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Duff JR, Alecxih AG, White CC, Doty JF. Minimally Invasive First Metatarsophalangeal Joint Arthrodesis With a Low-Profile Hybrid Locking Plate and a Beveled Compression Screw: A Surgical Technique. Foot Ankle Spec 2025:19386400251331648. [PMID: 40219862 DOI: 10.1177/19386400251331648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2025]
Abstract
Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a valuable intervention for a variety of hallux pathologies and is still considered the gold standard treatment for advanced hallux rigidus, one of the most commonly encountered pathologies of the forefoot. With the advent and expansion of minimally invasive surgery (MIS) techniques, MIS First MTPJ arthrodesis offers a new approach to treat hallux conditions with the potential to limit complications and further enhance patient satisfaction. We describe a technique that affords the benefits of MIS surgery without compromising the biomechanical superiority of a dorsal hybrid low-profile plate with a beveled, partially threaded compression screw.Level of Evidence: Therapeutic, Level V: Technique article.
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Affiliation(s)
- Joseph R Duff
- Department of Orthopaedic Surgery, College of Medicine-Chattanooga, University of Tennessee, Chattanooga, TN, USA
| | - Austin G Alecxih
- Department of Orthopaedic Surgery, College of Medicine-Chattanooga, University of Tennessee, Chattanooga, TN, USA
| | - Charles C White
- Department of Orthopaedic Surgery, College of Medicine-Chattanooga, University of Tennessee, Chattanooga, TN, USA
| | - Jesse F Doty
- Department of Orthopaedic Surgery, College of Medicine-Chattanooga, University of Tennessee, Chattanooga, TN, USA
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Maor D, Meyerkort D, Sobhi S, Calder J. Return to sport after first metatarsophalangeal arthrodesis in elite athletes. J ISAKOS 2025; 11:100390. [PMID: 39826803 DOI: 10.1016/j.jisako.2025.100390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 01/12/2025] [Accepted: 01/13/2025] [Indexed: 01/22/2025]
Abstract
INTRODUCTION Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a reliable procedure in alleviating pain and restoring function. However, there is limited published literature of the outcomes of this procedure and the ability to return to sport in elite athletes. This study aims to assess the outcomes of first MTPJ arthrodesis in the elite athlete population and their ability to return to professional sport. METHODS A single-center prospective case series of elite athletes undergoing first MTPJ arthrodesis between 2004 and 2016 was conducted. Patients were assessed a minimum of 2, 6, 12 weeks, and 1-year postoperation and at the final follow-up. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and visual analogue scale (VAS) scores and assessing satisfaction. RESULTS Sixteen elite athletes with a mean age of 27 years (range 19-32, 81 %) and mean follow-up of 81 months (range 60-121 months) were included. At 1-year postoperation, 12 (75 %) athletes returned to their original level of sport. Of the four unable to return, two soccer players dropped a division, an ATP tennis player never regained his original ranking, and a badminton player was unable to return to the same level of competition. Mean VAS scores improved from preoperation to final follow-up (5.6-0.4, p < 0.001). All FAOS subscores showed significant improvement from preoperation to final follow-up (all p < 0.05). All (100 %) athletes were either very satisfied or satisfied at final follow-up. CONCLUSION To our knowledge, this is the first study investigating return to elite level sport post first MTPJ arthrodesis. Our results confirm that a significant majority will return to their elite level of sport post operatively. Improved clinical outcomes and pain reduction was achieved in all patients. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Dror Maor
- Fortius Clinic, London, United Kingdom; Academic Centre for Evidence-Based Orthopaedics & Sports Medicine, Perth, Western Australia, Australia; Department of Orthopaedics, Fremantle Hospital, Perth, Western Australia, Australia
| | - Daniel Meyerkort
- Fortius Clinic, London, United Kingdom; Department of Orthopaedics, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Salar Sobhi
- Department of Orthopaedics, Fremantle Hospital, Perth, Western Australia, Australia.
| | - James Calder
- Fortius Clinic, London, United Kingdom; Department of Bioengineering, Imperial College, London, United Kingdom
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Thong YJ, Davies BM, Bedi H. Return to activities in younger individuals (<60 yrs) undergoing first metatarsophalangeal joint arthrodesis. J Foot Ankle Surg 2025; 64:192-196. [PMID: 39433210 DOI: 10.1053/j.jfas.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 05/03/2024] [Accepted: 10/05/2024] [Indexed: 10/23/2024]
Abstract
Arthrodesis is a common procedure in the treatment of forefoot conditions affecting the first metatarsophalangeal (MTP) joint. Although this procedure has been shown to significantly improve individuals' activities of daily living and effectively relieve pain, there is a lack of research specifically investigating younger patients below 60 yrs of age wishing to return to sports. Our aim is to evaluate their ability to return to sports after 1st MTP joint arthrodesis. A retrospective analysis of clinical records of 159 patient that had undergone first MTP arthrodesis performed by a single surgeon was undertaken to determine pre- and postoperative sf-FAOS and sporting activity scores. The Tobit constant censoring limit model was used to analyze change in sf-FAOS scores. After the application of inclusion and exclusion criteria, 58 patients (median age 54 years, range 30 - 59) were included in the final cohort with a mean follow up of 5.3 years (range 2.0 to 9.44, SD 2.10). There was a significant improvement in the mean pain score (p<0.001), as well as an improvement in the mean function score (p<0.001). The number of hours spent in sporting activities per week were significantly higher (p<0.001) post-surgery (5.29 hours, SD 5.0) in comparison to preoperative levels (4.26 hours, SD 3.1). There was no significant change in the intensity of sporting activities (p=0.176). First MTP joint arthrodesis remains a good treatment option for younger individuals wishing to achieve a satisfactory return to sports.
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Affiliation(s)
| | - Benjamin Michael Davies
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom; OrthoSport Victoria, Epworth Richmond, Level 5, 89 Bridge Road, Richmond, VIC 3121, Australia.
| | - Harvinder Bedi
- OrthoSport Victoria, Epworth Richmond, Level 5, 89 Bridge Road, Richmond, VIC 3121, Australia; Monash University, VIC, Australia
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Lim B, Jassim S, Kilkenny C, Lyons F, Shaalan M. Crossed screws versus plating supplemented with an interfragmentary screw in first metatarsophalangeal joint fusion: A systematic review and meta-analysis. J Foot Ankle Surg 2025:309-317. [PMID: 39864491 DOI: 10.1053/j.jfas.2025.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 11/26/2024] [Accepted: 01/18/2025] [Indexed: 01/28/2025]
Abstract
First metatarsophalangeal joint (MTPJ) fusion is an effective surgical intervention for conditions such as hallux valgus and hallux rigidus. This systematic review and meta-analysis aims to compare the safety and efficacy of crossed screws versus plating supplemented with an interfragmentary screw. A literature search of the Scopus, Embase, Web of Science, and MEDLINE databases was performed to identify all studies directly comparing the two techniques. Meta-analysis was carried out using RevMan Web. Nine studies with 976 patients (1,035 toes in total, 512 toes in the crossed screws group, and 523 toes in the plate supplemented with screws group) were included. There was no significant difference in union rates (OR=0.75, CI 0.45 - 1.27, p = 0.29), overall complication rates (OR = 1.13, CI = 0.71 - 1.77, p = 0.61), superficial complications, (OR = 0.41, CI = 0.10 - 1.68, p = 0.22), revision surgery (OR = 1.92, CI 0.81 - 4.57, p = 0.14), hardware removal (OR = 1.07, CI = 0.55 - 2.08, p = 0.85), and malunion (OR = 1.63, CI 0.27 - 10.00, p = 0.60). Plate and screws had a significantly shorter time to fusion than crossed screws (MD = 0.51, CI = 0.10 - 0.92, p = 0.02). No significant difference was noted in patient-reported outcome measures or in postoperative hallux valgus, intermetatarsal, and lateral metatarsophalangeal angles. Other potential factors that should influence the decision to use one technique over the other include the indication for MTPJ fusion, the patient's bone quality, and the differing costs of surgery.
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Affiliation(s)
- Brandon Lim
- Department of General Medicine, Changi General Hospital, Singapore, Singapore.
| | - Samher Jassim
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Conor Kilkenny
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Frank Lyons
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Mohamed Shaalan
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
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Minelli M, deMeireles AJ, Marciano GF, Chien BY, Malempati M, Vulcano E. Percutaneous hallux fusion with calcaneus bone autograft: a retrospective cohort study of clinical and radiographic outcomes. Arch Orthop Trauma Surg 2025; 145:123. [PMID: 39797994 DOI: 10.1007/s00402-024-05613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 11/18/2024] [Indexed: 01/13/2025]
Abstract
BACKGROUND In the case of end-stage hallux rigidus, first metatarsophalangeal (MTP) joint arthrodesis is the gold-standard and is traditionally performed via an open approach. However, complications such as nonunion have been reported to be as high as 30%. Recently, there have been reports demonstrating a percutaneous approach to be effective and safe. METHODS Forty-nine patients with end-stage hallux rigidus underwent percutaneous first MTP joint arthrodesis with calcaneus autograft performed by a single surgeon. Each patient underwent a minimum of 24 month clinical and radiographic follow up, including 3 month post operative computed tomography scans. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Foot Function Index (FFI) preoperatively and at final follow-up. RESULTS Mean follow-up was 27.3 months. Bone union was observed in 46 patients (93.9%). Mean time to union was 3.1 months. Nonunion rate was 6.1%. Overall complication rate was 12.2%. Mean pre- and postoperative VAS scores were 7.5 and 0.2, respectively (P < .0001). Mean pre- and postoperative total FFI values were 56.3 and 15.7 (P < .0001), respectively. Patient satisfaction after the procedure was 93.9%. CONCLUSION Observed union rate is comparable to the average fusion rate previously reported for open and minimally invasive procedure union rates. Mean time to union was observed to be comparable to open procedures union time. Observed overall complication rate is similar to those reported for open techniques as well. Patient reported outcomes demonstrated a significant reduction in postoperative VAS and FFI for the percutaneous metatarsophalangeal arthrodesis with calcaneus bone autograft. Patient satisfaction rates compared favorably to those reported following open surgery. LEVEL OF EVIDENCE LEVEL IV
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Affiliation(s)
- Marco Minelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Alirio J deMeireles
- Department of Orthopedic Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, 622 West 168Th Street, PH 11 - 1102, New York, NY, 10032-3720, USA
| | - Gerard F Marciano
- Department of Orthopedic Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, 622 West 168Th Street, PH 11 - 1102, New York, NY, 10032-3720, USA
| | - Bonnie Y Chien
- Department of Orthopedic Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, 622 West 168Th Street, PH 11 - 1102, New York, NY, 10032-3720, USA
| | - Mahant Malempati
- Department of Orthopedic Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, 622 West 168Th Street, PH 11 - 1102, New York, NY, 10032-3720, USA
| | - Ettore Vulcano
- Department of Orthopedic Surgery, Columbia University Orthopedics at Mount Sinai Medical Center, 4302 Alton Road, Suite 220, Miami Beach, FL, 33140, USA.
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Everitt RS, Jose R, Yaseen I. An anatomical feasibility study using the first metatarsal head as a vascularized bone graft for proximal pole of scaphoid reconstruction. J Hand Surg Eur Vol 2025; 50:120-121. [PMID: 38833541 DOI: 10.1177/17531934241256792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
A cadaveric study showed that vascularized transfer of the articular surface of the ipsilateral first metatarsal head with the lateral collateral ligament could be suitable for reconstruction of the proximal pole of scaphoid and scapholunate ligament. Further study of the technique is recommended.
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Sakai S, Fujiwara T, Yamaguchi R, Yokoyama N, Hara D, Akasaki Y, Nakashima Y. First Metatarsophalangeal Joint-Preserving Surgery Is Effective for Forefoot Deformity With Moderate to Severe Joint Destruction in Rheumatoid Arthritis. FOOT & ANKLE ORTHOPAEDICS 2025; 10:24730114251322790. [PMID: 40013106 PMCID: PMC11863219 DOI: 10.1177/24730114251322790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2025] Open
Abstract
Background The study compares the clinical outcomes of first metatarsophalangeal (MTP) joint fusion vs joint-preserving surgery in rheumatoid arthritis (RA) patients with severe forefoot deformities. Methods This single-center retrospective study at Kyushu University Hospital reviewed RA patients who underwent either first MTP joint arthrodesis or joint-preserving surgery for hallux valgus (HV) deformity between January 2008 and December 2022. A total of 103 feet (73 cases) were analyzed, with 75 feet (58 cases) showing radiographic bone destruction of Larsen grade 3 or higher. One foot underwent resection arthroplasty, so ultimately 74 feet in 57 cases were evaluated. Surgical procedures included joint-preserving biplane osteotomy or arthrodesis with crossed screws. Clinical outcomes were measured using the Japanese Society for Surgery of the Foot (JSSF) Hallux scale, whereas radiographic assessments included HV angle (HVA). Propensity score matching was used to minimize bias when comparing postoperative outcomes between the arthrodesis and joint-preserving surgery groups. Results This study analyzed 74 feet undergoing either arthrodesis (27 feet) or joint-preserving surgery (47 feet) for HV. Patients in the 2 groups showed similar demographic and clinical characteristics except with respect to length of follow-up, which was greater in the arthrodesis group (5.1 ± 2.6 years vs 2.4 ± 2.0 years, P < .01) than the joint-preserving group. In the arthrodesis group, all patients underwent resection arthroplasty on the second to fifth toes. The joint-preserving group included first MTP joint surgery alone (n = 5) and first MTP joint and lesser MTP joint surgeries (resection arthroplasty, n = 29; joint-preserving surgery, n = 13). Functional scores significantly improved in both groups, with first metatarsophalangeal joint-preserving surgery yielding better postoperative outcomes. In cases of deformity recurrence, the recurrent cases exhibited greater immediate postsurgical HVA, but other foot function outcomes remained similar at the end of follow-up. Conclusion Joint-preserving surgery for advanced rheumatoid forefoot deformity showed better functional improvement than arthrodesis using the propensity score matching and comparable clinical outcomes, highlighting it as a potential treatment option for severe joint destruction. Level of Evidence Level Ⅳ, retrospective study.
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Affiliation(s)
- Soichiro Sakai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshifumi Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuhiko Yokoyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Hara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Agrawal S, Sridhar S, Harrison M, Houchen-Wolloff L, Divall P, Mangwani J. Effect of co-morbidities on outcomes of first metatarsophalangeal joint fusion: A systematic review. J Orthop 2024; 58:29-34. [PMID: 39040136 PMCID: PMC11260351 DOI: 10.1016/j.jor.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 06/22/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction The pre-existing co-morbidities have a major impact on the outcomes of Orthopaedic procedures as shown by the several studied in various contexts. However, the specific influence of these co-morbidities on first metatarsophalangeal joint fusion remains relatively underexplored. This study aims to address this gap by examining the association between co-morbidities such as obesity, smoking, diabetes, advancing age, and rheumatoid arthritis, and the outcomes of first metatarsophalangeal joint fusion. Methods A comprehensive search was conducted across multiple databases, including MEDLINE, EMBASE, and CINAHL. Relevant articles were identified and processed using Covidence, with independent assessment conducted to ensure inclusion criteria were met. The focus of the review was on analysing the effects of specific co-morbidities on fusion outcomes. Results Seven qualifying studies were identified for full-text extraction, revealing significant heterogeneity across the literature, which hindered direct statistical comparisons. The findings presented inconclusive effects of obesity on fusion outcomes, with ambiguous impacts observed for diabetes mellitus and smoking. Additionally, no discernible variance was observed in functional outcomes across different age groups. Furthermore, steroid usage in rheumatoid arthritis cases demonstrated delayed fusion in revision procedures, while primary outcomes remained uncertain. Conclusion This systematic review highlights the need for further research with standardised methodologies to better understand the correlation between pre-existing co-morbidities and outcomes in first metatarsophalangeal joint fusion. By elucidating these relationships, clinicians can better tailor treatment approaches and optimise patient care in this specific Orthopaedic context. Level of evidence Level III.
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Affiliation(s)
- Somen Agrawal
- Department of Orthopaedic Surgery University Hospital Coventry and Warwickshire, Clifford Bridge Rd, Coventry, CV2 2DX, United Kingdom
| | - Sumedh Sridhar
- Leicester Medical School, University Road, Leicester, LE1 7RH, United Kingdom
| | - Matt Harrison
- Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, United Kingdom
| | - Linzy Houchen-Wolloff
- Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, United Kingdom
| | - Pip Divall
- University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, United Kingdom
| | - Jitendra Mangwani
- Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, United Kingdom
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Semelsberger SD, Lee MS, Dobson CB, Miller CP, Gianakos AL. Modern Treatment of Hallux Rigidus by Cheilectomy: A Systematic Review of Patient-Reported Outcomes in Minimally Invasive Techniques. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241303169. [PMID: 39698377 PMCID: PMC11653460 DOI: 10.1177/24730114241303169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2024] Open
Abstract
Background Minimally invasive cheilectomy is becoming a more prominent surgical approach in the management of mild to moderate hallux rigidus. This systematic review aims to analyze and present the current literature on patient-reported outcomes following minimally invasive (MIS) cheilectomy for mild to moderate hallux rigidus. Methods PubMed, Cochrane Central Register of Controlled Trials, and Scopus databases were searched in April 2024. Inclusion criteria consisted of articles evaluating patients undergoing cheilectomy through an MIS approach either using fluoroscopy or arthroscopy, studies that reported patient-reported outcomes, and studies written in English. The primary outcome measure was scored patient-reported outcomes. The secondary outcome measures included complications, secondary surgeries, surgical techniques, return to activity, patient satisfaction, and grades of hallux rigidus. Results Eight studies met the inclusion criteria, and a total of 296 patients were evaluated. Overall, 36 of 296 (12.2%) underwent arthroscopy with a shaver, 130 of 296 (43.9%) underwent an MIS percutaneous approach with burr, and 130 of 296 (43.9%) had a combination of both techniques. The mean reported range of motion (dorsiflexion) improved from 32.4 degrees (range, 6.3-50.0 degrees) to 61.2 degrees (range, 47.6-89.6 degrees). All studies that reported patient outcomes scores demonstrated improved outcomes regardless of surgical technique. Overall combined reported complication rate was 18 of 296 (6.1%), with the most common complication being dorsomedial cutaneous nerve problems, affecting 6 of 296 patients (2.0%). Conclusion Minimally invasive cheilectomy results in positive patient outcomes, patient satisfaction, preserves range of motion, and has low complication rates for the treatment of mild to moderate hallux rigidus.
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Affiliation(s)
- Scott D. Semelsberger
- Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Michael S. Lee
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cale B. Dobson
- Department of Orthopaedic Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Christopher P. Miller
- Department of Orthopaedic Surgery, Harvard-Brigham and Women’s Hospital, Boston, MA, USA
| | - Arianna L. Gianakos
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Acker AS, Liles J, Easley ME. Arthrodesis for Hallux Rigidus. Foot Ankle Clin 2024; 29:507-520. [PMID: 39068025 DOI: 10.1016/j.fcl.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
First metatarsophalangeal (MTP) joint fusion, or arthrodesis, has been a cornerstone treatment for advanced joint degeneration since the 1950s, benefiting not only older patients but also younger individuals. The procedure boasts favorable long-term outcomes and a low rate of revision when fusion is successful. However, complications such as interphalangeal arthritis may occur, and nonunion or malunion can necessitate revision. While the first MTP fusion provides significant relief, its applicability varies, underscoring the need for careful patient selection.
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Affiliation(s)
- Antoine S Acker
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA; Centre of Foot and Ankle Surgery, Clinique La Colline, Geneva, Switzerland.
| | - Jeffrey Liles
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Curran MG, Feeney KM, Murphy EP, Faustino ASC, Kearns SR. Bilateral first metatarsophalangeal joint arthrodesis: An investigation of functional, surgical and radiological outcomes. Foot Ankle Surg 2024; 30:411-416. [PMID: 38458912 DOI: 10.1016/j.fas.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND First metatarsophalangeal joint (MTPJ) arthrodesis is a commonly utilised procedure. In this study, the authors aim to explore functional outcomes of patients undergoing nonsynchronous bilateral first MTPJ arthrodesis under the care of a single surgeon using a compression screw/locking plate construct. METHODS This is a prospectively collected, retrospectively analysed case series of fifty five patients who underwent bilateral nonsynchronous first MTPJ arthrodesis. Clinical and radiological outcomes were assessed preoperatively and at a minimum of two years postoperatively. Clinical outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), the Self-Reported Foot and Ankle Score (SEFAS) and the Sports Questionnaire version 1 (SQ). Postoperative radiographs were used to assess evidence of union and compare both hallux valgus and intermetatarsal angles. Removal of hardware, revision surgery and correction of deformities were also recorded. RESULTS Fifty five patients were included in the study. There was statistically significant improvements in all five facets of the FAOS (p value < 0.05). The mean postoperative SEFAS was 45.1. In total, patients participated in thirteen different sporting activities. This represented 92 patient specific activities preoperatively and 104 postoperatively. The most common activities were walking, cycling and swimming. Overall, 94.5% (N = 52) of the cohort were satisfied with their return to sport while 98.2% (N = 54) would recommend bilateral first MTPJ arthrodesis. Mean reductions in hallux valgus angles and intermetatarsal angles were noted at 18.87 and 4.69 degrees respectively. There was one non-union in the cohort which required revision surgery. One patient required removal of hardware. CONCLUSIONS Bilateral first MTPJ arthrodesis is a safe and effective surgical option for patients with bilateral first MTPJ pathology. It has a high union rate, low complication rate and significantly improves clinical outcomes and allows patients reliably return to physical activities.
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Affiliation(s)
- Michael G Curran
- Department of Orthopaedics, Bon Secours Hospital, Galway, Ireland; Department of Orthopaedics, Galway University Hospital, Galway, Ireland.
| | - Kaylem M Feeney
- Department of Orthopaedics, Bon Secours Hospital, Galway, Ireland
| | - Evelyn P Murphy
- Department of Orthopaedics, Galway University Hospital, Galway, Ireland
| | | | - Stephen R Kearns
- Department of Orthopaedics, Bon Secours Hospital, Galway, Ireland; Department of Orthopaedics, Galway University Hospital, Galway, Ireland
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12
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Akcaalan S, Kavaklilar A, Caglar C, Simsek ME, Gursoy S, Akkaya M. Long-term outcomes of first metatarsophalangeal hemiarthroplasty for hallux rigidus. Foot Ankle Surg 2024; 30:338-342. [PMID: 38395674 DOI: 10.1016/j.fas.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/13/2023] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
Hallux rigidus (HR) is arthritis of the first metatarsophalangeal joint.First metatarsophalangeal joint hemiarthroplasty surgery is one of the treatment options for end stage hallux rigidus.The aim of this study is to evaluate the long-term outcomes of hemiarthroplasty of the first MTPJ with a metallic implant in patients with end-stage HR. Patients who underwent hemiarthroplasty surgery with the diagnosis of HR were included in the study. Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and Foot and Ankle Disability Index (FADI) scores were used in pre-operative and post-operative final follow-ups to evaluate the clinical status of the patients. Post-operative 1st metatarsophalangeal joint range of motion was measured and recorded separately for each patient. The intra-hospital and follow-up complications and revision surgeries of the patients were recorded. Thirty-five patients with a mean follow-up of 8.1 years were included in the study. There was a statistically significant positive change in both FADI and SAFE-Q scores compared to the pre-operative process(p = 0.0001). The average dorsiflexion angle at the final follow-up was 22.0 ± 8.2. Thus, it was determined that the 5-year and 8-year survival rates of patients in this study were 97.1% and 87.8%, respectively. In conclusion, the long-term results show that the use of hemiarthroplasty in the treatment of end-stage HR leads to high patient satisfaction, increased range of motion and a high survival rate.
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Affiliation(s)
| | | | - Ceyhun Caglar
- Ankara City Hospital, Türkiye; Ankara Yıldırım Beyazıt University, Orthopedics and Traumatology, Department, Türkiye
| | - Mehmet Emin Simsek
- Ankara Lokman Hekim University, Orthopedics and Traumatology, Department, Türkiye
| | - Safa Gursoy
- Acibadem University, Orthopedics and Traumatology, Department, Türkiye
| | - Mustafa Akkaya
- Ankara Guven Hospital, Orthopedics and Traumatology Clinic, Ankara, Türkiye
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13
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Dayton P, Dayton M, Hatch DJ, DeCarbo WT, McAleer JP. What Do Patients Report Regarding Their Real-World Function Following Concurrent Arthrodesis of the First Tarsometatarsal and First Metatarsophalangeal Joints. J Foot Ankle Surg 2024; 63:187-193. [PMID: 37931740 DOI: 10.1053/j.jfas.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/04/2023] [Accepted: 10/28/2023] [Indexed: 11/08/2023]
Abstract
First metatarsal phalangeal joint and the first Tarsometatarsal arthrodesis have both been used for deformity correction and treatment of pain and arthritis. Concomitant arthrodesis of the first metatarsophalangeal and first tarsometatarsal joints (Double First Ray Arthrodesis) has rarely been described. We surveyed 29 patients who underwent double first-ray arthrodesis for primary or revision correction of hallux valgus. A custom questionnaire was used to assess their activities of daily living and sports activity at a mean follow-up of 19.6 months (median 18.4 months). Secondary endpoints were return to activity, deformity correction, and arthrodesis healing rate. The primary outcomes showed an excellent return to activities of daily living with 96.6% of patients capable of walking as much as they liked after surgery at a normal pace. About 96.6% reported they felt that their surgery was successful, they had no pain, and the loss of motion at the joint fusion sites did not affect their ability to perform daily activities. Protected walking in a fracture boot was initiated at a mean (SD) of 9.8 (9.9) days. Return to an athletic shoe occurred at a mean (SD) of 44.2 (11.7) days. Full unrestricted activity was at a mean (SD) of 105.2 (19.3) days with 65% of the patient group reporting that their recovery was easier than expected. There was 1 nonunion and no other complications. This data set supports the hypothesis that patients undergoing double first-ray arthrodesis can return to activities of daily living and sports with and low complication rate.
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Affiliation(s)
| | | | | | | | - Jody P McAleer
- Department of Podiatry, Jefferson City Medical Group, Jefferson City, MO
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14
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Ellis S. The Data Have Landed: You May Now Fuse the First MTP Joint in Young Patients. Foot Ankle Int 2024; 45:223-224. [PMID: 38158809 DOI: 10.1177/10711007231218005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
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Webb AR, Manz WJ, Fuqua A, Coleman MM, Bariteau JT, Kadakia RJ. Effect of Obesity on Patient-Perceived Outcomes After First Metatarsophalangeal Joint Arthrodesis. Foot Ankle Spec 2024; 17:58-66. [PMID: 36124436 DOI: 10.1177/19386400221118894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While first metatarsophalangeal joint (MTPJ) arthrodesis is a common and effective procedure, there is a paucity of studies examining obesity's effect on outcomes of 1st MTPJ arthrodesis. This study's purpose was to evaluate patient-reported outcomes following 1st MTPJ arthrodesis in obese versus non-obese patients. METHODS A retrospective cohort study of 94 patients undergoing first MTPJ fusion over the age of 18 with a diagnosis of hallux valgus or hallux rigidus was performed. Surgical and postoperative outcomes were examined preoperatively and at 6 and 12 months follow-up via Visual Analog Pain scale (VAS), and Short Form 36 (SF-36) surveys, and data were stratified into 2 patient groups: BMI < 30 (n = 62, mean age 63.9 ± 9.1 and ≥ 30 (n = 32, mean age 61.9 ± 8.4). RESULTS Average overall VAS and SF-36 physical component scores improved significantly at 6 months (P < .001, .006) and 1 year postoperative visits (P < .001, .007) with no differences in survey scores, outcomes, or complications between weight groups. CONCLUSION Our study showed first MTPJ fusion improves short-term pain and physical quality-of-life in arthritic obese and non-obese patients without differences in nonunion, complications, or patient-reported measures. LEVEL OF EVIDENCE Level III, Prognostic, Case-Control Study.
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Affiliation(s)
- Alex R Webb
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Wesley J Manz
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Andrew Fuqua
- Emory University School of Medicine, Atlanta, Georgia
| | - Michelle M Coleman
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Jason T Bariteau
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Rishin J Kadakia
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
- Department of Orthopaedics, Emory University, Atlanta, Georgia
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16
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Baumann AN, Walley KC, Kermanshahi N, Anastasio AT, Holmes JR, Walton DM, Talusan PG. Return to Sport After First Metatarsophalangeal Arthrodesis: A Systematic Review. Foot Ankle Int 2023; 44:1319-1327. [PMID: 37750390 DOI: 10.1177/10711007231198817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND First metatarsophalangeal (MTP) arthrodesis is a common surgical intervention for addressing MTP pain and deformity. Despite great interest on the topic of return to sport (RTS) after first MTP arthrodesis in the literature, no systematic review exists on this topic. The purpose of this systematic review is to investigate RTS after first MTP arthrodesis. METHODS This study is a systematic review using PubMed, Web of Science, CINAHL, and MEDLINE from database inception until May 10, 2023. Search algorithm used was (MTPJ OR MTP OR "hallux rigidus" OR cheilectomy OR metatarsal OR metatarsophalangeal) AND (arthrodesis OR fusion) AND sport. Inclusion criteria were surgical intervention of first MTP arthrodesis and outcomes related to sport. RESULTS Ten articles were included out of 249 articles initially retrieved. Patients (n = 450) had a frequency weighted mean (FWM) age of 58.6 ± 5.1 years with a FWM follow-up time of 32.1 ± 18.9 months. A total of 153 patients (reported in 34.0% of patients) had a FWM postoperative Foot and Ankle Ability Measure Sport score of 70.4 ± 21.8 at final follow-up. For sporting activities reported by multiple studies (running, yoga, golf, hiking, tennis, elliptical, and biking), about 9.8% to 28.1% of patients (n = 69 reports) stated that sporting activity difficulty decreased, 67.2% to 87.5% of patients (n = 340 reports) stated that sporting activity remained the same, and 1.8% to 8.5% of patients (n = 23 reports) stated that sporting activity difficulty increased after first MTP arthrodesis depending on the sporting activity. One article reported RTS time of 11.7 ± 5.1 weeks after first MTP arthrodesis (n = 39). CONCLUSION RTS after first MTP arthrodesis is highly variable depending on patient and sport. Numerous different sporting activities have high rates of RTS after first MTP arthrodesis, with a majority of patients reporting similar or increased ability to perform sporting activities after surgery.
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Affiliation(s)
- Anthony N Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Kempland C Walley
- Department of Orthopaedics, University of Michigan|Michigan Medicine, Ann Arbor, MI, USA
| | | | | | - James R Holmes
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - David M Walton
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Paul G Talusan
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
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Balu AR, Baumann AN, Tsang T, Talaski GM, Anastasio AT, Walley KC, Adams SB. Evaluating the Biomechanical Integrity of Various Constructs Utilized for First Metatarsophalangeal Joint Arthrodesis: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6562. [PMID: 37834699 PMCID: PMC10573906 DOI: 10.3390/ma16196562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
The first metatarsophalangeal (MTP) joint is a frequently loaded joint, handling loads up to 90% of bodyweight. First MTP arthrodesis is a frequently performed procedure designed to improve pain in patients with degenerative MTP joint disease. There are a wide variety of fixation constructs for this procedure without consensus on the most effective method. The purpose of this study was to compare the biomechanical integrity of various constructs utilized for first MTP arthrodesis. A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, MEDLINE, and Web of Science databases were searched from inception to 18 June 2023. Articles discussing the biomechanics of first MTP arthrodesis constructs were included. A total of 168 articles were retrieved. A total of 20 articles involving 446 cadaveric and synthetic bone constructs were included in the final review. Of the six articles comparing dorsal plating with compression screws to crossed interfragmentary screws, five found that dorsal plating had significantly higher stiffness. All three studies assessing shape-memory staples found them to be significantly less stable than crossed screws or dorsal plates alone. Both studies evaluating fully threaded screws found them to be stronger than crossed cancellous screws. Wedge resections have been shown to be 10 times stronger than standard planar or conical excision. Dorsal plating with compression screws is the gold standard for MTP arthrodesis. However, more research into newer methods such as fully threaded screws and wedge resections with an increased focus on translation to clinical outcomes is needed.
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Affiliation(s)
- Abhinav R. Balu
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60208, USA
| | - Anthony N. Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA;
| | - Terence Tsang
- Campbell University School of Osteopathic Medicine, Lillington, NC 27546, USA;
| | - Grayson M. Talaski
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA;
| | - Albert T. Anastasio
- Department of Orthopaedic Surgery, Duke University, Durham, NC 27708, USA; (A.T.A.); (S.B.A.)
| | - Kempland C. Walley
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Samuel B. Adams
- Department of Orthopaedic Surgery, Duke University, Durham, NC 27708, USA; (A.T.A.); (S.B.A.)
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18
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Dayton M, Dayton P, Togher CJ, Thompson JM. What Do Patients Report Regarding Their Real-World Function Following Triplane Metatarsophalangeal Joint Arthrodesis for Hallux Valgus? J Foot Ankle Surg 2023; 62:905-911. [PMID: 37209902 DOI: 10.1053/j.jfas.2023.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/22/2023]
Abstract
First metatarsal phalangeal (MTP) joint arthrodesis has been employed for decades for pain related to arthritis and other associated abnormalities. Despite the commonality of the procedure there continues to be questions regarding functional expectations following the procedure especially when employed for correction of hallux valgus deformity. We surveyed 60 patients who had a tri plane MTP joint arthrodesis at mean 28.4 months (median 27.8) regarding their activities of daily living and sports activity through a direct conversation. Secondary endpoints assessed were return to activity, deformity correction and arthrodesis healing rate based on chart review and weightbearing radiographs. The primary outcomes showed robust return to all activities of daily living with 96.7% able to walk without restrictions and or pain, 98.3% were able to walk at a normal pace and 95% responded that loss of motion of their big toe did not affect their daily function. Regarding return to sports all patients that participated in sports before surgery resumed participation after with a trend toward increased sports activity. Early return to walking in a fracture boot was noted in this cohort at mean 4.1 days, return to athletic shoe at mean 6.3 weeks and full unrestricted activity at mean 13.3 weeks with no non-unions identified on radiographic or clinical exam. Deformity correction of the typical components of hallux valgus deformity was similar to previously published studies. This data set supports the hypothesis that patients undergoing first MTP joint arthrodesis can expect rapid and full return to activities of daily living and sports with a low complication rate.
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19
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von Deimling C, Tondelli T, Brunner S, Andronic O, Graf AD. Achieving high union rates after first metatarsophalangeal joint arthrodesis: Radiographic outcomes and technical pitfalls. World J Orthop 2023; 14:436-442. [PMID: 37377987 PMCID: PMC10292060 DOI: 10.5312/wjo.v14.i6.436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/14/2023] [Accepted: 05/15/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Fusion of the first metatarsophalangeal (MTP1) joint is a common surgery performed to correct hallux rigidus, hallux rigidus et valgus and other painful degenerative diseases of the MTP1.
AIM To assess outcomes of our surgical technique including non-union rates, accuracy and aims of correction.
METHODS Between September 2011 and November 2020 a total 72 of MTP1 fusions were performed using a low profile, pre-contoured dorsal locking plate and a plantar compression screw. Union and revision rates were analyzed with a minimum clinical and radiological follow up of at least 3 mo (range 3-18 mo). The following parameters were evaluated on pre- and postoperative conventional radiographs: Intermetatarsal angle, Hallux-valgus angle, dorsal extension of the proximal phalanx (P1) in relation to the floor and the angle between the Metatarsal 1 and the P1 (MT1-P1 angle). Descriptive statistical analysis was performed. Pearson analysis was used to assess for correlations between radiographic parameters and achievement of fusion.
RESULTS An overall union rate of 98.6% (71/72) was achieved. Two out of 72 patients did not primarily fuse with one patient suffering from a non-union, whilst the other demonstrating a radiological delayed union without clinical symptoms, with eventually complete fusion after 18 mo. There was no correlation between the measured radiographic parameters and the achievement of fusion. We believe the reason for the non-union was mainly attributed to the patient’s incompliance without wearing the therapeutic shoe leading to a fracture of the P1. Furthermore, we didn`t find any correlation between fusion and the degree of correction.
CONCLUSION With our surgical technique, high union rates (98%) can be achieved using a compression screw and a dorsal variable-angle locking plate to treat degenerative diseases of the MTP1.
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Affiliation(s)
- Christian von Deimling
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
| | - Timo Tondelli
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
| | - Samuel Brunner
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
| | - Octavian Andronic
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
| | - Alexander David Graf
- Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
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20
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Dayton M, Dayton P, Togher CJ, Thompson JM. What Do Patients Report Regarding Their Real-World Function Following Triplane Metatarsophalangeal Joint Arthrodesis for Hallux Valgus? J Foot Ankle Surg 2023; 62:254-260. [PMID: 35999115 DOI: 10.1053/j.jfas.2022.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/06/2022] [Accepted: 07/10/2022] [Indexed: 02/03/2023]
Abstract
First metatarsalphalangeal (MTP) joint arthrodesis has been employed for decades for pain related to arthritis and other associated abnormalities. Despite the commonality of the procedure there continues to be questions regarding functional expectations following the procedure especially when employed for correction of hallux valgus deformity. We surveyed 60 patients who had a triplane MTP joint arthrodesis at mean 28.4 months (median 27.8) regarding their activities of daily living and sports activity through a direct conversation. Secondary endpoints assessed were return to activity, deformity correction and arthrodesis healing rate based on chart review and weightbearing radiographs. The primary outcomes showed robust return to all activities of daily living with 97% able to walk without restrictions and or pain, 98% were able to walk at a normal pace and 95% responded that loss of motion of their big toe did not affect their daily function. Regarding return to sports all patients that participated in sports before surgery resumed participation after with a trend toward increased sports activity. Early return to walking in a fracture boot was noted in this cohort at mean 4.1 days, return to athletic shoe at mean 6.3 weeks and full unrestricted activity at mean 13.3 weeks with no non-unions identified on radiographic or clinical exam. Deformity correction of the typical components of hallux valgus deformity was similar to previously published studies. This data set supports the hypothesis that patients undergoing first MTP joint arthrodesis can expect rapid and full return to activities of daily living and sports with a low complication rate.
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21
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Chodaba Y, Andrews NA, Halstrom J, Sankey T, Sanchez T, Harrelson WM, Agarwal A, Shah A. First Metatarsophalangeal Arthrodesis for Hallux Rigidus and Hallux Valgus: A Comparison of Patient Reported and Clinical Outcomes. J Foot Ankle Surg 2023:S1067-2516(23)00036-4. [PMID: 36964117 DOI: 10.1053/j.jfas.2023.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 03/26/2023]
Abstract
Few prior studies have compared the patient reported outcomes of first metatarsophalangeal arthrodesis between hallux rigidus and hallux valgus patients. Furthermore, we sought to examine the impact of postoperative radiographic hallux alignment on outcomes scores within each group. A retrospective review of 98 patients who a received primary metatarsophalangeal arthrodesis from January 2010 to March 2020. Clinical complications including nonunion were collected. Patient Reported Outcomes Measurement Information Systems (PROMIS) Physical Function, PROMIS Pain Interference, and the foot function index (FFI) revised short form scores were obtained via telephone. Patients were grouped based on review of preoperative radiographs of the foot and this grouping 37 hallux rigidus and 61 hallux valgus patients. Clinical and patient reported outcomes were compared between these pathologies. No differences in the rate of wound complications, radiographic union, and revision surgery were found between the 2 subgroups. At a median of 2.4 years (3.9 IQR) postoperatively, PROMIS and FFI scores did not vary by pathology group. For both groups, PROMIS scores were similar to the general population of the United States. The postoperative first MTP dorsiflexion angle in the hallux rigidus group was correlated with decreased FFI Pain, FFI Total, and PROMIS Pain Interference domain scores (|r| ≥ 0.40, p < .05 for all). When performing MTP arthrodesis in patients with hallux rigidus, increasing the first MTP dorsiflexion angle may correlate with improved intermediate term patient reported outcomes. However, further studies will need to be done to confirm this theoretical relationship.
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Affiliation(s)
- Yvonne Chodaba
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Nicholas A Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jared Halstrom
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Turner Sankey
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Thomas Sanchez
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Whitt M Harrelson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Abhinav Agarwal
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
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22
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Roth W, Hoch C, Gross CE, Scott DJ. First metatarsophalangeal arthrodesis outcomes for hallux rigidus versus hallux valgus. Foot Ankle Surg 2023; 29:50-55. [PMID: 36210270 DOI: 10.1016/j.fas.2022.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/04/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study compared radiographic and functional patient outcomes of 1st MTP arthrodesis between hallux rigidus (HR) and hallux valgus (HV) cohorts. METHODS A retrospective review was conducted at an academic medical center on patients who underwent 1st MTP arthrodesis during 2009-2021. In total, 136 patients (148 feet: HR=57, HV=47, combined=44) met the inclusion criteria of minimum three-month follow-up (mean=1.25 years, range=0.25-6.14 years). Data collection included patient-reported outcome measures (PROMs), radiographic markers, and complication and reoperation rates. RESULTS PROMs improved overall, with HV patients significantly improving the least. The HR group had a significantly smaller improvement in HV angle (HR=-3.6, HV=-17, Combined=-15 p < .001), intermetatarsal angle (H=-0.16, HV=-2.8, Combined=-2.6 p < .001), and 1st-5th metatarsal width (HR=-0.98, HV=-4.6, Combined=-4.6, p < .001). Complication and reoperation rates did not differ by group. CONCLUSION Outcomes of 1st MTP arthrodesis does not appear to differ between diagnostic indications of hallux rigidus, hallux valgus, or both. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
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Affiliation(s)
- Warren Roth
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA
| | - Caroline Hoch
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA
| | - Christopher E Gross
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA
| | - Daniel J Scott
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA.
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23
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D'sa P, Vaidhyanathaswamy S, Teoh KH, Hariharan K. The ability to wear heeled footwear following first metatarsophalangeal joint fusion. Foot Ankle Surg 2022; 28:510-513. [PMID: 35165001 DOI: 10.1016/j.fas.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/22/2021] [Accepted: 02/04/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Fusion remains the gold standard treatment for symptomatic first metatarsophalangeal joint (MTPJ) arthritis. Surgeons have traditionally advised female patients during the consenting process that they would have limitations or be unable to wear heeled footwear following first MTPJ fusion due to the loss of dorsiflexion at the first MTPJ. Anecdotally, surgeons have found that some patients were still able to continue wearing heeled footwear post fusion surgery. Heeled footwear has long been a trendy fashion accessory dating back from ancient Egyptian times and are regularly worn by a significant proportion of women today. Given the lack of literature in this matter, this study was conducted to investigate the effect of first MTPJ fusion surgery on the ability to wear heeled footwear, to aid in the consenting process. METHODS A retrospective review of 50 female patients who have had an isolated first MTPJ fusion between 2004 and 2015 at the authors' institution was undertaken with a follow-up telephone survey which included questions on ability to wear heeled footwear pre and post-operatively, duration, and the height of heels they could wear. RESULTS This study included 50 patients (62 feet) with a mean age of 63 years (range 43-78 years) at the time of surgery, with a mean follow-up of eight years (range 5-16years) from surgery. Of the 42 patients who wore heeled footwear pre-surgery, 26 (62%) continued wearing them. The majority of them (n = 23, 88%) were able to wear the same height heels. Patients could use heeled footwear from 30 min to eight hours continuously (mean=3 h) and, 88% were able to wear heel heights of 1.5 in. or higher. None of the patients wearing heeled footwear returned to the clinic with midfoot/hindfoot symptoms, one returned for worsening of pre-existing first IPJ (interphalangeal joint) symptoms. CONCLUSION This study has important implications for information given to patients during the consent process for this operation. The results have shown that many patients continue to wear heeled footwear following first MTPJ fusion with minimal or no symptoms in neighbouring joints.
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Affiliation(s)
- Prashanth D'sa
- Foot and Ankle Unit, Ysbyty Ystrad Fawr, Ystrad Fawr Way, Ystrad Mynach, Hengoed, CF82 7EP, United Kingdom. Prashanth.D'
| | - Sundar Vaidhyanathaswamy
- Foot and Ankle Unit, Ysbyty Ystrad Fawr, Ystrad Fawr Way, Ystrad Mynach, Hengoed, CF82 7EP, United Kingdom
| | - Kar Hao Teoh
- Foot and Ankle Unit, Ysbyty Ystrad Fawr, Ystrad Fawr Way, Ystrad Mynach, Hengoed, CF82 7EP, United Kingdom
| | - Kartik Hariharan
- Foot and Ankle Unit, Ysbyty Ystrad Fawr, Ystrad Fawr Way, Ystrad Mynach, Hengoed, CF82 7EP, United Kingdom
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24
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Meyr AJ, Doyle MD, King CM, Kwaadu KY, Nasser EM, Ramdass R, Theodoulou MH, Zarick CS. The American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Hallux Valgus. J Foot Ankle Surg 2022; 61:369-383. [PMID: 34706857 DOI: 10.1053/j.jfas.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | - Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship - Palo Alto Medical Foundation, Mountain View, CA
| | - Christy M King
- Residency Director, Kaiser San Francisco Bay Area Foot & Ankle Residency Program and Attending Surgeon, Kaiser Foundation Hospital, Oakland, CA
| | - Kwasi Y Kwaadu
- Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| | | | - Roland Ramdass
- Residency Training Committee, INOVA Fairfax Medical Campus, Fairfax, VA
| | - Michael H Theodoulou
- Chief Division of Podiatric Surgery, Cambridge Health Alliance, and Instructor of Surgery, Harvard Medical School, Boston, MA
| | - Caitlin S Zarick
- Assistant Professor, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
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Curran MG, Murphy EP, Murphy FM, Fenelon CG, Kearns SR. Functional Capabilities After First Metatarsal Phalangeal Joint Arthrodesis Using a Locking Plate and Compression Screw Construct. J Foot Ankle Surg 2022; 61:79-83. [PMID: 34429264 DOI: 10.1053/j.jfas.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 02/01/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
Arthrodesis of the first metatarsal phalangeal joint (MTPJ) is a widely utilized surgical procedure for a wide array of metatarsal pathologies. This study aims to explore the functional limitations following first MTPJ arthrodesis, overall satisfaction and patient's abilities to achieve activities of daily living (ADL). This prospective cohort study assessed functional limitations as well as footwear and lifestyle restrictions using several questionnaires. One hundred and three participants who had a first MTPJ arthrodesis under the care of a single surgeon were recruited. Pre- and postoperative patient-reported outcome measures were recorded. The American Orthopaedic Foot and Ankle Score (AOFAS) and the Manchester-Oxford Foot Questionnaire were also used to further examine functional status. Hallux valgus angle (HVA) and intermetatarsal angle (IMA) were compared using preoperative and postoperative weightbearing radiographs and successful fusion was recorded. Complications were documented and are discussed in detail. The duration of follow-up was more than 12 months. There was one nonunion in the cohort while 2 patients experienced delay to fusion. Approximately 97% of patients were very satisfied with the procedure and their ability to achieve ADLs post operatively. A further 82.5% of patients were able to return to wearing nonadaptive footwear. The mean reduction in HVA and IMA was 21.78° and 6.84°, respectively. This study demonstrates the safe and successful use of a compression screw/locking plate construct for arthrodesis of the first MTPJ. Furthermore, the study provides clear evidence of high levels of functionality after the procedure with statistically significant differences (p value <.05) in all 4 facets of the AOFAS questionnaire as well as several notable differences in activity levels and footwear restrictions pre and postoperatively.
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Affiliation(s)
- Michael G Curran
- Clinical Specialist Podiatrist, Orthopaedic Department, Bon Secours Hospital, Galway, Ireland.
| | - Evelyn P Murphy
- Specialist Registrar, Orthopaedic Department, Galway University Hospital, Galway, Ireland
| | - Fiona M Murphy
- Intern, Orthopaedic Department, Galway University Hospital, Galway, Ireland
| | - Christopher G Fenelon
- Specialist Registrar, Orthopaedic Department, Galway University Hospital, Galway, Ireland
| | - Stephen R Kearns
- Consultant Orthopaedic Surgeon, Orthopaedic Department, Galway University Hospital, Bon Secours Hospital, Galway, Ireland
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West TA, Pollard JD, Carpenter DM, DeTommaso J, Patel SB. Crossed Screw Fixation Versus Dorsal Plating for First Metatarsophalangeal Joint Arthrodesis: A Retrospective Cohort Study. J Foot Ankle Surg 2022; 61:32-36. [PMID: 34376342 DOI: 10.1053/j.jfas.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/06/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023]
Abstract
Multiple fixation techniques for first metatarsophalangeal joint arthrodesis have been described with an average fusion rate of 93.5%. This retrospective cohort study assesses the association between crossed screws (vs dorsal plating) and medical comorbidities and the outcome radiographic union. Bivariate tests of association and multivariable logistic regression were employed to assess differences across fixation type and outcomes. We identified 305 patients who underwent a first metatarsophalangeal joint arthrodesis during the study period. Crossed screw fixation was used in 158 (51.8%) patients while dorsal plating (tubular or anatomic locking plate) was used in 147 (48.2%) patients. Dorsal plating was utilized more often in patients with rheumatoid arthritis (p = .019) and history of smoking (p = .044). At 12 weeks post-operatively there were no significant differences in fusion rates between the two groups (crossed screw group = 95.3% vs dorsal plate group (referent) = 93.5%, Adjusted odds ratio (AOR) 1.39, 95% confidence interval [CI] 0.45-4.26). Not smoking was associated with a greater odds of fusion at 12 weeks (96.2% for nonsmokers vs 75.0% for smokers (referent), AOR 0.07, 95% CI 0.02-0.28). Lower body mass index was associated with a greater odds of fusion at 12 weeks (AOR 0.90, 95% CI 0.82-0.99). Surgeons allowed weightbearing earlier with dorsal plate fixation (2 weeks (interquartile range [IQR] 2.6) versus 5 weeks (IQR 2.6) for crossed screw fixation, p = .001). Patients with multiple medical comorbidities were more likely to require revision surgery than patients having 0-1 comorbidities (p < .05). Crossed screws can provide an inexpensive yet effective option for first metatarsophalangeal joint arthrodesis.
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Affiliation(s)
- Tenaya A West
- Fellow, Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, CA
| | - Jason D Pollard
- Research Director and Attending Staff, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Podiatric Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | - Diane M Carpenter
- Group Leader Data Consulting, Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Sandeep B Patel
- Attending Staff and Surgeon, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Podiatric Surgery, Kaiser Permanente Antioch Medical Center, Antioch, CA.
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Weigelt L, Redfern J, Heyes GJ, Butcher C, Molloy A, Mason L. Risk Factors for Nonunion After First Metatarsophalangeal Joint Arthrodesis With a Dorsal Locking Plate and Compression Screw Construct: Correction of Hallux Valgus Is Key. J Foot Ankle Surg 2021; 60:1179-1183. [PMID: 34112585 DOI: 10.1053/j.jfas.2020.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/27/2020] [Indexed: 02/03/2023]
Abstract
First metatarsophalangeal joint (MTPJ) arthrodesis is currently the gold standard technique for advanced hallux rigidus. This retrospective study aimed to identify the risk factors for nonunion after first MTPJ arthrodesis with a dorsal locking plate and compression screw construct. Between April 2014 and April 2019, 165 consecutive patients (28 men and 137 women; mean age, 60 (range, 28-84) years) who underwent 178 primary first MTPJ arthrodeses were retrospectively reviewed. All arthrodeses were performed using either a dorsal locking plate with an integrated compression screw (Anchorage CP plate, Stryker, n = 97) or a dorsal locking plate (Anchorage V2 plate, Stryker, n = 81) with a separate compression screw (4 mm cannulated ACE screw). Union was defined as bone bridging across the fusion site on at least 2 of the 3 standard foot radiographs (anteroposterior, lateral, oblique) and no MTPJ movement or pain during clinical examination. Potential risk factors for nonunion were analyzed with the use of univariate and multivariate analyses. The overall nonunion rate was 6.2% (11 of 178 cases). The risk factors identified in the univariate analysis included preoperative hallux valgus deformity, postoperative residual hallux valgus deformity, and diabetes (p < .05). Multivariate analysis confirmed that postoperative residual hallux valgus deformity (odds ratio 6.5; p= .015) and diabetes (odds ratio 7.4; p = .019) are independent risk factors for nonunion after first MTPJ arthrodesis. Diabetes is the most important independent risk factor for nonunion after first MTPJ arthrodesis with a dorsal locking plate and compression screw construct. A residual postoperative hallux valgus deformity is associated with a significantly increased risk for nonunion. It is therefore crucial to correct the hallux valgus deformity to a hallux valgus angle of less than 20°.
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Affiliation(s)
- Lizzy Weigelt
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
| | - James Redfern
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Gavin John Heyes
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Clifford Butcher
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew Molloy
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
| | - Lyndon Mason
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
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Challagundla SR, Thomas R, Ferdinand R, Crane E. First Metatarsophalangeal Joint Arthrodesis Using Memory Staples: Clinical and Functional Results. Foot Ankle Spec 2021; 14:410-414. [PMID: 32390479 DOI: 10.1177/1938640020921573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
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.
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Affiliation(s)
- Sudhakar Rao Challagundla
- Department of Trauma and Orthopaedics, Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom
| | - Roshin Thomas
- Department of Trauma and Orthopaedics, Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom
| | - Rupert Ferdinand
- Department of Trauma and Orthopaedics, Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom
| | - Evan Crane
- Department of Trauma and Orthopaedics, Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom
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Joo PY, Baumhauer JF, Waldman O, Hoffman S, Houck J, Kohring JM, Flemister AS, Ketz JP, DiGiovanni BF, Oh I. Physical Function and Pain Interference Levels of Hallux Rigidus Patients Before and After Synthetic Cartilage Implant vs Arthrodesis Surgery. Foot Ankle Int 2021; 42:1277-1286. [PMID: 34024138 DOI: 10.1177/10711007211007843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux rigidus is a common and painful degenerative condition of the great toe limiting a patient's physical function and quality of life. The purpose of this study was to investigate pre- and postoperative physical function (PF) and pain interference (PI) levels of patients undergoing synthetic cartilage implant hemiarthroplasty (SCI) vs arthrodesis (AD) for treatment of hallux rigidus using the Patient-Reported Outcomes Measurement Information System (PROMIS). METHODS PROMIS PF and PI t scores were analyzed for patients who underwent either SCI or AD. Postoperative final PROMIS t scores were obtained via phone survey. Linear mixed model analysis was used to assess differences in PF and PI at each follow-up point. Final follow-up scores were analyzed using independent sample t tests. RESULTS Total 181 (59 SCI, 122 AD) operatively managed patients were included for analysis of PROMIS scores. Final phone survey was performed at a minimum of 14 (mean 33, range, 14-59) months postoperatively, with 101 patients (40 SCI, 61 AD) successfully contacted. The mean final follow-up was significantly different for SCI and AD: 27 vs 38 months, respectively (P < .01). The mean age of the SCI cohort was lower than the AD cohort (57.5 vs 61.5 years old, P = .01). Average PF t scores were higher in the SCI cohort at baseline (47.1 and 43.9, respectively, P = .01) and at final follow-up (51.4 vs 45.9, respectively, P < .01). A main effect of superior improvement in PF was noted in the SCI group (+4.3) vs the AD group (+2) across time intervals (P < .01). PI t scores were similar between the 2 procedures across time points. CONCLUSION The SCI cohort reported slightly superior PF t scores preoperatively and at most follow-up time points compared with the arthrodesis group. No differences were found for PI or complication rates between the 2 treatment groups during this study time frame. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Peter Y Joo
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Judith F Baumhauer
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Olivia Waldman
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Samantha Hoffman
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey Houck
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Jessica M Kohring
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - A Samuel Flemister
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - John P Ketz
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Benedict F DiGiovanni
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Irvin Oh
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
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Lunati M, Mahmoud K, Kadakia R, Coleman M, Bariteau J. Complications Associated with the Surgical Management of Hallux Rigidus. Orthop Clin North Am 2021; 52:291-296. [PMID: 34053574 DOI: 10.1016/j.ocl.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hallux rigidus is the most common arthritic pathology of the foot. This review article discusses the pathophysiology and common clinical presentation of hallux rigidus. Furthermore, we discuss multiple classification systems that categorize the arthritic process and guide management. Surgical interventions include cheilectomy, Moberg osteotomy, synthetic cartilage implants, interpositional arthroplasty, and arthrodesis. The common complications are reviewed, and the rates of these complications highlighted. Surgical options for hallux rigidus globally have successful outcomes with low rates of complications when done on appropriate patients.
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Affiliation(s)
- Matthew Lunati
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Karim Mahmoud
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Rishin Kadakia
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Michelle Coleman
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA
| | - Jason Bariteau
- Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA.
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31
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Giunta JC, Mouton T, Fessy MH, Besse JL. Rheumatoid Forefoot Reconstruction in Nonrheumatic Patients: Lesser Metatarsal Head Resection versus Osteotomy. J Foot Ankle Surg 2021; 60:252-257. [PMID: 33423887 DOI: 10.1053/j.jfas.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 03/09/2020] [Indexed: 02/03/2023]
Abstract
In the literature, first metatarsophalangeal joint arthrodesis with lesser metatarsal head resection seems to be a reliable procedure in rheumatoid foot deformity. Maybe this procedure could be proposed in nonrheumatoid severe forefoot deformity (hallux valgus angle >40° and lesser metatarsophalangeal dislocation). The aim of this study was to compare radiological and clinical outcomes between lesser metatarsal head resection and lesser metatarsal head osteotomy in nonrheumatoid patients. Thirty-nine patients (56 feet) suffering from well-defined nonrheumatoid severe forefoot deformity were retrospectively enrolled in our institution between 2009 and 2015. Metatarsal head resection and metatarsal head osteotomy represented 13 patients (20 feet) and 26 patients (36 feet), respectively. In this observational study, a rheumatoid population (21 patients) was included as the control. The clinical outcome measures consisted of American Orthopaedic Foot and Ankle Society score, Foot and Ankle Ability Measurement, and Short Form-36. The radiological outcomes were: intermetatarsal angle, hallux valgus angle, and metatarsophalangeal alignment. Mean follow-up was 24 months. Satisfaction rate was, respectively, 92% for resection, 91% for osteotomy procedure, and 80% for surgery in rheumatoid patients. Short Form-36 global score was, respectively, 80.7 (52.5-96.4), 76 (57.7-93), and 68.3 (22.6-86). No functional outcome difference was found between resection and osteotomy procedures, except that the metatarsal head resection group had poorer results in sports activities than the osteotomy group. Complications were similar between osteotomy and resection (p > .05). The radiological outcomes were improved significantly from preoperative to postoperative. First metatarsophalangeal joint arthrodesis with lesser metatarsal head resection in nonrheumatoid severe forefoot deformity might be a good therapeutic option.
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Affiliation(s)
- Jean-Charles Giunta
- Orthopaedic Surgeon, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cedex, France.
| | - Tanguy Mouton
- Orthopaedic Surgeon, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cedex, France
| | - Michel-Henri Fessy
- Orthopaedic Surgeon, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cedex, France; Orthopaedic Surgeon, Université Lyon 1, IFSTTAR, LBMC UMR-T 9406 - Laboratoire de Biomécanique et Mécanique des Chocs, Bron Cedex, France
| | - Jean-Luc Besse
- Orthopaedic Surgeon, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cedex, France; Orthopaedic Surgeon, Université Lyon 1, IFSTTAR, LBMC UMR-T 9406 - Laboratoire de Biomécanique et Mécanique des Chocs, Bron Cedex, France; Orthopaedic Surgeon, Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, Lyon, France; Orthopaedic Surgeon, Université de Lyon, Lyon, France; Orthopaedic Surgeon, Université Lyon 1, Villeurbanne, France; Orthopaedic Surgeon, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
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Garcia-Ortiz MT, Talavera-Gosalbez JJ, Moril-Peñalver L, Fernandez-Ruiz MD, Alonso-Montero C, Lizaur-Utrilla A. First Metatarsophalangeal Arthrodesis After Failed Distal Chevron Osteotomy for Hallux Valgus. Foot Ankle Int 2021; 42:425-430. [PMID: 33143483 DOI: 10.1177/1071100720968831] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare the clinical outcomes after first metatarsophalangeal (MTP) joint arthrodesis for hallux rigidus between patients who underwent primary arthrodesis and those who had had a prior surgery for hallux valgus. METHODS Our design was a retrospective cohort study comparing 29 patients who underwent primary arthrodesis (primary group) and 34 patients with hallux rigidus after hallux valgus surgery (secondary group). The clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score and a visual analog scale (VAS) for pain. Radiological evaluation was also performed. Overall, the mean postoperative follow-up was 3.4 (range, 2-5) years. RESULTS At final follow-up, AOFAS and VAS pain scores significantly improved in both groups (P = .001). However, the mean AOFAS (P = .001) and VAS pain (P = .008) scores were significantly better in the primary group than in the secondary group. Radiologically, there were no significant differences between the groups in any angle after arthrodesis. Revision surgeries were not required in the primary group. In the secondary group, there was 1 revision due to deep infection, and 3 other patients required dorsal plate removal. Excluding plate removal, the Kaplan-Meier survival at 3 years was not significantly different between groups (P = .775). CONCLUSION Although arthrodesis of the first MTP joint was an effective procedure for hallux rigidus, the clinical outcomes in patients who had prior hallux valgus surgery were worse than those for patients who underwent primary surgery for hallux rigidus. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
| | | | - Lorena Moril-Peñalver
- Department of Orthopaedic Surgery, Elche University Hospital, Elche, Alicante, Spain
| | | | - Carolina Alonso-Montero
- Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain
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Hoveidaei AH, Roshanshad A, Vosoughi AR. Clinical and radiological outcomes after arthrodesis of the first metatarsophalangeal joint. INTERNATIONAL ORTHOPAEDICS 2021; 45:711-719. [PMID: 32929546 DOI: 10.1007/s00264-020-04807-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The main aim of this study was to investigate the correlation between radiographic findings and clinical outcomes following the first metatarsophalangeal (MTP) joint arthrodesis. METHODS In a comparative retrospective study, on 46 patients (48 ft), the correlation between post-operative radiographic findings including hallux valgus angle (HVA) and first MTP dorsiflexion angle (MTPDA) and clinical outcomes including VAS pain, modified AOFAS hallux score, and FFI questionnaire were evaluated. Moreover, clinical outcomes were compared between cases with pre-operative diagnosis of first MTP inflammatory arthritis, hallux valgus, hallux varus, and grade 3 and 4 of hallux rigidus. The effect of first MTP arthrodesis on Meary's angle and intermetatarsal angle (IMA) were found out. RESULTS The mean age of the patients was 56.3 ± 9.1 (range, 29-69) years, including 42 (91.3%) females and 4 (8.7%) males. We had fusion rate of 97.9%, one asymptomatic nonunion case (2.1%). Totally, mean scores of modified AOFAS hallux score, FFI percentage, and VAS pain were 88.9 ± 12.6, 9.4 ± 16.5, and 1.23 ± 2.24, respectively. Hallux varus was associated with the most favourable outcomes; whereas, patients with first MTP arthritis got the worst outcome. Regression analysis test between clinical outcomes and HVA > 15° and first MTPDA >15° showed correlation coefficient of almost zero. No statistically significant differences were found between the clinical outcomes of grade 3 and 4 of hallux rigidus (p value of modified AOFAS hallux score, FFI percentage, and VAS pain: 0.879, 0.906, and 0.298, respectively). Mean of HVA and IMA reduction in 15 hallux valgus underwent first MTP fusion were 34.4° and 8.4°, respectively. Meary's angle increased about 4° with statistically significant difference (p value 0.001). CONCLUSION Patients with first MTP fusion > 15° in coronal and transverse plans could have acceptable clinical outcomes. The clinical outcome of first MTP arthrodesis for grade 3 hallux rigidus is comparable with grade 4. First MTP fusion would have positive effect on IMA and Meary's angle.
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Affiliation(s)
| | | | - Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Glenn RL, Gonzalez TA, Peterson AB, Kaplan J. Minimally Invasive Dorsal Cheilectomy and Hallux Metatarsal Phalangeal Joint Arthroscopy for the Treatment of Hallux Rigidus. FOOT & ANKLE ORTHOPAEDICS 2021; 6:2473011421993103. [PMID: 35097431 PMCID: PMC8702932 DOI: 10.1177/2473011421993103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Hallux rigidus (HR) is a common source of forefoot pain and disability. For those who fail nonoperative treatment, minimally invasive dorsal cheilectomy (MIDC) is an increasingly popular alternative to the open approach with early positive results. Early failures may be due to lose bone debris from the MIDC as well as other intra-articular pathology that cannot be addressed with MIDC alone. Metatarsophalangeal (MTP) arthroscopy can be used in addition to MIDC to assess the joint after MIDC and address any intra-articular pathology while still maintaining the benefits of minimally invasive surgery. We report our clinical outcomes following MIDC combined with MTP arthroscopy. Methods: From November 2017 to July 2020, a retrospective analysis of all MIDC cheilectomies with MTP arthroscopy performed by the 2 senior authors was done. Wound complications, infections, revision rates, need for future surgery, conversion to fusion rates, pre- and postoperative range of motion, visual analog scale (VAS) scores, time to return to normal shoe, intraoperative arthroscopic findings, and operative time were collected. Follow-up average was 16.5 months (range 3-33 months). Results: A total of 20 patients were included with an average follow-up of 16.5 months. The average VAS score improved from 7.05 preoperatively to 0.75 postoperatively ( P < .05). Average range of motion in dorsiflexion increased from 32 to 48 degrees ( P < .05) and plantarflexion increased from 15 to 19 degrees plantarflexion ( P < .05). All patients were weightbearing as tolerated immediately after surgery in a postoperative shoe and transitioned to a regular shoe at average of 2.1 weeks. We had no wound infections, wound complications, revision surgeries, tendon injuries or nerve damage. One patient required conversion to a fusion 3 years after the index procedure. Average tourniquet time was 30.39 minutes (range 17-60 minutes) and total average operating room time was 59.7 minutes (range 40-87 minutes). On arthroscopic evaluation of the MTP joint after MIDC, 100% of patients had bone debris, 100% had synovitis, 10% had loose bodies, and 30% had large cartilage flaps within the joint. Conclusion: MIDC and first MTP joint arthroscopy for treatment of hallux rigidus provide improved pain relief with minimal complications while still maintaining the benefits touted for minimally invasive operative procedures. Additionally, we have shown a high rate of intra-articular debris along with intra-articular pathology such as synovitis, loose chondral flaps, and loose bodies that exist after MIDC. This combined procedure has the potential for improving patient outcomes and may minimize risk of future revision surgeries compared with MIDC alone. Level of Evidence: Level IV, case series study.
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Affiliation(s)
- Rachel L. Glenn
- Department of Orthopaedic Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Tyler A. Gonzalez
- Department of Orthopaedic Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Alexander B. Peterson
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jonathan Kaplan
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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35
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Lunati MP, Manz WJ, Maidman SD, Kukowski NR, Mignemi D, Bariteau JT. Effect of Age on Complication Rates and Outcomes Following First Metatarsophalangeal Arthrodesis for Hallux Rigidus. Foot Ankle Int 2020; 41:1347-1354. [PMID: 32791854 DOI: 10.1177/1071100720942140] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux rigidus is one of the most common toe pathologies in patients greater than 50 years old. Although metatarsophalangeal (MTP) arthrodesis is used to improve pain and function, older patients are often considered to be higher-risk operative candidates. There are minimal data on outcomes of MTP fusion and no studies comparing outcomes between geriatric and younger patients. METHODS This is a single-center, prospective study of all patients who underwent MTP fusion between August 1, 2015, and July 1, 2018. Patient-reported outcomes were assessed using the Short Form Health Survey (SF-36), Life-Space Assessment survey (LSA), and visual analog scale (VAS) for pain administered preoperatively as well as 6 months and 1 year postoperatively. Baseline characteristics and operative outcomes were collected from the electronic medical record. Clinical and patient-reported outcomes were compared between patients <65 years old and ≥65 years old. Of 143 included patients, 79 were in the younger group (mean of 56.5 years) and 64 were in the older group (mean of 72.0 years). RESULTS Compared with the younger group, the older group was more predominantly female (95.3% older group, 77.2% younger group, P = .002). More patients in the older group had hypertension (73.4% older group, 50.6% younger group, P = .005) and coronary artery disease (9.4% older group, 0.0% younger group, P = .005). Both age groups had similar rates of postoperative wound complications requiring operative irrigation and debridement, deep vein thrombosis, deformity recurrence, and revision surgery. No differences were detected in SF-36, LSA, and VAS surveys administered at baseline, 6 months postoperation, or 1 year postoperation between younger and older patients. CONCLUSION Despite more comorbidities, older patients had similar rates of postoperative complications and reported similar outcomes for pain, function, and mobility following MTP fusion. These findings support increased implementation of MTP fusion surgery for older patients with hallux rigidus. LEVEL OF EVIDENCE Level II, prospective cohort.
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Affiliation(s)
- Matthew P Lunati
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Wesley J Manz
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Nathan R Kukowski
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Jason T Bariteau
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Chrea B, Eble SK, Day J, Ellis SJ, Drakos MC. Comparison Between Polyvinyl Alcohol Implant and Cheilectomy With Moberg Osteotomy for Hallux Rigidus. Foot Ankle Int 2020; 41:1031-1040. [PMID: 32723096 DOI: 10.1177/1071100720947380] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In 2016, the US Food and Drug Administration (FDA) approved the use of a polyvinyl alcohol (PVA) hydrogel implant for the surgical management of hallux rigidus. Though recent studies have evaluated the safety and efficacy of the implant, no study has compared outcomes following PVA implantation with those following traditional joint-preserving procedures for hallux rigidus, such as cheilectomy with Moberg osteotomy. The purpose of this study was to compare clinical and patient-reported outcomes for patients undergoing cheilectomy and Moberg osteotomy, with or without PVA implant, at a single multisurgeon academic center. Our hypothesis was that the addition of the PVA implant would result in superior clinical and patient-reported outcomes. METHODS In total, 166 patients were identified who underwent cheilectomy and Moberg osteotomy with (PVACM; n = 72) or without (CM; n = 94) a PVA implant between January 2016 and December 2018 by 1 of 8 foot and ankle fellowship-trained orthopedic surgeons at our institution. Of these patients, 60 PVACM and 73 CM patients had both baseline and minimum 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores. The average time to survey follow-up was 14.5 months for PVACM patients and 15.6 months for CM patients. Retrospective chart review was performed to assess the incidence of postoperative complications and reoperations, with an average clinical follow-up of 27.7 (range, 16.0-46.4) months for PVACM patients and 36.6 (range, 18.6-47.8) months for CM patients. RESULTS Both PVACM and CM cohorts demonstrated significant improvement in the PROMIS Physical Function, Pain Interference, Pain Intensity, and Global Physical Health domains when comparing preoperative and postoperative scores within each group (P < .01). When comparing scores between the PVACM and CM cohorts, preoperative scores were similar, while CM patients demonstrated significantly higher postoperative Physical Function (51.8 ± 8.7 vs 48.8 ± 8.0; P = .04) and significantly lower Pain Intensity (39.9 ± 8.3 vs 43.4 ± 8.7; P = .02) scores. The pre- to postoperative change in Physical Function was also significantly greater for CM patients (7.1 ± 8.5 vs 3.6 ± 6.2; P = .011). In the PVACM group, there were 3 revisions (5%), 1 reimplantation, 1 conversion to arthrodesis, and 1 revision to correct hyperdorsiflexion. In the CM group, there was 1 revision (1.4%), a conversion to arthrodesis (P = .21). Other postoperative complications included persistent pain (7 out of 60 PVACM patients [11.7%] and 8 out of 73 CM patients [11.0%]; P = .90) and infection in 3 PVACM patients (5%) and no CM patients (P = .05). CONCLUSION Though our results generally support the safety and utility of the PVA implant as previously established by the clinical trial, at 1 to 2 years of follow-up, CM without a PVA implant may provide equivalent or better relief compared with a PVACM procedure, while avoiding potential risks associated with the implant. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Bopha Chrea
- Hospital for Special Surgery, New York, NY, USA
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- Hospital for Special Surgery, New York, NY, USA
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McKissack H, Alexander B, Viner GC, Abyar E, Andrews NA, Shah A. Joint Preparation and Ray Shortening in Arthroscopic Versus Open First Metatarsophalangeal Fusion: A Cadaver Study. Cureus 2020; 12:e9633. [PMID: 32923234 PMCID: PMC7478926 DOI: 10.7759/cureus.9633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/09/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose This study compares the amount of joint preparation and first ray shortening following first metatarsophalangeal (MTP) joint fusion utilizing open conical reaming versus arthroscopic technique. Methods Ten below-knee cadaver specimens were randomly assigned to undergo either open or arthroscopic first MTP fusion. Following fixation, first ray length measurements were obtained from pre-operative and post-operative radiographs and were used to determine first ray shortening. Additionally, the ratio of first ray length to second ray length was calculated both pre-operatively and post-operatively and compared between the two approaches. All ankles were then completely dissected, and prepared surface areas were demarcated. ImageJ photo analysis software (National Institutes of Health, Bethesda, MD, USA) was used to calculate the percentage of prepared and unprepared cartilage of each articular surface of each specimen. Results Overall, the open approach resulted in 99.3% ± 1.6% joint surface preparation, whereas the arthroscopic approach yielded 92.9% ± 7.2% (p = 0.089). On average, the head of the first metatarsal was significantly more prepared with the use of the open approach (99.5% ± 1.1%) than with the arthroscopic approach (96.6% ± 1.5%) (p = 0.008). However, with respect to the base of the phalanx, the average difference in preparation between the arthroscopic approach and the open approach was not statistically significant (90.0% ± 12.8% vs. 99.0% ± 2.2%; p = 0.160). The average amount of first ray shortening in the arthroscopic approach was 2.2 ± 1.8 mm compared to 2.1 ± 3.2 mm in the open approach (p = 0.934). The average change in the first to second ray length ratio was 0.02 for both approaches (p = 0.891). Conclusion Arthroscopic first MTP fusion can be used to achieve joint preparation comparable to open technique while maintaining first ray length.
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Affiliation(s)
- Haley McKissack
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Bradley Alexander
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Gean C Viner
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Eildar Abyar
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Nicholas A Andrews
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Ashish Shah
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
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Picouleau A, Orsoni N, Hardy J, Mabit C, Charissoux JL, Marcheix PS. Analysis of the effects of arthrodesis of the hallux metatarsophalangeal joint on gait cycle: results of a GAITRite ® treadmill test. INTERNATIONAL ORTHOPAEDICS 2020; 44:2167-2176. [PMID: 32683459 DOI: 10.1007/s00264-020-04716-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Approximately 80% of patients are satisfied with the outcome of arthrodesis of the hallux metatarsophalangeal (MTP) joint. The hypothesis of this study was that MTP arthrodesis does not influence the walking cycle. The aim of this study was to evaluate the effect of MTP arthrodesis on gait cycle and to measure the functional outcome of MTP arthrodesis after a minimum of two year follow-up. METHOD This was an observational prospective cohort study performed at a single centre that included 26 patients (32 ft) who underwent unilateral or bilateral MTP arthrodesis during the period 2004-2014. An X-ray assessment based on the American Orthopaedic Foot and Ankle Society score was performed pre-operatively and at the last follow-up (average follow-up duration 8.3 years). The walking cycle was analysed at the final follow-up using a GAITRite® treadmill test. RESULTS Twenty unilateral and six bilateral MTP arthrodeses were included in this study. The average age of the patients was 70 years. No significant difference was found in the walking cycle between the operated and non-operated sides for unilaterally MTP arthrodesis. However, we observed a non-significant increase in the percentage of contact time after MTP arthrodesis (65% on the operated side vs. 63% on the non-operated side). We also observed a significant decrease in the average walking rate, and a decrease in walking speed, in cases of bilateral MTP arthrodesis compared with normal walking cycle data from a laboratory study. CONCLUSIONS MTP joint arthrodesis does not appear to have any effect on the walking cycle, but reduced patient pain and increased the walking distance. The patients reported satisfaction with the surgical outcomes and would recommend it to a relative with the same pathology.
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Affiliation(s)
- Alexandre Picouleau
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Nathlaie Orsoni
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Jeremy Hardy
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Christian Mabit
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Jean-Louis Charissoux
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France
| | - Pierre-Sylvain Marcheix
- Department of Orthopedic Surgery, Dupuytren University Hospital, 2, Avenue Martin Luther King, 87042, Limoges cedex, France.
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Zulauf EE, Connors JC, Boike AM, Hardy MA. Intrinsic Fixation of the Tibial Sesamoid in First Metatarsophalangeal Joint Arthrodesis: A Cadaveric Study. Clin Podiatr Med Surg 2020; 37:287-293. [PMID: 32146984 DOI: 10.1016/j.cpm.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nonunion rate of first metatarsophalangeal joint (MTP) joint arthrodesis is reportedly less than 6%, regardless of fixation type. Robust modern plating constructs aim to decrease incidence of nonunion while also allowing early postoperative weight-bearing. Quicker transition to weight-bearing postoperatively increases patient adherence, decreases adjacent joint stiffness, and reduces risk of deep vein thrombosis in the postoperative period. The purpose of this study was to investigate the effect tibial sesamoid fixation has on first MTP joint arthrodesis.
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Affiliation(s)
- Emily E Zulauf
- Grant Medical Center, 323 East Town Street, First Floor, Suite 100, Columbus, OH 43215, USA.
| | - James C Connors
- Division of Surgery and Biomechanics, Kent State University College of Podiatric Medicine, 6000 Rockside Woods Boulevard, Independence, OH 44131, USA
| | - Allan M Boike
- Kent State University College of Podiatric Medicine, 6000 Rockside Woods Boulevard, Independence, OH 44131, USA
| | - Mark A Hardy
- Division of Surgery and Biomechanics, Kent State University College of Podiatric Medicine, 6000 Rockside Woods Boulevard, Independence, OH 44131, USA
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40
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Dabash S, Buksbaum JR, Fragomen A, Rozbruch SR. Distraction arthroplasty in osteoarthritis of the foot and ankle. World J Orthop 2020; 11:145-157. [PMID: 32280604 PMCID: PMC7138864 DOI: 10.5312/wjo.v11.i3.145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/08/2020] [Accepted: 03/01/2020] [Indexed: 02/06/2023] Open
Abstract
Post-traumatic osteoarthritis (PTOA) is a complex and painful problem in the foot and ankle. Ninety percent of osteoarthritis cases in the foot and ankle can be classified as post-traumatic. PTOA can affect any of the 33 joints in the foot and the ankle. Distraction arthroplasty is a method for treatment of early arthritic joints without fusing or replacing them and its effectiveness has been well documented. The purpose of this case series is to present our successful experiences and positive results using distraction arthroplasty to treat PTOA in the ankle, subtalar, first metatarsophalangeal, and second tarsometatarsal joints, and to present distraction arthroplasty as a viable alternative to invasive joint sacrificing procedures such as arthrodesis or arthroplasty. Distraction Arthroplasty effectively and safely treats PTOA and improves the stability of joints in the Foot and Ankle. Additionally, the use of bone marrow aspirate concentrate as an adjuvant can improve the long-term functional and structural outcomes of the joint, and can prolong the need for further, more aggressive surgical interventions such as fusion or arthroplasty.
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Affiliation(s)
- Sherif Dabash
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY 10021, United States
| | - Joshua R Buksbaum
- SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York, NY 11226, United States
| | - Austin Fragomen
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY 10021, United States
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Weill Cornell Medical College Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY 10021, United States
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Cassinelli SJ, Chen S, Charlton TP, Thordarson DB. Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States. Foot Ankle Int 2019; 40:1140-1148. [PMID: 31195830 DOI: 10.1177/1071100719855049] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to determine the early outcomes and complications following the implantation of a hydrogel synthetic cartilage implant (SCI, Cartiva) for the treatment of hallux rigidus by a single surgeon. METHODS A retrospective chart review was performed of consecutive patients who underwent treatment for hallux rigidus with an SCI between August 2016 and April 2018 by a single surgeon. Demographic information, radiographic assessment, and concomitant operative procedures performed were evaluated for all patients. Postoperatively, PROMIS physical function (PF) and pain interference (PI) scores, patient satisfaction, reoperation, conversion to arthrodesis, and need for further clinical treatment were collected. Sixty-four SCIs were implanted in 60 patients. Follow-up averaged 18.5 months (range 12-30 months). RESULTS 14% (9/64) of patients were very satisfied, 28% (18/64) satisfied, 20% (13/64) neutral, 11% (7/64) unsatisfied, and 27% (17/64) very unsatisfied with their outcome. In addition, 45% of patients underwent additional procedures at the time of SCI, and 23% had a history of surgery on the hallux before implantation. PROMIS PF scores averaged 42 and PROMIS PI scores averaged 60. Overall, 63% completed PROMIS PI, 66% completed PROMIS PF, and 100% completed a satisfaction survey. In addition, 30% (19/64) underwent magnetic resonance imaging (MRI) postoperatively due to pain. There was a 20% reoperation rate, which included an 8% rate of conversion to arthrodesis. CONCLUSION Synthetic cartilage implantation yielded neutral patient satisfaction, mild pain, and physical dysfunction at early follow-up. We believe patient selection and counseling regarding early postoperative limitations are important before proceeding with SCI. LEVEL OF EVIDENCE Level IV, case series.
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Da Cunha RJ, MacMahon A, Jones MT, Savenkov A, Deland J, Roberts M, Levine D, Elliot A, Kennedy J, Drakos M, Ellis SJ. Return to Sports and Physical Activities After First Metatarsophalangeal Joint Arthrodesis in Young Patients. Foot Ankle Int 2019; 40:745-752. [PMID: 30990076 DOI: 10.1177/1071100719842799] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthrodesis of the first metatarsophalangeal (MTP) joint has been shown to be effective in alleviating pain and correcting deformity in hallux rigidus. However, outcomes in specific sports and physical activities remain unclear. The aim of this study was to assess sports and physical activities in young patients following first MTP joint arthrodesis and to compare these results with clinical outcomes. METHODS Patients between ages 18 and 55 years who underwent MTP arthrodesis were identified by review of a prospective registry. Fifty of 73 eligible patients (68%) were reached for follow-up at a mean of 5.1 (range, 2.2-10.2) years with a mean age at surgery of 49.7 (range, 23-55) years. Physical activity was evaluated with a previously developed sports-specific, patient-administered questionnaire. Clinical outcomes were evaluated with the Foot and Ankle Outcome Score (FAOS). RESULTS Patients participated in 22 different sports and physical activities. The most common were walking, biking, weightlifting, swimming, running, and golf. Compared to preoperatively, patients rated 27.4% of activities as less difficult, 51.2% as the same, and 21.4% as more difficult. Patients returned to 44.6% of preoperative physical activities in less than 6 months and reached their maximal level of participation in 88.6% of physical activities. Ninety-six percent of patients (48/50) were satisfied with the procedure regarding return to sports and physical activities. Improvements in the FAOS Symptoms subscore were associated with increased postoperative running and walking duration, and improvements in FAOS Pain subscores were associated with greater patient satisfaction. CONCLUSION Patients were able to participate in a wide variety of sports and physical activities postoperatively. Some patients reported increased difficulty, but were nonetheless satisfied with the procedure regarding physical activity participation. These findings suggest that first MTP joint arthrodesis is a reasonable option in young, active patients, and may be used to guide postoperative expectations. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Rachael J Da Cunha
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Aoife MacMahon
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Mackenzie T Jones
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Aleksander Savenkov
- 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Jonathan Deland
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Matthew Roberts
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - David Levine
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Andrew Elliot
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - John Kennedy
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Mark Drakos
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- 1 Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
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Coutts A, Kilmartin TE. Dorsiflexory Phalangeal Osteotomy for Grade II Hallux Rigidus: Patient-Focused Outcomes at Eleven-Year Follow-Up. J Foot Ankle Surg 2019; 58:17-22. [PMID: 30316644 DOI: 10.1053/j.jfas.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Indexed: 02/03/2023]
Abstract
Dorsiflexory phalangeal osteotomy has been shown to be an effective treatment for mild to moderate hallux rigidus in short- to medium-term follow-up studies. It is speculated that the procedure alters the mechanical function of the joint and reduces the demand for hallux dorsiflexion by elevating the proximal phalanx into a more dorsiflexed position. However, it has been demonstrated that the first metatarsophalangeal (MTP) joint space and joint range of motion are reduced by the procedure, calling into question the long-term effectiveness of the operation. This study reviewed 27 dorsiflexory phalangeal osteotomy cases at an average of 11 years postoperatively. Twenty-one (77%) patients reported that they were completely satisfied with the results of their surgery; 4 (15%) patients reported that they were satisfied with reservations; and 2 (7%) patients reported that they were dissatisfied. The patients who were satisfied with reservations complained of interphalangeal (IP) joint pain or stiffness. One patient developed second MTP joint metatarsalgia after surgery, and in 1 patient first MTP joint pain returned at 24 months after surgery. One dissatisfied patient complained of second MTP joint metatarsalgia, and a second patient required revision excisional arthroplasty for continued joint pain. Ten patients (38%) reported stiffness of the first MTP joint, but only 2 patients reported any restriction of activity. Footwear restrictions were reported by 15 (58%) patients preoperatively and by 9 (35%) patients at final follow-up. Dorsiflexory phalangeal osteotomy maybe a reliable long-term treatment for grade II or moderate hallux rigidus and is a safe and effective alternative to first MTP joint fusion in joints where movement is still present and joint cartilage is viable.
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Affiliation(s)
- Andrew Coutts
- Specialist Registrar in Podiatric Surgery, Ilkeston Hospital, Derbyshire Community Health Services NHS Foundation Trust, Derbyshire, UK.
| | - Timothy E Kilmartin
- Consultant Podiatric Surgeon, Ilkeston Hospital, Derbyshire Community Health Services NHS Foundation Trust, Derbyshire, UK; Consultant Podiatric Surgeon, Kingsbridge Private Hospital, Belfast, Northern Ireland
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Abben KW, Sorensen MD, Waverly BJ. Immediate Weightbearing After First Metatarsophalangeal Joint Arthrodesis With Screw and Locking Plate Fixation: A Short-Term Review. J Foot Ankle Surg 2018; 57:771-775. [PMID: 29752219 DOI: 10.1053/j.jfas.2018.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Indexed: 02/03/2023]
Abstract
Historically, the postoperative protocol for patients undergoing first metatarsophalangeal joint arthrodesis has included 6 weeks of non-weightbearing, followed by protected weightbearing in a below-the-knee cast boot or postoperative shoe. This prolonged period of non-weightbearing predisposes the patient to disuse atrophy, osteopenia, deep vein thrombosis risk, and, overall, a prolonged time to recovery. The present study reports a retrospective review of a patient cohort that underwent first metatarsophalangeal joint fusion with immediate full weightbearing postoperatively. Thirty consecutive first metatarsophalangeal joint arthrodeses were performed during the study period. Five patients were excluded secondary to insufficient postoperative follow-up data or a lack of adequate radiographic evaluation at regular postoperative intervals. Conical reamers were used for joint preparation. Internal fixation, consisting of a single cannulated interfragmentary compression screw and a dorsal locking plate, was used in all patients. The results showed that patients achieved clinical healing at an average of 5.92 weeks and showed radiographic fusion at an average of 6.83 weeks. The patients in the present study had an overall union rate of 96%. Complications included 1 nonunion, 1 superficial wound infection, 1 wound dehiscence, 1 case of symptomatic hardware, and 2 patients with symptomatic hallux interphalangeal joint arthralgia. The mean visual analog pain score preoperatively was 6.64 (range 4 to 8) and postoperatively was 0.6 (range 0 to 4). In conclusion, we found that immediate full weightbearing after first metatarsophalangeal joint fusion in the context of interfragmentary compression and locked plating techniques is a safe, predictable postoperative protocol that allows for a successful fusion interval and an early return to regular activity.
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Affiliation(s)
- Kyle W Abben
- Fellowship Trained Foot and Ankle Surgeon, Park Nicollet Health Services, St. Louis Park, MN
| | - Matthew D Sorensen
- Fellowship Trained Foot and Ankle Surgeon, Weil Foot and Ankle Institute, Des Plaines, IL.
| | - Brett J Waverly
- Fellowship Trained Foot and Ankle Surgeon, Orthopedic Specialty Clinic Ltd., Fredericksburg, VA
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Gaudin G, Coillard JY, Augoyard M, Tourné Y, Meusnier T, Beaudet P, Bernard JN, Augoyard R, Besse JL. Incidence and outcomes of revision surgery after first metatarsophalangeal joint arthrodesis: Multicenter study of 158 cases. Orthop Traumatol Surg Res 2018; 104:1221-1226. [PMID: 30318469 DOI: 10.1016/j.otsr.2018.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/30/2018] [Accepted: 08/23/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION First metatarsophalangeal (MTP1) joint arthrodesis, described as a safe and effective procedure, has complications that may require surgical revision. These complications are rarely studied. The aim of this study was to determine the incidence and outcomes of revision surgery after MT1 arthrodesis. HYPOTHESIS The incidence of surgical revision after MTP1 arthrodesis is not insignificant; however, the outcomes are satisfactory. MATERIALS AND METHODS In this multicenter retrospective study between January 2014 and December 2015, 190 forefoot revisions in patients who had previously undergone MTP1 arthrodesis were included by 8 surgeons. There were no exclusion criteria and all patients had at least 1 year of follow-up. Over the same period, 958 primary MTP1 arthrodesis procedures were performed. RESULTS The mean time to revision was 4.6±10.9 years. At a mean follow-up of 20.5±7.4 months, 158 cases were available for analysis in 135 women and 20 men who had a mean age of 67.1±10.5 years. These revision procedures were carried out because of discomfort related to the hardware at the arthrodesis site (n=86, 54%), nonunion (n=22, 14%), malunion (n=13, 8%) metatarsalgia or claw toe (n=18, 11%) and first interphalangeal (IP1) joint disorders (n=13, 8%). The mean postoperative scores were 75±13.9 for the AOFAS and 65±19.6 for the SF36 total. In the nonunion cases, removal of the hardware led to better outcomes than repeating the arthrodesis procedure. Osteotomy in the malunion cases healed successfully. In the cases of IP1 osteoarthritis, secondary arthrodesis or arthroplasty led to good outcomes. DISCUSSION Relative to published results of primary MTP1 arthrodesis, the outcomes in our series of revision MTP1 arthrodesis surgery cases are practically equivalent, thus considered acceptable. LEVEL OF EVIDENCE IV, Retrospective study.
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Affiliation(s)
- Gaël Gaudin
- Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
| | | | - Marc Augoyard
- Clinique Saint-Charles, 25, rue de Flesselles, 69001 Lyon, France
| | - Yves Tourné
- Clinique des Cèdres, 21, rue Albert-Londres, 38432 Échirolles, France
| | - Tristan Meusnier
- Clinique Saint-Charles, 25, rue de Flesselles, 69001 Lyon, France
| | - Philippe Beaudet
- Clinique Trénel, 575, rue du Docteur-Trénel, 69560 Sainte-Colombe, France
| | - Jean-Noël Bernard
- Hôpital d'instruction des armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - Romain Augoyard
- Clinique Saint-Charles, 25, rue de Flesselles, 69001 Lyon, France
| | - Jean-Luc Besse
- Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; IFSTTAR, LBMC UMR-T 9406 - laboratoire de biomécanique et mécanique des chocs, université Lyon 1, 69675 Bron cedex, France
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- Clinique du Parc, 155 ter, boulevard de Stalingrad, 69006 Lyon, France
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Crowell A, Van JC, Meyr AJ. Early Weight-Bearing After Arthrodesis of the First Metatarsal-Phalangeal Joint: A Systematic Review of the Incidence of Non-Union. J Foot Ankle Surg 2018; 57:1200-1203. [PMID: 30201557 DOI: 10.1053/j.jfas.2018.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Indexed: 02/03/2023]
Abstract
Arthrodesis of the first metatarsal-phalangeal joint is a reliable procedure for correction of both hallux limitus/rigidus and severe hallux abducto valgus deformities. However, 1 potential contraindication to the procedure is the extended period of non-weight-bearing immobilization that is typically associated with the postoperative course. The objective of this investigation was to perform a systematic review of the incidence of non-union after early weight bearing in patients who underwent arthrodesis of the first metatarsal-phalangeal joint. We performed a review of electronic databases with the inclusion criteria of retrospective case series, retrospective clinical cohort analyses, and prospective clinical trials with n ≥ 15 feet, a mean follow-up of ≥12 months, a defined postoperative early weight-bearing protocol (defined as ≤2 weeks), a clear description of the fixation construct, a reported incidence rate of non-union, and patients who underwent primary surgery for hallux abducto valgus or hallux limitus/rigidus deformities. Seventeen studies met our inclusion criteria, with a total of 898 feet analyzed. Of these, 57 (6.35%) were described as developing a non-union. This would likely be considered an acceptable crude, heterogeneous incidence of non-union when considering this procedure. It might also indicate that arthrodesis of the first metatarsal-phalangeal joint does not always require an extended period of non-weight-bearing postoperative immobilization.
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Affiliation(s)
- Amanda Crowell
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA.
| | - Jennifer C Van
- Clinical Assistant Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Andrew J Meyr
- Clinical Assistant Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
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Beekhuizen SR, Voskuijl T, Onstenk R. Long-Term Results of Hemiarthroplasty Compared With Arthrodesis for Osteoarthritis of the First Metatarsophalangeal Joint. J Foot Ankle Surg 2018; 57:445-450. [PMID: 29366661 DOI: 10.1053/j.jfas.2017.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 02/03/2023]
Abstract
If operative treatment is opted for grade 3 and 4 osteoarthritis of the first metatarsophalangeal joint, arthrodesis is considered the standard of care. However, if preservation of joint mobility is preferred, implant arthroplasty could be favored. Previous studies have suggested hemiarthroplasty might result in less pain, better function, and greater patient satisfaction compared with arthrodesis. However, these studies only evaluated short-term results (range 2.2 to 6.6 years). The aim of our study was to determine whether patients treated with hemiarthroplasty would show better postoperative outcomes compared with those treated with arthrodesis after ≥5 years after surgery. The American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal interphalangeal (AOFAS-HMI) scale score was used as the primary outcome measure. Secondary outcomes addressed satisfaction rates, patient procedure recommendation, and number of unplanned repeat surgical procedures. We also addressed the influence of the procedures on daily activities (work and sports), the influence of smoking on the postoperative results, and the costs for both procedures. A total of 47 primary arthrodeses and 31 hemiarthroplasties performed between January 2005 and December 2011 were evaluated. After a mean follow-up period of 8.3 (range 5 to 11.8) years, the mean AOFAS-HMI scale score after arthrodesis and hemiarthroplasty was 72.8 ± 14.5 and 89.7 ± 6.6, respectively (p = .001). The patients were significantly more pleased after hemiarthroplasty (p < .001), and this procedure was recommended more often (p < .001). The number of unplanned repeat surgical procedures did not differ between the 2 groups. Patients resumed sports activities significantly sooner after hemiarthroplasty (p = .002). The overall crude costs were similar for both procedures. Our results have shown more favorable postoperative outcomes for hemiarthroplasty compared with arthrodesis as operative treatment of osteoarthritis of the first metatarsophalangeal joint after a mean follow-up period of 8.3 years.
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Affiliation(s)
- Stefan R Beekhuizen
- Orthopaedic Resident, Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands.
| | - Timothy Voskuijl
- Orthopaedic Resident, Orthopaedic Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Ron Onstenk
- Orthopaedic Surgeon, Orthopaedic Surgery, Green Heart Hospital, Gouda, The Netherlands
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Guo H, Xu HL, Lu H, Jiang BG. A Modified Foot and Ankle Score for Assessing Patient Outcomes After First Metatarsophalangeal Arthrodesis. J Foot Ankle Surg 2018; 57:254-258. [PMID: 29224948 DOI: 10.1053/j.jfas.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 09/10/2017] [Indexed: 02/03/2023]
Abstract
First metatarsophalangeal (MTP) arthrodesis is commonly used to treat many end-stage first MTP diseases. The most widely used scale for measuring the clinical outcomes after this procedure, the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal scale, has not been adequately validated and does not measure specific foot functions. Another outcome measure, the patient-reported Foot and Ankle Outcome Score (FAOS) has acceptable construct validity but poor content validity. The FAOS scale has 42 questions, many of which are unrelated to the hallux. We designed a short-form FAOS (sf-FAOS) consisting of 11 questions that are more relevant to first MTP arthrodesis. The sf-FAOS includes a pain subscale and a function subscale, and the score of each subscale ranges from 0 (worst outcome) to 100 (best outcome). Our study has shown that the sf-FAOS scale has acceptable validity, reliability, and responsiveness. In 21 feet (16 patients) with hallux valgus after >1 year of follow-up, the mean sf-FAOS pain score had improved by 44.9 points after surgery (from 51.2 to 96.0; p < .001), and the mean sf-FAOS function score had improved by 22.5 points (from 47.3 to 69.8; p <.001). The improvement in the function score for running and jumping was limited.
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Affiliation(s)
- Hao Guo
- Resident, Department of Trauma and Orthopedics, People's Hospital, Peking University, Beijing, China
| | - Hai-Lin Xu
- Professor, Department of Trauma and Orthopedics, People's Hospital, Peking University, Beijing, China; Secretary-General, Chinese Orthopedic Foot and Ankle Society, Beijing, China
| | - Hao Lu
- Associate Professor, Department of Trauma and Orthopedics, People's Hospital, Peking University, Beijing, China
| | - Bao-Guo Jiang
- Professor and Director, Department of Trauma and Orthopedics, People's Hospital, Peking University, Beijing, China; Chairman, Traumatology Branch of Chinese Medical Association, Beijing, China.
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50
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Stevens J, Meijer K, Bijnens W, Fuchs MCHW, van Rhijn LW, Hermus JPS, van Hoeve S, Poeze M, Witlox AM. Gait Analysis of Foot Compensation After Arthrodesis of the First Metatarsophalangeal Joint. Foot Ankle Int 2017; 38:181-191. [PMID: 27770063 DOI: 10.1177/1071100716674310] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthrodesis of the first metatarsophalangeal (MTP1) joint is an intervention often used in patients with severe MTP1 joint osteoarthritis and relieves pain in approximately 80% of these patients. The kinematic effects and compensatory mechanism of the foot for restoring a more normal gait pattern after this intervention are unknown. The aim of this study was to clarify this compensatory mechanism, in which it was hypothesized that the hindfoot and forefoot would be responsible for compensation after an arthrodesis of the MTP1 joint. METHODS Gait properties were evaluated in 10 feet of 8 patients with MTP1 arthrodesis and were compared with 21 feet of 12 healthy subjects. Plantar pressures and intersegmental range of motion were measured during gait by using the multisegment Oxford Foot Model. Pre- and postoperative X-rays of the foot and ankle were also evaluated. RESULTS The MTP1 arthrodesis caused decreased eversion of the hindfoot during midstance, followed by an increased internal rotation of the hindfoot during terminal stance, and ultimately more supination and less adduction of the forefoot during preswing. In addition, MTP1 arthrodesis resulted in a lower pressure time integral beneath the hallux and higher peak pressures beneath the lesser metatarsals. A mean dorsiflexion fusion angle of 30 ± 5.4 degrees was observed in postoperative radiographs. CONCLUSION This study demonstrated that the hindfoot and forefoot compensated for the loss of motion of the MTP1 joint after arthrodesis in order to restore a more normal gait pattern. This resulted in a gait in which the rigid hallux was less loaded while the lesser metatarsals endured higher peak pressures. Further studies are needed to investigate whether this observed transfer of load or a preexistent decreased compensatory mechanism of the foot can possibly explain the disappointing results in the minority of the patients who experience persistent complaints after a MTP1 arthrodesis. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Jasper Stevens
- 1 Department of Orthopaedics, Maastricht University Medical Centre, The Netherlands
| | - Kenneth Meijer
- 2 Department of Human Movement Sciences, Maastricht University, The Netherlands
| | - Wouter Bijnens
- 2 Department of Human Movement Sciences, Maastricht University, The Netherlands
| | - Mathijs C H W Fuchs
- 1 Department of Orthopaedics, Maastricht University Medical Centre, The Netherlands
| | - Lodewijk W van Rhijn
- 1 Department of Orthopaedics, Maastricht University Medical Centre, The Netherlands
| | - Joris P S Hermus
- 1 Department of Orthopaedics, Maastricht University Medical Centre, The Netherlands
| | - Sander van Hoeve
- 3 Department of Surgery, Division of Trauma surgery, Maastricht University Medical Centre, The Netherlands
| | - Martijn Poeze
- 3 Department of Surgery, Division of Trauma surgery, Maastricht University Medical Centre, The Netherlands
| | - Adhiambo M Witlox
- 1 Department of Orthopaedics, Maastricht University Medical Centre, The Netherlands
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