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

Majeed, Haroon

doi:10.1302/2058-5241.4.180055

Cited by 15 publications

(20 citation statements)

References 53 publications

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“…21,22 This was due to the high rates of complications and patient dissatisfaction with early implant designs. 21,22 In the late 1990s, the third-generation implants were produced with a novel material, silicone, allowing for better physical properties of the implant. 22 These third-generation implants appeared to yield superior functional outcomes and higher patient satisfaction rates based on initial data with short-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…21,22 In the late 1990s, the third-generation implants were produced with a novel material, silicone, allowing for better physical properties of the implant. 22 These third-generation implants appeared to yield superior functional outcomes and higher patient satisfaction rates based on initial data with short-term follow-up. 6,10,21,25 This led to an increase in arthroplasty procedures with a subsequent decrease in arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

“…1,5,6,15,20,27 Arthrodesis remains the primary surgical treatment despite the development of first- and second-generation implants for MTP arthroplasty in the 1970s and 1980s, respectively. 21,22 This was due to the high rates of complications and patient dissatisfaction with early implant designs. 21,22 In the late 1990s, the third-generation implants were produced with a novel material, silicone, allowing for better physical properties of the implant.…”

Section: Discussionmentioning

confidence: 99%

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Preoperative Risk Factors for Primary Metatarsophalangeal Arthroplasty Revision to MTP Arthrodesis for Hallux Rigidus

et al. 2022

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Background: Revision or conversion to arthrodesis following metatarsophalangeal (MTP) joint arthroplasty are salvage procedures to manage complications of MTP joint arthroplasty. The purpose of this study is to use a national administrative database to characterize nationwide trends of patients undergoing hallux MTP arthrodesis vs arthroplasty for hallux rigidus. Additionally, the authors sought to evaluate demographic trends and evaluate influence of patient-related risk factors in those undergoing MTP arthroplasty revision to arthrodesis. Methods: Patients who underwent MTP arthroplasty for diagnosis of hallux rigidus from 2010 to 2019 were identified in the Mariner subset of the PearlDiver database. Patients were included if they had undergone MTP arthroplasty for the diagnosis of hallux rigidus. Notably, the database lacks resolution about critical features of the arthroplasty design and materials. The revision cohort encompassed patients who underwent subsequent ipsilateral MTP arthrodesis or arthroplasty within 2 years of index arthroplasty procedure. Demographic characteristics and medical comorbidities were examined as potential patient-related risk factors for arthroplasty revision or revision to fusion. Univariate analyses were performed to analyze differences in patient demographics, comorbidities, and risk factors. A multivariate regression analysis was subsequently conducted to control for confounding variables. Results: 2750 patients underwent primary MTP arthroplasty for diagnosis of hallux rigidus. Of these, 44 (1.6%) underwent revision arthroplasty and 188 patients (6.8%) were revised to arthrodesis within the first 2 years after the index procedure. Multivariate regression analysis indicates that obesity (odds ratio [OR] 1.48, 95% CI 1.05-2.09), depression (OR 1.59, 95% CI 1.15-2.20), and steroid use (OR 2.94, 95% CI 1.30-6.65) were associated with a statistically significant increase in revision to arthrodesis from primary arthroplasty. Conclusion: Revision arthrodesis following primary MTP arthroplasty for hallux rigidus within 2 years was found to be a relatively common occurrence in this national insurance database study. Risk factors for revision arthroplasty to arthrodesis within 2 years of primary arthroplasty include obesity, depression, and steroid use. Level of Evidence: Level III, case-control study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Preoperative Risk Factors for Primary Metatarsophalangeal Arthroplasty Revision to MTP Arthrodesis for Hallux Rigidus

et al. 2022

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“…Some less common complications include overcorrection due to oversized implants, synovitis, infection, and peroneal spasm [21]. Many cases of synovitis are likely caused by a reaction to silicone microparticles from silastic implants [25]. While silicone is prone to fragmentation over time due to shear forces in the joint, the use of metal instead of silastic may decrease the rates of implant degradation and the ensuing inflammatory reaction [26].…”

Section: Complicationsmentioning

confidence: 99%

Arthroereisis: Treatment of Pes Planus

Ghali¹,

Mhapankar²,

Momtaz³

et al. 2022

Cureus

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Arthroereisis is a surgical procedure primarily used to treat flexible pes planus (flatfoot) in pediatric and young adult patients. The principal goal of subtalar arthroereisis is to relieve pain and restore function. This is primarily done by restoring the medial foot arch without fusing the subtalar joint and without requiring a long recovery period needed after osteotomies. Although the procedure can be performed in isolation to treat flexible flatfoot, it can also be performed as an ancillary in the treatment of tarsal coalition, posterior tibial tendon dysfunction, and accessory navicular syndrome. Various implants and multiple surgical techniques exist for arthroereisis, such as the sinus tarsi implant and calcaneo-stop. The type of device and the surgical approach to proceed with are based on the surgeon's discretion rather than an evidence-based protocol. Multiple complications can arise from subtalar arthroereisis, most commonly sinus tarsi pain. Currently, there is a dearth of quality clinical data and evidence on the long-term outcomes and complications of arthroereisis. This lack of literature for a commonly performed procedure validates the need for future studies to better guide a standard protocol, reach consensus on well-defined indications and contraindications, provide expected complications, and improve the practice of evidence-based medicine.

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“…Silicone implants are frequently used for arthroplasty of the metatarsophalangeal joint which is damaged due to diseases such as osteoarthritis or rheumatoid arthritis that generate alterations of gait [1][2][3][4] and limitations in daily activities. 5 The joint replacement with an implant is one of the various forms of surgical treatment for advanced stages of the pathology hallux rigidus.…”

Section: Introductionmentioning

confidence: 99%

Structural assessment of pre-flexion in silicone implants for arthroplasty of the first metatarsophalangeal joint

Campos

Lesso

Bayod-López

et al. 2022

Proc Inst Mech Eng H

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The development of numerical models to analyze pathologies and implants related to the first metatarsophalangeal joint of the foot remains an issue for attention. The structural effects of implants pre-flexion have been discarded in several finite elements analyses due to complexities to achieve these positions. This work aims to evaluate if the pre-flexion stress state should be included or could be discarded when only flexion is applied in two different silicone commercial implants, Swanson and Tornier, during a gait cycle. Finite element models were created for silicone implants. Both models were discretized using high-order finite elements. The hyperelasticity constitutive material model of Arruda-Boyce was used, based on experimental data; its behavior was compared with linear elastic models reported and used frequently assuming small and large deformations and applying to the Swanson and Tornier implants a flexion angle of 64°, which corresponds to in vivo measurements reported after implantation. Comparison between models, regarding hyperelastic model, showed mean variations of up to 32.5% for stresses and 14.01% for bending moment in Swanson implant, while for Tornier implant mean variations of 29.73% and 632.55% was obtained for stress and bending moment respectively. The maximum stress value obtained for the hyperelastic model in the Swanson implant reached a value of 22.82% of the tensile strength of the implant material while in the Tornier implant reached a value of 25.92%, the above values were evaluated at a flexion angle of 64°. The results suggest considering in finite element analyses not only the stress state generated to achieve critical flexion position in pleflexed implants models but also the hyperelastic material behavior of silicone for implants to avoid dismissing the non-linear structural behavior of hyperelastic materials.

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

Cited by 15 publications

References 53 publications

Preoperative Risk Factors for Primary Metatarsophalangeal Arthroplasty Revision to MTP Arthrodesis for Hallux Rigidus

Preoperative Risk Factors for Primary Metatarsophalangeal Arthroplasty Revision to MTP Arthrodesis for Hallux Rigidus

Arthroereisis: Treatment of Pes Planus

Structural assessment of pre-flexion in silicone implants for arthroplasty of the first metatarsophalangeal joint

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