When both the superior and inferior portions of the pelvis achieve osteointegration into the porous metal cup, a long-term durability can be expected.

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