Replacement of the First Metatarsophalangeal Joint

Kundert, Hans-Peter; Knessl, Jürg; Zollinger-Kies, Hans

doi:10.1097/01.btf.0000173657.90773.2f

Cited by 6 publications

(2 citation statements)

References 16 publications

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“…This is independent of the adverse orientation of the metatarsal component to raise the dorsal extension to be parallel to the impact plane as described by Kundert and co-workers [16].…”

Section: Discussionmentioning

confidence: 84%

“…The only clinical observation is the too stiff artificial MTP1 joint, which causes pain during roll off and induces a negative effect on the affected bones due to relieving load transfer onto the outer foot and altered gait [12][13][14][15][16]. This risk can be minimized by means of precise surgical technique in accordance with the surgical instructions.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of hallux rigidus with the TOEFIT-PLUS™ joint replacement system

Seeber

Knessl²

2007

Interact Surg

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Background: Hemi-and total-replacement of the first metatarsophalangeal joint (MTP1) remains controversial due to failures observed in earlier decades. The TOEFIT-PLUS TM system was developed in part to address these earlier failures, but published reports investigating its use have been limited.Materials: The TOEFIT-PLUS TM MTP1 joint replacement system is designed with a self-tapping thread on a conical titanium core that provides cement-free, primary stable anchorage and focal pressure reduction in the corticocancellous bone due to an enlarged surface area. The modular design allows surgeons to decide intraoperatively whether to proceed with hemi-or total arthroplasty. Data from 3 studies are presented: 64 patients receiving total prostheses and followed-up annually (Seeber); 12 hemi-prostheses in 10 patients with 5.1 years average follow-up and 6 total prostheses in 5 patients with 1.5 years average follow-up (Knessl); and 54 prostheses (14 hemi-prostheses, 40 total prostheses) in 52 patients followed-up for an average of 3 years (multicenter study).Results: Seeber reported a 42.7-month service life of the prosthesis at the time of follow-up. Five patients (6.8%) were reoperated. Passive hallux motion was 15-18g reater than active motion, and patient satisfaction at follow-up was high. Knessl reported an average range of motion (ROM) in the sagittal plane of 55˚with an average dorsal extension of 25.3˚and plantar flexion of 30˚in patients who received hemi-prostheses. Prosthesis removal was necessary in 3 patients. Prosthesis loosening has not been observed. In patients undergoing total arthroplasty, ROM was recorded at 58˚. A revision operation was necessary in 1 patient. Revision surgery was necessary in 11 patients (21.1%) in the multicenter study. Patient-reported outcomes were favorable.Conclusion: The TOEFIT-PLUS TM joint replacement system offers improved implant stability and is able to handle high biomechanical loads and neutralize shear forces. When compared with other systems, it is associated with reduced osseointegration problems. Intensive postoperative strategies are recommended. Long-term follow-up studies are needed to further investigate the utility of this system.

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“…This is independent of the adverse orientation of the metatarsal component to raise the dorsal extension to be parallel to the impact plane as described by Kundert and co-workers [16].…”

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Treatment of hallux rigidus with the TOEFIT-PLUS™ joint replacement system

Seeber

Knessl²

2007

Interact Surg

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Fusion vs. Arthroplasty in the Treatment of 1st MTP Arthritis

Tan

Yee

Lau

2011

Evidence‐Based Orthopedics

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Endoprothetik bei Hallux rigidus

Kundert

Zollinger-Kies

2005

Orthopäde

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Replacement of the first metatarsophalangeal joint (MTP1) is still controversial when compared with MTP1 fusion in treating hallux rigidus and other disabling conditions of the MTP1 joint. Prospective studies concerning endoprosthetic replacement of the MTP1 joint are not available yet. Nevertheless, better understanding of biomechanics and tribology show favour towards total endoprosthesis. Some currently available models are described (Toefit-Plus, Roto-glide, ReFlexion, Bio-Action, Moje). Furthermore the authors report their results with 30 Toefit-Plus total endoprostheses. Five complications (16.6%) included two dislocations of total prostheses and three bone fissures. In 3 of 14 cases (21%) with a 3-year follow-up, revision surgery was necessary (subluxation, persistent pain, recurrence of hallux rigidus). Of 11 cases (63%) with a 4-year follow-up, 7 revealed secondary loss of range of motion. A more aggressive postoperative treatment with early weight bearing and regular push-off of the first ray is recommended. Based on our results, MTP1 replacement should be indicated restrictively (hallux rigidus, no experiments in cases of important first ray insufficiency).

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Replacement of the First Metatarsophalangeal Joint

Cited by 6 publications

References 16 publications

Treatment of hallux rigidus with the TOEFIT-PLUS™ joint replacement system

Treatment of hallux rigidus with the TOEFIT-PLUS™ joint replacement system

Fusion vs. Arthroplasty in the Treatment of 1st MTP Arthritis

Endoprothetik bei Hallux rigidus

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