End-Stage Hallux Rigidus

Peace, Ruth A.; Hamilton, Graham A.

doi:10.1016/j.cpm.2012.04.002

Cited by 12 publications

(8 citation statements)

References 34 publications

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“…Different internal fixation devices made of various materials have been used in orthopedic surgery to stabilize fractures and bone fragments including metallic (like steel and titanium) and bioabsorbable devices, as well as bone grafts (auto-, allo- and xenografts) [ 2 , 16 , 17 , 18 ]. The advantage of the sterilized bone graft is the absence of a second surgery for the device removal, a compatibility of the graft with radiology (CT and MRI), and the absence of an adverse tissue reaction or inflammation.…”

Section: Discussionmentioning

confidence: 99%

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Incorporation of an Allogenic Cortical Bone Graft Following Arthrodesis of the First Metatarsophalangeal Joint in a Patient with Hallux Rigidus

Brčić

Pastl²,

Plank

et al. 2021

Life

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Hallux rigidus is degenerative arthritis of the first metatarsophalangeal joint characterized by pain and stiffness in the joint with limitation of motion and functional impairment. Recently, bone grafts have been introduced in orthopedic procedures, namely osteosynthesis and arthrodesis. Allografts can induce bone formation, provide support for vascular and bone ingrowth and have a low risk of immunological rejection. A 52-year-old female patient with hallux rigidus underwent arthrodesis of the first metatarsophalangeal joint using Shark Screw® made of allogenic cortical bone. Corrective surgery was performed after 10 weeks, and a 5 × 3 mm large part of the Shark Screw® with the surrounding patient’s bone was removed. A histological evaluation revealed a vascularized graft with the newly formed compact lamellar bone fitting exactly to the cortical graft. The bone surface was lined by plump osteoblasts with osteoid production, and osteocytes were present in the lacunae. The arthrodesis of the first metatarsophalangeal joint using an allogenic cortical bone graft results in fast, primary bone healing without immunological rejection. This case suggests that the cortical allograft is a good and safe treatment option with an excellent graft incorporation into the host bone. However, as the literature evaluating the histology of different bone grafts is scarce, further high-level evidence studies with adequate sample sizes are needed to confirm our findings.

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Section: Discussionmentioning

confidence: 99%

“…Several surgical procedures were used in hallux rigidus treatment [ 2 , 3 ]. The surgical approach is based on the degree of joint involvement, the extent of deformity visible on radiographs, the ROM limitations, and the patient’s activity level.…”

Section: Introductionmentioning

confidence: 99%

Incorporation of an Allogenic Cortical Bone Graft Following Arthrodesis of the First Metatarsophalangeal Joint in a Patient with Hallux Rigidus

Brčić

Pastl²,

Plank

et al. 2021

Life

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“…3–5 Arthrodesis, popularized by McKeever in 1952, 6 remains the gold standard and is the preferred choice due to its generally more predictable results, patient-reported outcomes and surgeons’ familiarity with the procedure. 7 The options for replacement include a silastic (silicone) or a metallic implant. It follows the basic principles of any joint-replacement surgery aiming to reduce pain, restore joint kinematics, be long lasting and not be difficult to revise if it fails.…”

Section: Introductionmentioning

confidence: 99%

“…It follows the basic principles of any joint-replacement surgery aiming to reduce pain, restore joint kinematics, be long lasting and not be difficult to revise if it fails. 7 Initially, silicone implants were popular among surgeons and were utilized in patients who were too young and too active for joint replacement surgery. 8…”

Section: Introductionmentioning

confidence: 99%

Silastic replacement of the first metatarsophalangeal joint: historical evolution, modern concepts and a systematic review of the literature

Majeed

2019

EFORT Open Reviews

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Silastic implants for the first metatarsophalangeal joint (MTPJ) have been in use for over 50 years. Initial reports were associated with high failure rates leading to development of new designs that are currently in use. The aim of this article is to review the historical evolution and the outcomes of silastic implants for the treatment of end-stage OA of the first MTPJ. Databases were searched for studies reporting the outcomes of silastic implants for the first MTPJ. Various relevant search terminologies were used. Studies reporting the outcomes of metallic implants or arthrodesis were excluded. The literature search revealed 522 studies, of which 28 were included. Eight studies used single-stemmed implants and 20 used double-stemmed implants for their patients. Twenty-eight studies had a total of 2354 feet with silastic replacements in 1884 patients (1968 to 2003) with an average age of 53 years and the average follow-up was 85.3 months. There were a total of 5.3% (124 feet) failed prostheses. Improvement in pain was reported in 76.6% (1804 feet) with an average patient satisfaction rate of 84%. Radiological changes around the implants were found to be significantly higher with single-stemmed implants (30.3%) compared to the double-stemmed implants (14.7%) (p < 0.05). Significantly more single-stemmed implants failed (11%) than the double-stemmed implants (3.6%) (p < 0.05). Despite the initial reports of failed implants and complications, first- and second-generation silastic implants were associated with high patient satisfaction and pain improvement. Current literature lacks long-term outcomes of implants currently in use. Cite this article: EFORT Open Rev 2019;4:77-84. DOI: 10.1302/2058-5241.4.180055

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“…Of those reported, the most common are amputation, limb loss, ischemic limb, osteomyelitis, non-union, mal-union, mal-position, failed hardware, wound infections, hematoma or seroma, wound dehiscence, interphalangeal joint arthritis, and transfer metatarsalgia (3, 5, 6, 9, 15, 21, 27, 29, 30, 33–37). Because of some of the more severe complications that can occur, many surgeons have chosen alternate procedures including and limited to first MTPJ cheilectomy, decompression osteotomies, arthroplasty, implant surgery, sesamoid removal, arthrodiastasis, and cartilage resurfacing to treat their patients’ symptoms (5, 9, 11, 14, 15, 19, 29, 32, 35, 38). Although complications do exist with this procedure, most are considered mild or moderate and advanced surgical techniques are continually being developed to better the outcomes.…”

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confidence: 99%

Complication rates in diabetics with first metatarsophalangeal joint arthrodesis

Anderson

Hansen²,

Rowe³

et al. 2014

Diabetic Foot & Ankle

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BackgroundFirst metatarsophalangeal joint (MTPJ) arthrodesis has been an effective surgical entity when indicated, but a range of severe to mild complications can occur from this procedure. Patients with diabetes mellitus have an increased risk in surgical complications, most commonly associated with soft tissue and bone healing, when compared to non-diabetic patients. The purpose of this study was to evaluate the complication rates of first MTPJ arthrodesis in diabetic patients and compare them to the existing complication rates for the procedure.MethodsA retrospective chart review was done on 76 diabetic patients, from June 2002 to August 2012. Thirty-two males and 44 females were included in the study. The authors evaluated many variables that could impact postoperative complications, including age, gender, bone graft incorporation, hemoglobin A1c, tobacco use, body mass index, peripheral neuropathy, hallux extensus, hallux interphalangeal arthritis, and rheumatoid arthritis, and compared them with the complication findings. Patient follow-up was no less than 24 months.ResultsOverall, approximately two-thirds of the patients had no complications and 35.5% of patients had at least one mild or moderate complication. Of the non-union and mal-union complications, 80 and 70% had peripheral neuropathy, respectively. One hundred percent of the patients that had mal-positions or hardware failure also had peripheral neuropathy. No severe complications were seen during follow-up. Only two of the moderate complications needed revisions, and the rest of those with moderate complications were asymptomatic.ConclusionIn conclusion, first MTPJ arthrodesis is overall an effective and beneficial procedure in patients with diabetes mellitus. Diabetic patients with peripheral neuropathy have an increased risk for mild and moderate complications.

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End-Stage Hallux Rigidus

Cited by 12 publications

References 34 publications

Incorporation of an Allogenic Cortical Bone Graft Following Arthrodesis of the First Metatarsophalangeal Joint in a Patient with Hallux Rigidus

Incorporation of an Allogenic Cortical Bone Graft Following Arthrodesis of the First Metatarsophalangeal Joint in a Patient with Hallux Rigidus

Silastic replacement of the first metatarsophalangeal joint: historical evolution, modern concepts and a systematic review of the literature

Complication rates in diabetics with first metatarsophalangeal joint arthrodesis

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