Horisberger Monika, Haeni David, Henninger Heath B, Valderrabano Victor, Barg Alexej
Department of Orthopaedic Surgery, University Hospital of Basel, Basel, Switzerland
Department of Orthopaedic Surgery, University Hospital of Basel, Basel, Switzerland.
Foot Ankle Int. 2016 Jul;37(7):755-65. doi: 10.1177/1071100716637901. Epub 2016 Mar 15.
The current gold standard in the treatment of severe hallux rigidus is arthrodesis of the first metatarsophalangeal (MTP-I) joint. We present the results of a new 3-component MTP-I prosthesis. We determined (1) the intraoperative and perioperative complications; (2) survivorship of prosthesis components and rate of secondary surgeries for any reason; (3) prosthetic component stability and radiographic alignment; (4) the degree of pain relief; and (5) the midterm functional outcomes including radiographic range of motion (ROM).
From 2008 to 2010, we prospectively included 29 MTP-I prostheses in 25 patients. The average age of the patients was 63.1 years (range, 48-87 years). The average follow-up was 49.5 months (range, 36-62 months). We observed complications and reoperations. A visual analog scale for pain and the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score were obtained pre- and postoperation. Component stability and alignment were assessed using weight-bearing radiographs. Fluoroscopy was used to determine radiographic MTP-I ROM.
Seven (24.1%) patients underwent 1 or more secondary surgeries. Four cases (13.7%) eventually had a conversion to MTP-I arthrodesis. Two patients (3 cases) died from causes not related to the procedure. This left 22 feet in 19 patients for final follow-up. All but 3 remaining prostheses showed stable osteointegration and no migration, but MTP-I alignment showed high variability. The average pain score decreased from 5.9 (range, 3-9) to 1.2 (range, 0-5). The average AOFAS forefoot score increased from 55 (range, 0-80) to 83.5 (range, 58-95). Range of motion initially increased from 37.8 degrees (range, 0-60 degrees) to 88.6 degrees (range, 45-125 degrees) intraoperatively and decreased to 29.0 degrees (range, 11-52 degrees) at latest follow-up.
Our data suggest that total arthroplasty of MTP-I leads to a high amount of revision surgeries, but the remaining patients had significant pain relief at midterm follow-up. However, we observed high variability regarding the prosthesis component alignment and poor range of motion.
Level IV, prospective cohort study.
目前治疗重度拇僵硬的金标准是第一跖趾（MTP-I）关节融合术。我们展示了一种新型的三组件MTP-I假体的治疗结果。我们确定了：（1）术中及围手术期并发症；（2）假体组件的生存率及因任何原因进行二次手术的发生率；（3）假体组件的稳定性及影像学对线情况；（4）疼痛缓解程度；（5）中期功能结果，包括影像学活动范围（ROM）。
2008年至2010年，我们前瞻性纳入了25例患者的29个MTP-I假体。患者的平均年龄为63.1岁（范围48 - 87岁）。平均随访时间为49.5个月（范围36 - 62个月）。我们观察了并发症及再次手术情况。术前及术后获取疼痛视觉模拟评分以及美国矫形足踝协会（AOFAS）前足评分。使用负重X线片评估组件稳定性及对线情况。通过荧光透视确定影像学MTP-I关节活动范围。
7例（24.1%）患者接受了1次或更多次二次手术。4例（13.7%）最终转为MTP-I关节融合术。2例患者（3例）因与手术无关的原因死亡。这使得19例患者的22只足可供最终随访。除3个剩余假体之外，所有假体均显示稳定的骨整合且无移位，但MTP-I关节对线情况存在高度变异性。平均疼痛评分从5.9（范围3 - 9）降至1.2（范围0 - 5）。平均AOFAS前足评分从55（范围0 - 80）增至83.5（范围58 - 95）。术中活动范围最初从37.8度（范围0 - 60度）增至88.6度（范围45 - 125度），在最近一次随访时降至29.0度（范围11 - 52度）。
我们的数据表明，MTP-I全关节置换术导致大量翻修手术，但其余患者在中期随访时疼痛得到显著缓解。然而，我们观察到假体组件对线存在高度变异性且活动范围较差。
IV级，前瞻性队列研究。
