University of Pittsburgh, Pittsburgh, PA 15215, USA.
Foot Ankle Int. 2013 May;34(5):716-25. doi: 10.1177/1071100713478930. Epub 2013 Feb 13.
Advanced stages of first metatarsophalangeal (MTP) arthritis have traditionally been treated with various arthroplasties or arthrodesis. Studies suggest the outcomes of arthrodesis are superior to those of metallic joint replacement; however, complications and suboptimal outcomes in active patients still remain with arthrodesis of the first MTP joint. This study reports results of patients with advanced MTP arthritis who underwent metallic resurfacing of the metatarsal side of the MTP joint.
From 2005 to 2006, 26 patients (30 implants) with stage II or III hallux rigidus underwent resurfacing with the HemiCAP® implant and consented to participate in a study comparing pre- and postoperative radiographs, range of motion (ROM), American Orthopedic Foot and Ankle Society, and Short Form 36 Health Survey (SF-36) scores. Average age of these patients was 51 years. Patients were assessed at a mean of 27 months with outcome measures and contacted at 60 months to assess current symptoms and satisfaction.
Assessment at 27 months demonstrated statistically significant improvements in ROM, AOFAS, and SF-36 scores (P < .05) when compared to baseline. Mean preoperative AOFAS scores improved from 51.5 to 94.1. Mean active ROM improved from 19.7 to 47.9 degrees. Mean passive ROM improved from 28.0 to 66.3 degrees. Mean RAND SF-36 physical component score improved significantly from 66.7 to 90.6. Average time for return to work was 7 days. At 60 months, all patients reported excellent satisfaction with their current state and would repeat the procedure. Implant survivorship was 87% at 5 years. Of the 30 implants, 4 were revised at 3 years.
The results at 5 years were very promising. Preservation of joint motion, alleviation of pain, and functional improvement data were very encouraging. Because minimal joint resection was performed, conversion to arthrodesis or other salvage procedures would be relatively simple if further intervention became necessary.
Level IV, prospective case series.
第一跖趾关节（MTP）关节炎的晚期传统上采用各种关节成形术或关节融合术治疗。研究表明，关节融合术的结果优于金属关节置换术；然而，对于活动患者，第一 MTP 关节融合术仍存在并发症和不理想的结果。本研究报告了接受 MTP 关节金属表面置换术的晚期 MTP 关节炎患者的结果。
2005 年至 2006 年，26 例（30 个植入物）II 期或 III 期僵硬拇趾接受了 HemiCAP®植入物的表面置换，并同意参加一项比较术前和术后 X 线片、活动范围（ROM）、美国矫形足踝协会和短格式 36 健康调查（SF-36）评分的研究。这些患者的平均年龄为 51 岁。患者在平均 27 个月时进行了评估，并在 60 个月时联系以评估当前症状和满意度。
与基线相比，27 个月时评估显示 ROM、AOFAS 和 SF-36 评分有统计学意义的改善（P<.05）。术前 AOFAS 评分平均从 51.5 提高到 94.1。主动 ROM 平均从 19.7 提高到 47.9 度。被动 ROM 平均从 28.0 提高到 66.3 度。平均 RAND SF-36 生理成分评分从 66.7 显著提高到 90.6。平均恢复工作时间为 7 天。60 个月时，所有患者对目前的状态表示非常满意，并愿意重复该程序。5 年时植入物存活率为 87%。30 个植入物中有 4 个在 3 年内进行了翻修。
5 年的结果非常有希望。关节运动的保留、疼痛的缓解和功能改善的数据非常令人鼓舞。由于进行了最小的关节切除，如果需要进一步干预，转换为关节融合术或其他挽救措施将相对简单。
IV 级，前瞻性病例系列。
