僵硬性拇趾的治疗：半关节成形术与Cartiva植入物、同种异体骨植入关节成形术及关节融合术的比较
Treatment of Hallux Rigidus: Comparison of Hemiarthroplasty with Cartiva Implant, Allograft Interpositional Arthroplasty, and Arthrodesis.
作者信息
Sanii Ryan, Phan Kevin, Krumm Drew, Patton Daniel J, Madden Tyler, Anderson John G, Maskill John D, Bohay Donald R, Padley Michelle A, Patthanacharoenphon Cameron G
机构信息
The University of Chicago Department of Orthopaedic Surgery, Chicago, IL, USA.
Orthopedic Associates of Michigan, Grand Rapids, MI, USA.
出版信息
Foot Ankle Orthop. 2025 Mar 29;10(1):24730114251324184. doi: 10.1177/24730114251324184. eCollection 2025 Jan.
BACKGROUND
A modern technique for the treatment of hallux rigidus (HR) is first metatarsophalangeal (MTP) hemiarthroplasty with the use of a Cartiva synthetic cartilage implant. Current scientific literature reporting early outcomes of the procedure is sparse and mixed, indicating the need for further analysis. The objective of this study was to compare improvement in visual analog scale (VAS) scores with first MTP hemiarthroplasty with Cartiva implant (HI), allograft interposition arthroplasty (IA), and arthrodesis (A) in patients who failed conservative management or cheilectomy.
METHODS
A retrospective cohort study of 99 patients was performed. There were 49 patients in the HI group, 25 patients in the IA group, and 25 patients in the A group. A follow-up survey was administered from which updated VAS and updated American Orthopaedic Foot & Ankle Society scores were obtained.
RESULTS
Mean VAS scores improved by 2.73 (SD ± 2.80) points in the HI group, 4.16 (SD ± 2.01) points in the IA group, and 4.36 (SD ± 3.67) points in the A group ( = .035). Mean AOFAS scores improved by 14.90 (SD ± 17.31) points in the HI group, 27.80 (SD ± 15.22) points in the IA group, and 27.88 (SD ± 25.34) points in the A group ( = .005). There were 3 (6.1%) revision surgeries in the HI group, 2 (8.0%) revision surgeries in the A group, and no revision surgeries in the IA group ( = .59). Within the HI group, all 3 revisions were due to pain associated with the implant and were revised to MTP arthrodesis. The A group had 1 revision due to broken hardware and 1 revision due to infection. In both cases, the patients were treated with hardware removal.
CONCLUSION
Pain and function may be slightly more improved with interpositional arthroplasty and arthrodesis for the treatment of HR, when compared to hemiarthroplasty with the Cartiva implant.
LEVEL OF EVIDENCE
Level III, therapeutic studies; case-control study.
背景
治疗僵硬性拇趾（HR）的一种现代技术是使用Cartiva合成软骨植入物进行第一跖趾关节（MTP）半关节成形术。目前报道该手术早期结果的科学文献稀少且结论不一，表明需要进一步分析。本研究的目的是比较在保守治疗或唇成形术失败的患者中，使用Cartiva植入物（HI）进行第一跖趾关节半关节成形术、同种异体骨植入关节成形术（IA）和关节融合术（A）后视觉模拟量表（VAS）评分的改善情况。
方法
对99例患者进行回顾性队列研究。HI组49例患者，IA组25例患者，A组25例患者。进行随访调查，获得更新后的VAS和更新后的美国矫形足踝协会评分。
结果
HI组VAS评分平均改善2.73（标准差±2.80）分，IA组改善4.16（标准差±2.01）分，A组改善4.36（标准差±3.67）分（P = 0.035）。HI组美国矫形足踝协会（AOFAS）评分平均改善14.90（标准差±17.31）分，IA组改善27.80（标准差±15.22）分，A组改善27.88（标准差±25.34）分（P = 0.005）。HI组有3例（6.1%）翻修手术，A组有2例（8.0%）翻修手术，IA组无翻修手术（P = 0.
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