Incidence and outcomes of revision surgery after first metatarsophalangeal joint arthrodesis: Multicenter study of 158 cases

Gaudin, Gaël; Coillard, Jean-Yves; Augoyard, Marc; Tourné, Y.; Meusnier, Tristan; Beaudet, Philippe; Bernard, Jean-Noël; Augoyard, R.; Besse, Jean-Luc

doi:10.1016/j.otsr.2018.08.011

Cited by 16 publications

(7 citation statements)

References 23 publications

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“…While implant prices vary widely depending on vendor-hospital contracts, Hyer et al found that a dorsal plate construct for first MTPJ arthrodesis cost $603 on average [ 13 ]. Second, rates of symptomatic hardware requiring implant removal after first MTPJ fusion have been reported to be as high as 17% [ 14 ]; this complication is eliminated if no hardware is used. We used allograft bone to create our construct.…”

Section: Discussionmentioning

confidence: 99%

“…Second, setting and maintaining the position of the great toe are more difficult without an implant to hold the correct position. With an implant, the recommended fusion angles of ten to 20 degrees of hallux dorsiflexion and valgus [ 14 ] can be set and maintained by the hardware. In our case, the bone dowels were contoured and the bone graft packed in a manner to set the position of the toe, but there is an increased risk that the toe could drift to an improper position.…”

Section: Discussionmentioning

confidence: 99%

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First Metatarsal Phalangeal Joint Arthrodesis without the Use of Hardware after Failed Arthroplasty: A Case Report

Adamson

Janney

Chen

et al. 2021

JOCR

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Introduction: First metatarsal phalangeal joint (MTPJ) arthroplasty has a high failure rate due to aseptic loosening, which leads to bone loss. The salvage procedure is conversion to an arthrodesis, but bone loss can make obtaining screw fixation difficult. Herein, we report a unique case of revision first-metatarsal arthrodesis without the use of hardware after a failed arthroplasty. Case Report: A 60-year-old women presented to us with first MTPJ pain in the setting of failed arthroplasty. We performed an arthrodesis; however, intraoperatively, hardware fixation could not be obtained due to bone loss. We utilized allograft bone struts to maintain first ray length and to hold the correct hallux position during arthrodesis maturation. Conclusion: Bone loss is a frequently encountered problem in revision surgery to a first MTPJ arthrodesis. An arthrodesis can be obtained without the use of hardware in scenarios where bone loss precludes screw fixation. Keywords: Hallux rigidus, revision, bone loss, arthrodesis

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

First Metatarsal Phalangeal Joint Arthrodesis without the Use of Hardware after Failed Arthroplasty: A Case Report

Adamson

Janney

Chen

et al. 2021

JOCR

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“…Although MTP1 joint arthrodesis is commonly described as a safe and effective procedure, the incidence of surgical revision after this procedure is not insignificant. The incidence of nonunion ranges from 5.4% to 10%, and hardware removal rates comprise 8.5% of cases [ 9 , 10 ]. The major causes of failures are related to the hardware.…”

Section: Introductionmentioning

confidence: 99%

Medially positioned plate in first metatarsophalangeal joint arthrodesis

et al. 2021

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Objective The purpose of this study was to biomechanically compare the stability of first metatarsophalangeal (MTP1) joint arthrodesis with dorsally and medially positioned plates. Methods A physical model of the MTP1 joint consists of printed synthetic bones, a titanium locking plate and screws. In the experiments, samples with dorsally and medially positioned plates were subjected to loading of ground load character in a universal testing machine. Force-displacement relations and relative displacements of bones were recorded. The obtained results were used to validate the corresponding finite element models of the MTP1 joint. Nonlinear finite element simulations of the toe-off phase of gait were performed to determine the deformation and stress state in the MTP1 joint for two positions of the plate. Results In numerical simulations, the maximum displacement in the dorsal direction was noticed at the tip of the distal phalanx and was equal to 19.6 mm for the dorsal plate and 9.63 mm for the medial plate for a resultant force of 150 N. Lower relative bone displacements and smaller plastic deformation in the plate were observed in the model with the medial plate. Stress values were also smaller in the medially positioned plate and locking screws compared to fixation with the dorsal plate. Conclusions A medially positioned locking plate provides better stability of the MTP1 joint than a dorsally positioned plate due to greater vertical bending stiffness of the medial plate. Smaller relative bone displacements observed in fixation with the medial plate may be beneficial for the bone healing process. Moreover, lower stress values may decrease the risk of complications associated with hardware failure.

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“… 2 Malunion (incidence of 6.1%) can occur in the sagittal, frontal, and transverse planes, especially at the sagittal plane. 2 , 7 , 8 , 9 Excessive plantar pressure can occur under the first metatarsal head, and, most of the time, it is due to excessive dorsiflexion resulting in increased plantar pressure at the first metatarsophalangeal joint, compensatory interphalangeal joint hyperflexion, and dorsal impingement of the great toe against the shoe wear. 2 , 6 This is typically treated by corrective osteotomy if conservative treatment fails to relieve symptoms.…”

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confidence: 99%

“… 2 , 6 This is typically treated by corrective osteotomy if conservative treatment fails to relieve symptoms. 9 In case of excessive plantar pressure at the fused first metatarsophalangeal joint with relatively normal sagittal alignment of the great toe, sesamoidectomy is an alternative surgical option. First metatarsophalangeal sesamoidectomy is a well-established procedure for intractable plantar keratosis, sesamoiditis, painful metatarsosesamoid osteoarthritis refractory to conservative treatment, sesamoidal osteomyelitis avascular necrosis, osteochondrosis and nonunion of sesamoid fractures.…”

mentioning

confidence: 99%

Arthroscopic Sesamoidectomy and Plantar Metatarsal Head Bone Shaving in Management of First Metatarsal Head Metatarsalgia After First Metatarsophalangeal Fusion

Chan,

Lui

2023

Arthroscopy Techniques

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Incidence and outcomes of revision surgery after first metatarsophalangeal joint arthrodesis: Multicenter study of 158 cases

Cited by 16 publications

References 23 publications

First Metatarsal Phalangeal Joint Arthrodesis without the Use of Hardware after Failed Arthroplasty: A Case Report

First Metatarsal Phalangeal Joint Arthrodesis without the Use of Hardware after Failed Arthroplasty: A Case Report

Medially positioned plate in first metatarsophalangeal joint arthrodesis

Arthroscopic Sesamoidectomy and Plantar Metatarsal Head Bone Shaving in Management of First Metatarsal Head Metatarsalgia After First Metatarsophalangeal Fusion

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