BackgroundInstability of the metatarsophalangeal (MTP) joints of the lesser toes (digiti 2–5) is increasingly being treated by repair of the plantar plate (PP). This systematic review examines the anatomy of the plantar plate of the lesser toes, and the relation between the integrity of the plantar plates of the lesser toes and lesser MTP joint stability.MethodsThe databases of Embase.com, Medline (Ovid), Web of Science, Scopus, Cochrane, Pubmed not medline, Cinahl (ebsco), ProQuest, Lilacs, Scielo and Google Scholar were searched in June 2015 from inception. Studies were included if they were in English, contained primary data, and had a focus on plantar plate anatomy of the lesser toes or on the relationship between integrity of the plantar plate and MTP joint (in)stability. Study characteristics were extracted into two main tables and descriptive anatomical and histological data were summarized into one schematic 3D drawing of the plantar plate.ResultsNine studies were included in this systematic review, of which five addressed plantar plate anatomy as such and four focused directly and indirectly on plantar plate integrity related to MTP joint stability.ConclusionThis is the first systematic review regarding plantar plate anatomy related to MTP joint stability of the lesser toes. This review iterates the importance of plantar plate anatomy and integrity for MTP joint stability, and it delineates the lack of primary data regarding plantar plate anatomy of the lesser toes and MTP joint stability.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-016-0165-2) contains supplementary material, which is available to authorized users.
BackgroundAlthough no prospective studies have compared functional results of trochanteric osteotomy and a non-trochanteric approach, most surgeons feel that trochanteric osteotomy is outdated in simple hip arthroplasty. Reasons not to perform an osteotomy include the fear of longer rehabilitation and worse (final) functional outcome.MethodThis prospective study examines differences in rehabilitation between posterolateral and trochanteric approach one year post-surgery using questionnaires (WOMAC, SF-36, HHS) and functional tests (walking, climbing stairs, rising from sitting, and strength tests). Of the 109 patients 24 had a trochanteric osteotomy: the selected approach was based on the surgeon's preference. The trochanteric osteotomy group included more patients with developmental dysplasia of the hip. Before the start of the study no power analysis was performed.ResultsData from the questionnaires showed no significant differences between the two groups at 3, 6 and 12-months follow-up. At 3-months follow-up patients in the trochanteric osteotomy group scored lower on the functional tests. This difference had disappeared at 6 and 12-months follow-up, except for abduction force which remained lower in the trochanteric osteotomy group in patients with a non union of the TO.ConclusionFor simple hip arthroplasty an approach without osteotomy seems a logical choice. Although the power of this study is low, in experienced hands trochanteric osteotomy seems to give good functional results at 6-12 months post surgery if trochanteric union is obtained. Therefore, one should not hesitate to perform an osteotomy in difficult cases.
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