Arthrodesis of the First Metatarsophalangeal Joint

2012 ◽  
Vol 102 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Kalpesh Shah ◽  
Angelica Augustine ◽  
Robert Carter ◽  
Angus McFadyen
Keyword(s):  
Interobserver Reliability ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
First Metatarsophalangeal Joint ◽  
Lag Screw ◽  
Fixation Group ◽  
Joint Fusion ◽  
Bone Fragments ◽  
The Mean ◽  
Mean Time

Background: There are cadaveric and biomechanical studies comparing different methods of fixation for achieving arthrodesis in hallux rigidus. However, there are no comparative clinical studies. We compared the clinical and radiologic outcomes of first metatarsophalangeal joint fusion using three different techniques: lag screw, lag screw and circlage wire, and Memory staples. Methods: This was a retrospective study of 46 patients who underwent first metatarsophalangeal joint fusion. All of the operations were performed by experienced surgeons. Each patient had clinical and radiologic assessments postoperatively. Results: The three groups were matching in terms of demographic features and comorbidity. Intraobserver and interobserver reliability for radiographic metatarsophalangeal joint fusion was excellent. The mean time to clinical and radiologic union in the Memory staples group was earlier (7.6 weeks) than that of the other two techniques (8.0 and 8.1 weeks). The Memory staples group also had the lowest incidence of nonunion (1 of 15 compared with 4 of 15 in the single lag screw fixation group and 3 of 16 in the lag screw and circlage wire fixation group) and no hardware-related problems. Conclusions: Our experience corroborates the advantages of Memory staples as described in the literature, including good approximation of bone fragments, technically easy application with fewer steps than an AO-applied screw, and an adequate source of internal fixation to achieve metatarsophalangeal joint fusion. There is also a suggestion that the time to achieve fusion is shorter. (J Am Podiatr Med Assoc 102(1): 13-17, 2012)

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.

scholarly journals TL 18237 - First metatarsophalangeal joint arthrodesis using a minimally invasive technique

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 112S
Author(s):  
Luiz Carlos Ribeiro Lara ◽  
Lúcio Carlos Torres ◽  
Gabriel Cervone ◽  
Juan Antonio Grajales ◽  
Fabio Lemos Rodrigues
Keyword(s):  
Minimally Invasive ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Percutaneous Technique ◽  
First Metatarsophalangeal Joint ◽  
The Mean ◽  
Larger Sample

Introduction: Metatarsophalangeal joint arthrodesis (MTPA) is a surgical technique indicated for the treatment of hallux rigidus with advanced arthrosis and for rheumatic diseases. This classic surgery is widely used and effective; however, the use of a minimally invasive technique remains mostly unknown. Objective: To present the outcome of MTPA performed using a percutaneous technique. Methods: Hallux MTPA was performed in 8 feet from 4 patients with hallux rigidus and 4 with rheumatoid arthritis, with a higher prevalence of women than men (5 vs. 3) and a mean postoperative follow-up time of 1.5 years. The outcomes were evaluated using a modified version of the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire and the union time. Results: All patients who underwent surgery showed improvements in pain and arthrodesis union at approximately 8 weeks. The mean AOFAS score increased to 85 points (of a total of 90 possible points). There were no complications, such as infection, nonunion or persistent pain. Conclusion: The percutaneous technique of hallux MTPA was effective, with satisfactory outcomes, reduced surgical invasiveness, immediate walking, rapid union with “arthrodesis take” and significant improvement in pain. However, a larger sample is required to confirm the outcomes.

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 Consumer Prices for Surgical Management of End-Stage Hallux Rigidus

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0007
Author(s):  
Niall A. Smyth ◽  
Vaishnavi Krishnan ◽  
Johnathon R. McCormick ◽  
Jonathan R. Kaplan ◽  
Amiethab A. Aiyer
Keyword(s):  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Treatment Modalities ◽  
Potential Cost ◽  
First Metatarsophalangeal Joint ◽  
Consumer Prices ◽  
Wide Range ◽  
Significant Difference ◽  
The Mean ◽  
End Stage

Category: Midfoot/Forefoot, Healthcare economics Introduction/Purpose: Hallux rigidus is the most prevalent arthritic condition of the foot. Treatment of end-stage disease traditionally consists of a first metatarsophalangeal joint (MTPJ) arthrodesis, however the use of a synthetic cartilage implant is becoming more common. With the high prevalence of disease and implementation of new treatment modalities, healthcare consumers should be aware of the costs associated with management. The purpose of this study was to determine access to the cost and variability in price of first MTPJ arthrodesis and synthetic cartilage implantation. Methods: Forty academic centers were contacted using a standardized patient script. The patient was a 59-year-old female who had failed conservative treatment of hallux rigidus. Each institution was contacted up to three times in an attempt to obtain a full bundled operative quote for a first MTPJ arthrodesis and synthetic cartilage implantation. Results: Twenty centers (50%) provided a quote for first MTPJ arthrodesis and 15 centers (38%) provided a quote for synthetic cartilage implantation. Only 14 centers (35%) were able to provide a quote for both procedures. The mean bundled price for MTPJ arthrodesis was $21,767 (range, $8,417 – $39,265). The mean bundled price for synthetic cartilage implantation was $21,546 (range, $4,903 – $74,145). There was no statistically significant difference between the bundled price for first MTPJ arthrodesis and synthetic cartilage implantation. Conclusion: There was limited availability of consumer prices for first MTPJ arthrodesis and synthetic implantation, therefore impeding healthcare consumers’ decision making. There was a wide range of quotes for both procedures, indicating potential cost savings.

First Metatarsophalangeal Joint Arthrodesis Using Memory Staples: Clinical and Functional Results

2020 ◽  
pp. 193864002092157
Author(s):  
Sudhakar Rao Challagundla ◽  
Roshin Thomas ◽  
Rupert Ferdinand ◽  
Evan Crane
Keyword(s):  
Metatarsophalangeal Joint ◽  
Functional Results ◽  
Hallux Rigidus ◽  
Union Rate ◽  
First Metatarsophalangeal Joint ◽  
Patient Satisfaction Scores ◽  
Extensor Hallucis Longus ◽  
The Mean ◽  
Ability Measure

Background. We present clinical and functional results of first metatarsophalangeal joint (MTPJ) arthrodesis using Memory staples. Methods. This retrospective observational study reviewed MTPJ arthrodesis with Memory staples from 2012 to 2016. Results. The mean age of 50 patients (55 feet) was 63 years (range 41-77 years). Forty-one feet were in women. Indication was hallux rigidus (n = 49) and hallux valgus (n = 6). The overall union rate was 98.2% (n = 54 of 55), including delayed healing in 3 (5.5%). The average time to union was 12 weeks. At a mean follow-up of 38 months (range 12-73 months), the mean Foot and Ankle Ability Measure score (47 out of 55, 86% response rate) was 87% (interquartile range 78%-100%). Complications included partial laceration of extensor hallucis longus (n = 1), wound infection (n = 4), wound-related (n = 2), lesser metatarsalgia (n = 3), cock up deformity (n = 1), and pain (n = 3). Conclusions. The high union rate, good patient satisfaction scores, and low rate of complications support our use of Memory staples. Levels of Evidence: Therapeutic, Level IV

scholarly journals Percutaneous First Metatarsophalangeal Joint Fusion

2017 ◽  
Vol 11 (1) ◽  
pp. 724-731 ◽  
Author(s):  
Thomas Bauer
Keyword(s):  
Simple Procedure ◽  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Full Weight Bearing ◽  
Normal Walking ◽  
First Metatarsophalangeal Joint ◽  
Joint Fusion ◽  
Forefoot Surgery ◽  
First Ray

The first metatarsophalangeal (MTP1) joint fusion is a very useful procedure in forefoot surgery and is still the gold standard for the treatment of severe and painful hallux rigidus. Normal walking and running are possible after MTP1 fusion, the first ray mobility being essentially in the interphalangeal (IP) joint with a compensatory hypermobility in dorsal flexion. Percutaneous MTP1 fusion is a simple procedure providing comparable results to fusions performed with open techniques. Postoperative cares are simplified with an immediate full weight bearing on rigid flat shoes and quick return to normal walking. Bone preparation is an important step and requires an experience in percutaneous forefoot surgery. Arthrodesis positioning and fixation with this percutaneous procedure are simple with possibility of clinical and radiological control. The indications for percutaneous MTP1 fusion are very large and only severe bone loss or osteoporosis represent the limits for this technique.

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.

Non-Constrained Titanium-Polyethylene Total Endoprosthesis in the Treatment of Hallux Rigidus

2002 ◽  
Vol 91 (2) ◽  
pp. 202-207 ◽  
Author(s):  
P. Ess ◽  
M. Hämäläinen ◽  
J. Leppilahti
Keyword(s):  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
First Metatarsophalangeal Joint ◽  
Total Arthroplasty ◽  
Total Endoprosthesis ◽  
Superficial Wound ◽  
The Mean ◽  
American Orthopaedic ◽  
Valgus Alignment

Background and Aims: To evaluate the outcome in a prospective 2-year follow-up study of a non-constrained titanium-polyethylene total endoprosthesis (ReFlexion®) in the treatment of hallux rigidus. Material and Methods: Ten patients with painful hallux rigidus were treated with non-constrained titanium-polyethylene total endoprosthesis (ReFlexion®). The American Orthopaedic Foot and Ankle Society (AOFAS) scoring was used preoperatively and at follow-up. Results: At 2-year follow-up, the AOFAS scoring showed 5 instances of excellent, 1 of good, 2 of fair, and 2 of poor outcome. Eight patient were subjectively satisfied and dissatisfied. Five of the patients were painless, 4 had mild, occasional pain, and 1 had moderate, daily pain in the first metatarsophalangeal joint. The mean VAS was 7.6 (SD 2.0) preoperatively and 1.1 (SD 1.4) at 2-year follow-up (p < 0.001). Extension increased by a mean of 25 (13–38) degrees and flexion by a mean of 15 (2–35) degrees (p < 0.001). Eight patients had no activity limitations, while 1 had mild and 1 moderate limitations. Alignment of the metatarsophalangeal joint was good in 7 cases, but some degree of valgus malalignment was seen in 2 and symptomatic malalignment in 1. Complications included one subluxation of a prosthesis, one recurrence of severe valgus alignment and one superficial wound infection. Radiological loosening of one cementless phalangeal component was seen at follow-up. Conclusion: The non-constrained titanium-polyethylene total arthroplasty gave satisfactory 2-year outcome in 60 % of the patients. It is an alternative treatment for hallux rigidus in low demand patients. We do not recommended it for athletes and young people, because high forces acting on the prosthesis may cause a failure.

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.

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