OrthoCarolina, Charlotte, NC, USA.
Foot Ankle Int. 2013 Sep;34(9):1227-32. doi: 10.1177/1071100713488093. Epub 2013 Apr 23.
Arthrodesis is currently the most commonly performed surgical procedure for the treatment of arthritis of the first metatarsophalangeal (MTP) joint. Hemiarthroplasty of the first MTP joint has been shown to have inferior clinical results and higher revision rates. The objective of this study was to assess the clinical outcome of the salvage of failed hallux phalangeal hemiarthroplasty with conversion to arthrodesis.
A retrospective review of patients who underwent salvage of the first MTP joint hemiarthroplasty with conversion to arthrodesis was performed. Preoperative assessment included the visual analog pain (VAP) scale and AOFAS Hallux Metatarsophalangeal Interphalangeal scoring system (AOFAS-HMI). Postoperative outcomes were graded via AOFAS-HMI, VAP, and Foot and Ankle Ability Measure (FAAM).
Twenty-one hemiarthroplasties were converted to arthrodesis in 21 patients, with 18 available for follow-up included in the study. There were 13 women and 5 men. Local autologous bone graft was used in 12 cases, while 6 patients required tricortical iliac crest bone graft for the treatment of extensive bone loss. At final follow-up, at a mean of 4.3 years, the average VAS pain score had diminished to 0.75 from 7.8 preoperatively out of 10, while the mean AOFAS-HMI improved from 36.2 out of 100 preoperatively to 85.3 out of 90 (modified to exclude first MTP motion). The mean FAAM ADL/sports were 97.3/91.3, respectively. All patients achieved fusion although at a longer interval than primary fusions.
Conversion from a failed hallux phalangeal hemiarthroplasty to arthrodesis showed similar success to primary arthrodesis which was achieved in the majority of cases with the use of regional bone graft for small defects. However, the time to fusion was longer than that of primary arthrodesis, and it sometimes required structural bone graft for augmentation.
Level IV, retrospective case series.
关节融合术目前是治疗第一跖趾（MTP）关节关节炎最常施行的手术。第一 MTP 关节的半关节成形术已被证明临床效果较差，翻修率较高。本研究的目的是评估初次 MTP 关节半关节成形术失败后行补救性融合术的临床结果。
对行第一 MTP 关节半关节成形术失败后行补救性融合术的患者进行回顾性研究。术前评估包括视觉模拟疼痛（VAP）评分和美国足踝外科协会（AOFAS）拇趾 MTP 间关节-中跗关节评分系统（AOFAS-HMI）。术后通过 AOFAS-HMI、VAP 和足踝能力测量（FAAM）来评估结果。
21 例患者共 21 例半关节成形术改行融合术，其中 18 例获得随访纳入研究。患者中女性 13 例，男性 5 例。12 例采用局部自体骨移植，6 例因广泛骨丢失需要三叶髂嵴骨移植。末次随访时，平均 4.3 年，VAP 疼痛评分从术前的 10 分 7.8 分降至 0.75 分，AOFAS-HMI 从术前的 100 分 36.2 分提高到 90 分（改良后不包括第一 MTP 关节活动度）。FAAM 日常生活/运动评分分别为 97.3/91.3。所有患者均获得融合，但融合时间长于初次融合，且需要结构性植骨来增加骨量。
初次 MTP 关节半关节成形术失败后改行融合术的成功率与初次融合术相似，大多数病例采用局部骨移植治疗小面积骨缺损即可获得成功。但融合时间长于初次融合，有时需要结构性植骨来增加骨量。
IV 级，回顾性病例系列。
