Polyvinyl Alcohol Hydrogel Hemiarthroplasty of the First Metatarsophalangeal Joint Augmented With 3D-printed Baseplate

Madi, Naji S.; Chopra, Aman; Parekh, Selene G.

doi:10.1097/btf.0000000000000351

Cited by 1 publication

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“…They attributed this poor satisfaction rate to higher rates of psoriatic arthritis and concomitant sesamoidal arthritis of the female population in the sample. Additionally, they concluded that the higher prevalence of osteoporosis in postmenopausal women may impede the integrity of the press-fit technique of implant introduction into the metatarsal head [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Polyvinyl Alcohol Hydrogel Hemiarthroplasty of First Metatarsophalangeal Joint Hallux Rigidus

Anastasio,

Chopra,

Madi

et al. 2024

Cureus

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Background Hallux rigidus (HR) is the most common arthritic condition of the foot. Although first metatarsophalangeal joint (MTPJ) arthrodesis has been the historical gold-standard treatment, polyvinyl alcohol (PVA) hydrogel implants have gained popularity as a joint-sparing technique. However, recent studies have shown variable failure rates of PVA hydrogel implants. The purpose of this study was to report the five-year experience with PVA hydrogel implants performed by a single surgeon. Methodology Health records were queried from August 2016 to 2021 for patients who underwent primary PVA hydrogel implant hemiarthroplasty for symptomatic late-stage HR. Patient demographics and postoperative outcomes variables were evaluated. Kaplan-Meier analysis was used to evaluate implant survival. A total of 146 PVA hydrogel implant procedures were performed with a minimum six-month follow-up. Results The majority of patients were female (n = 103, 70.5%), with a mean age of 58.1 (±10.1) years, body mass index of 27.3 (±5.2) kg/m 2 , and American Society of Anesthesiologists score <3 (n = 131, 89.7%). The majority had stage II or III disease (n = 115, 78.8%). Patients experienced significant improvement in visual analog scale score (p < 0.0001) and hallux dorsiflexion (p = 0.0005). There were 22 (15.1%) complications, including implant subsidence (n = 15, 10.3%), deep infection (n = 6, 4.1%), and hypertrophic ossification (n = 1, 0.7%). Revision surgeries were required in 12.3% (n = 18) of patients at an average of 9.4 (±9.2) months postoperatively. This included nine (6.2%) revision PVA hydrogel implant procedures and nine (6.2%) first MTJP arthrodesis. The one- and two-year survival rates for MTPJ arthrodesis (n = 9) were 95.9% and 86.3%, respectively. Conclusions In the largest single-surgeon series reported, first MTPJ hemiarthroplasty with a PVA hydrogel implant significantly improved pain and hallux dorsiflexion at an average of 14.5 months postoperatively. There was a high two-year survivorship of 86.3% until failure which required first MTPJ arthrodesis. Future studies should be performed to refine the indications for PVA hydrogel implants and identify risk factors.

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Section: Discussionmentioning

confidence: 99%

“…After final fluoroscopic images were obtained, the MTPJ capsule and skin were closed in a layered fashion with vicryl suture for the deep layers and silk suture for the skin [ 20 ]. Postoperative oblique, anteroposterior, lateral, and weight-bearing films were obtained to confirm the proper placement of hardware (Figure 5 ).…”

Section: Methodsmentioning

confidence: 99%