Department of Orthopaedics and Traumatology, Konya City Hospital, Konya, Turkey.
Department of Orthopaedics and Traumatology, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, Turkey.
J Orthop Surg Res. 2024 Aug 27;19(1):508. doi: 10.1186/s13018-024-04995-3.
The treatments for hallux rigidus (HR) encompass a wide spectrum, including conservative methods and surgical approaches such as arthroplasty and arthrodesis. This study aims to evaluate the outcomes of revision with arthrodesis following the failure of the first metatarsophalangeal joint total arthroplasty (MTPJ1TA).
Patients who had surgery at two advanced orthopedic centers between January 1, 2020, and January 1, 2024, were reviewed. Those with at least 6 months of postoperative follow-up were assessed for demographics (gender, age, side), reoperation rates, complications, Visual Analogue Scale (VAS) scores, Foot and Ankle Disability Index (FADI) scores, and American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal and Interphalangeal Scale (AOFAS-HMI) scores. Radiological evaluations included hallux valgus angle (HVA), intermetatarsal angle (IMA), dorsiflexion angle (DFA), and first ray length (FRL) in anteroposterior and lateral views.
Of 27 patients, 4 were male (15%) and 23 female (85%), with an average age of 56.18 ± 7.49 years (range 41-72). Arthrodesis was performed in 26 patients, with one requiring reoperation due to implant failure. Average VAS scores were 7.14 preoperatively and 3.55 postoperatively (p < 0.05). Average FADI scores were 50.51 preoperatively and 71.51 postoperatively (p < 0.05). Average AOFAS-HMI scores were 51.22 preoperatively and 70.59 postoperatively (p < 0.05). Average HVA was 19.7° preoperatively and 6.29° postoperatively (p < 0.05). Average IMA was 10.66° preoperatively and 11.37° postoperatively (p = 0.406). Average DFA was 34.14° preoperatively and 22.33° postoperatively (p < 0.05). Average anteroposterior FRL was 10.17 cm preoperatively and 10.77 cm postoperatively (p < 0.05). Average lateral FRL was 10.12 cm preoperatively and 10.42 cm postoperatively (p < 0.05). None of the patients in the study exhibited postoperative donor site complications or transfer metatarsalgia, while a 100% rate of bone union was observed.
We think that revision of MTPJ1TA with arthrodesis is a safe treatment option. Additionally, the use of an iliac crest autograft can be a viable option to restore bone stock and create a biological environment conducive to fusion. This study evaluates revision surgery with arthrodesis in the largest patient group with failed MTPJ1TA, highlighting its significance in the field. However, further studies are needed to determine the ideal surgical procedure.
治疗拇僵硬（HR）包括广泛的治疗方法，包括保守方法和关节成形术和关节融合术等手术方法。本研究旨在评估第一跖趾关节全关节置换术（MTPJ1TA）失败后融合术翻修的结果。
对 2020 年 1 月 1 日至 2024 年 1 月 1 日在两家高级骨科中心接受手术的患者进行了回顾性分析。对至少有 6 个月术后随访的患者进行了人口统计学（性别、年龄、侧别）、再次手术率、并发症、视觉模拟评分（VAS）、足踝残疾指数（FADI）和美国矫形足踝协会拇趾跖趾关节和趾间关节评分（AOFAS-HMI）的评估。影像学评估包括拇外翻角（HVA）、跖间角（IMA）、背屈角（DFA）和第一跖骨长度（FRL）在前后位和侧位。
27 例患者中，男性 4 例（15%），女性 23 例（85%），平均年龄 56.18±7.49 岁（41-72 岁）。26 例患者行融合术，1 例因植入物失败需再次手术。术前 VAS 平均评分 7.14 分，术后 3.55 分（p<0.05）。术前 FADI 平均评分 50.51 分，术后 71.51 分（p<0.05）。术前 AOFAS-HMI 平均评分为 51.22 分，术后为 70.59 分（p<0.05）。术前 HVA 平均为 19.7°，术后为 6.29°（p<0.05）。术前 IMA 平均为 10.66°，术后为 11.37°（p=0.406）。术前 DFA 平均为 34.14°，术后为 22.33°（p<0.05）。术前前后位 FRL 平均为 10.17 cm，术后为 10.77 cm（p<0.05）。术前侧位 FRL 平均为 10.12 cm，术后为 10.42 cm（p<0.05）。研究中无患者出现术后供区并发症或转移性跖痛，且均观察到 100%的骨愈合率。
我们认为 MTPJ1TA 融合术翻修是一种安全的治疗选择。此外，使用髂嵴自体骨移植物是一种可行的选择，可以恢复骨量并创造有利于融合的生物环境。本研究评估了最大一组 MTPJ1TA 失败后融合术翻修的手术，突出了其在该领域的重要性。然而，还需要进一步的研究来确定理想的手术方案。
