RESUMEN
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.
Asunto(s)
Artrodesis/efectos adversos , Articulación Metatarsofalángica/cirugía , Complicaciones Posoperatorias/cirugía , Reoperación/estadística & datos numéricos , Anciano , Artrodesis/instrumentación , Artroplastia , Remoción de Dispositivos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Metatarsalgia/cirugía , Persona de Mediana Edad , Osteoartritis/cirugía , Osteotomía , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de TiempoRESUMEN
The aim of the study is to provide some characteristic parameters of the anatomy of metatarsals from computed tomography (CT) scans. These data are important for more anatomical metatarsal head resurfacing prosthesis conception. Measures were performed on 20 CT scans from 17 patients with a mean age of 44.35 ± 15.75 years old. The panel was composed of 40% male and 50% left feet. Measurements were divided in 2 distinct categories: linear measurements with length of metatarsal, head radius and head, and diaphysis and base thicknesses, and cross-sectional area measurements, including cortical and cancellous bone area at 10%, 25%, 50%, 60%, 75%, and 90% of the metatarsal's length. The results included the mean and SD found for each measured value. This study is the first step toward a better understanding of the metatarsal's anatomy, so as to design a more anatomical range of metatarsal head resurfacing implants. LEVELS OF EVIDENCE: Level IV.
Asunto(s)
Artroplastia de Reemplazo/métodos , Huesos Metatarsianos/anatomía & histología , Huesos Metatarsianos/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Huesos Metatarsianos/cirugía , Articulación Metatarsofalángica/anatomía & histología , Articulación Metatarsofalángica/diagnóstico por imagen , Articulación Metatarsofalángica/cirugía , Persona de Mediana Edad , Estudios Prospectivos , Diseño de Prótesis , Sensibilidad y EspecificidadRESUMEN
Myriad forms of fixation have been proposed for arthrodesis of the first metatarsophalangeal joint (MTPJ). Regardless of fixation type, nonunion of the arthrodesis site has been purported as a common complication. The authors performed a retrospective analysis of all patients undergoing arthrodesis of the first MTPJ for severe hallux valgus with 2 crossed, flexible titanium intramedullary nails and a dorsal static 10-mm titanium staple followed by immediate protected weightbearing. Patients were included if they had: surgery for severe hallux valgus of the first MTPJ; undergone the exact internal fixation technique described; not undergone bilateral surgery in the same setting; weightbearing preoperative radiographs; at least 6-week postoperative weightbearing radiographs; initiated weightbearing on the operative foot immediately postoperative in a protective shoe; been followed up clinically for at least 6 months' time postoperatively; and documentation of any complications. One hundred fifty-six female patients (195 feet) with a mean age of 67 ± 9.3 years met the inclusion criteria. Complications due to technical error during insertion of the crossed, flexibe titanium intramedullary nails occurred in 22 (11.3%) feet, but none led to revision surgery. There were 5 (2.6%) asymptomatic nonunions and 1 (0.5%) delayed union, but this ultimately united. The incidence of nonunion after arthrodesis of the first MTPJ using the specific internal fixation construct presented here for severe hallux valgus is lower than the historic mean for most other fixation techniques. However, there is still a need for methodologically sound prospective cohort studies that compare the technique presented here with other modern osteosynthesis techniques.
Asunto(s)
Artrodesis/instrumentación , Clavos Ortopédicos , Hallux Valgus/cirugía , Articulación Metatarsofalángica/cirugía , Complicaciones Posoperatorias , Anciano , Artrodesis/métodos , Femenino , Hallux Valgus/diagnóstico por imagen , Humanos , Articulación Metatarsofalángica/diagnóstico por imagen , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía , TitanioRESUMEN
Myriad forms of fixation have been proposed for arthrodesis of the first metatarsal-phalangeal joint (MTPJ). Regardless of the fixation type, nonunion of the arthrodesis site has been purported to be a common complication. We performed a retrospective review of all patients undergoing arthrodesis of the first MTPJ for end-stage hallux rigidus with 2 crossed flexible titanium intramedullary nails and a dorsal static 10-mm titanium staple followed by immediate protected weight-bearing. The inclusion criteria were as follows: the exact internal fixation technique described was employed for end-stage hallux rigidus of the first MTPJ only; preoperative and at least 6 weeks of postoperative weight-bearing radiographs were available; weight-bearing was initiated on the operative foot immediately in a protective shoe; the patient was followed for at least 6 months postoperatively; any complication was documented; and bilateral surgery was not done in the same setting. A total of 42 female patients (51 feet) with a mean age ± SD of 69.4 ± 9.2 years met the inclusion criteria. Complications resulting from technical error during insertion of the crossed titanium flexible intramedullary nails occurred in 3 feet (5.9%), but none led to nonunion or revision surgery. One delayed union (2%) occurred but it ultimately united. The incidence of nonunion after arthrodesis of the first MTPJ consisting of 2 crossed flexible titanium intramedullary nails and a dorsal static 10-mm titanium staple for end-stage hallux rigidus in an exclusively female population was lower than the historic mean for most other fixation techniques. However, methodologically sound prospective cohort studies that focus on the use of isolated arthrodesis of the first MTPJ for end-stage hallux rigidus in both male and female patients are still needed, as are comparisons of the presented technique with other modern osteosynthesis techniques.
Asunto(s)
Artrodesis/métodos , Clavos Ortopédicos , Hallux Rigidus/cirugía , Articulación Metatarsofalángica/cirugía , Complicaciones Posoperatorias/epidemiología , Titanio , Soporte de Peso , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Hallux Rigidus/diagnóstico , Humanos , Incidencia , Masculino , Articulación Metatarsofalángica/diagnóstico por imagen , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Diseño de Prótesis , Radiografía , Estudios Retrospectivos , Técnicas de Sutura/instrumentación , Suturas , Estados Unidos/epidemiologíaRESUMEN
Myriad forms of fixation have been proposed for arthrodesis of the first metatarsal-phalangeal joint (MTPJ). Regardless of fixation type, nonunion of the arthrodesis site has been purported as a common complication. We performed a retrospective review of all patients undergoing arthrodesis of the first MTPJ with crossed flexible titanium intramedullary nails and a dorsal static staple followed by immediate protected weight bearing. The subjects were included if they had undergone the exact internal fixation technique described; surgery had been performed only by 1 of us; and they had not undergone bilateral surgery in the same setting. Also, the indication for surgery was required to be pathology of the first MTPJ other than rheumatoid arthritis. Weight bearing preoperative radiographs and weight bearing radiographs at least 6 weeks postoperatively were required. Also, the patients had to have initiated weight bearing on the operative foot immediately postoperatively in a protective shoe. Finally, documentation of any complications was required. A total of 83 patients (95 feet) met the inclusion criteria and were included. Of the 83 patients, 77 (92.7%) were female and 6 (7.3%) were male. Their mean age ± standard deviation was 69.7 ± 16.7 years. Of the 95 feet, 55 (57.9%) were right and 40 (42.1%) were left feet. The indications included 61 (64.2%) with severe hallux valgus deformity, 24 (25.3%) with hallux rigidus, and 10 (9.5%) with failed first MTPJ surgery. Complications related to technical error during insertion of the crossed titanium flexible intramedullary nails occurred in 16 feet (16.8%) but none led to nonunion or revision surgery. A total of 3 asymptomatic nonunions (3.2%) occurred, all in female patients with severe hallux valgus that did not require revision surgery. The incidence of nonunion after arthrodesis of the first MTPJ consisting of crossed flexible titanium intramedullary nails and a dorsal static staple for predominantly severe hallux valgus and hallux rigidus was lower than the historic mean for most other fixation techniques. However, methodologically sound prospective cohort studies are still needed that focus on the use of isolated arthrodesis of the first MTPJ for purely severe hallux valgus or hallux rigidus and a comparison of the technique we have presented with other modern osteosynthesis techniques.
Asunto(s)
Artrodesis/instrumentación , Artrodesis/métodos , Clavos Ortopédicos , Articulación Metatarsofalángica/cirugía , Suturas , Soporte de Peso , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hallux Rigidus/cirugía , Hallux Valgus/cirugía , Humanos , Masculino , Articulación Metatarsofalángica/diagnóstico por imagen , Persona de Mediana Edad , Oseointegración , Periodo Posoperatorio , Radiografía , Estudios Retrospectivos , TitanioRESUMEN
Myriad forms of fixation have been proposed for arthrodesis of the first metatarsal-phalangeal joint (MTPJ). However, nonunion of the arthrodesis site remains a common complication. The authors performed a retrospective review of all patients undergoing arthrodesis of the first MTPJ with flexible titanium intramedullary nails alone or supplemented with static staples followed by immediate protected weight bearing. Subjects were included if they had surgery performed only by one of us; not undergone bilateral surgery in the same setting; surgery for pathology of the first MTPJ other than rheumatoid arthritis; weight-bearing preoperative radiographs; postoperative weight-bearing radiographs demonstrating presence or absence of union at the arthrodesis site; initiated weight bearing on the operative foot immediately postoperative in a protective shoe; and documentation of any complications. A total of 128 patients (148 feet) met inclusion criteria and were included. There were 110 (85.9%) females and 18 (14.1%) males with a mean age ± SD of 64 ± 14.1 years. Indications included (a) 93 (62.8%) severe hallux valgus deformity, (b) 37 (25%) hallux rigidus, and (c) 18 (12.2%) failed first MTPJ surgeries. Ten different configurations where included based on the requirements needed to achieve a solid construct intraoperatively. There were a total of 9 (6.1%) complications consisting of 4 (2.7%) asymptomatic nonunions, 4 (2.7%) hardware removals, and 1 (0.7%) loss of reduction requiring revision surgery. The incidence of nonunion with flexible titanium intramedullary nails alone or supplemented with static staples followed by immediate protected weight bearing for predominantly severe hallux valgus and hallux rigidus is lower than the historic mean for most other fixation techniques. However, there is still a need for methodologically sound prospective cohort studies that focus on the use of isolated arthrodesis of the first MTPJ for purely severe hallux valgus or hallux rigidus, and comparison of the technique presented here with other modern osteosynthesis techniques. Levels of Evidence : Therapeutic, Level IV.