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

Abstract

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.

Recreational sport activity after total replacement of the first metatarsophalangeal joint: a prospective study

“…In literature, the rate of radiolucent lines around the implants after total first MTP joint replacement varies between 3.1% and 33% [9,12,13,24,30,32]. It can be argued that, in our series, a longer follow-up is required in order to fully assess the clinical and radiological outcomes.…”

“…In a recent study, Seeber and Knessl recorded the results in 52 patients followed-up for an average of Fig. 3 Anteroposterior (a) and lateral (b) radiographs 12 months after TOEFIT-PLUS™ system implantation three years after TOEFIT-PLUS™ implantation [32]. Revision surgery was necessary for 11 patients due to infection, dislocation, chronic pain, aseptic loosening, persistent stiffness and traumatic loosening.…”

“…The clinical outcomes after first MTP arthroplasty are satisfactory, even though controversial results have been reported concerning revision rates of hemi-and total arthroplasty [10,12,13,23,24,27,30,32].…”

Hallux rigidus

“…3) und Wundheilungsstörungen (2,5%). Hinzu kommt eine bereits radiologisch erkennbare Implantatlockerung von 42% nach durchschnittlich 3 Jahren [12,13,16].…”

“…Generation) sind die publizierten klinischen Ergebnisse (Nachbeobachtungszeitraum >3 Jahre) mit einem AOFASScore (AOFAS: American Orthopaedic Foot and Ankle Society) von 75-80 Punkten als befriedigend zu bewerten [10,13,16].…”