Arthrodesis of the First Metatarsophalangeal Joint to Salvage Failed Silicone Implant Arthroplasty
| Autor: | Samuel A. Hoisington, Chris Cooke, Paul J. Hecht, Keith L. Wapner, Michael J. Gibbons |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Adult
Male Metatarsophalangeal Joint medicine.medical_specialty medicine.medical_treatment Arthrodesis 0206 medical engineering Silicones 02 engineering and technology Arthroplasty Arthritis Rheumatoid 03 medical and health sciences 0302 clinical medicine Refractory Humans Medicine Orthopedics and Sports Medicine Treatment Failure Aged Retrospective Studies Salvage Therapy business.industry Prostheses and Implants 030229 sport sciences Silicone implant Middle Aged 020601 biomedical engineering Surgery Conservative treatment Female business Follow-Up Studies |
| Zdroj: | Foot & Ankle International. 18:383-390 |
| ISSN: | 1944-7876 1071-1007 |
| DOI: | 10.1177/107110079701800702 |
| Popis: | Between 1987 and 1992, all patients presenting to the senior author with a symptomatic failed silicone implant arthroplasty refractory to conservative treatment were converted to a metatarsophalangeal joint arthrodesis. Internal fixation was achieved with either dual intramedullary threaded Steinmann pins or an obliquely placed AO compression screw and a three- or four-hole one-third tubular dorsal neutralization plate. Bone grafting was used to maintain hallux length. Successful arthrodesis was achieved in all five feet in patients with rheumatoid arthritis. Subjectively, patients improved from an average of 0.69 before arthrodesis to 4.89 after arthrodesis. The average walking tolerance improved from 1.11 to 4.80, and the overall level of satisfaction improved from 0.0 to 4.79. The patient's ability to wear shoes improved from 0.87 to 3.1.Successful arthrodesis produces a foot that is more functional and durable than excisional arthroplasty. Subjectively, these patients stated that their level of pain, walking tolerance, and overall satisfaction improved significantly after the arthrodesis. Clinically, there was no evidence of transfer lesions, tenderness, or hallux subluxation. Hallux length was well maintained after surgery with bone grafting, but it was more difficult to obtain the alignment goals. The average postoperative metatarsophalangeal dorsiflexion angle was 15.6° and the first metatarsophalangeal angle was 3.1°. Despite this, patient satisfaction was high.Arthrodesis of the first metatarsophalangeal joint using a bone graft to salvage failed silicone implant arthroplasty produces acceptable subjective and radiographic results. Although technically demanding, it provides long-term stability to the hallux, restores weightbearing, and allows for maintenance of a propulsive gait. We recommend this procedure instead of an excisional arthroplasty to maintain high level of function and overall patient satisfaction. |
| Databáze: | OpenAIRE |
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