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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIII | Pages 15 - 15
1 May 2012
Coetzee C
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In most cases the etiology of Hallux rigidus is unknown. The purpose of this presentation is to discuss the classification of hallux rigidus, as well as the treatment options for every stage. Treatment suggestions should be individualised depending not only on the grade of the hallux rigidus, but also the patient's expectations. These include expectations regarding footwear, recreational activities and the potential of further surgeries depending upon the initial choice of treatment. Emphasis will be placed on joint preserving options, including adding a Moberg osteotomy to proximal halangs to increase perceived dorsiflexion of the great toe


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_8 | Pages 114 - 114
1 May 2016
Laky B Koelblinger R Brandl G Anderl W Schwameis E
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Arthrodesis of the first metatarsophalangeal joint (MTPJ) has been reported as gold standard for the treatment of advanced hallux rigidus and is a well-documented procedure. However, many patients demand a mobile MTPJ and therefore joint sparing procedures like MTPJ-arthroplasty have gained popularity. The aim of the present study was to present first mid-term results after hemiarthroplasty to treat advanced osteoarthritis of the first MTPJ. Between April 2006 and October 2013, a total of 81 hemiprostheses (AnaToemic®, Arthrex) in 71 consecutive patients (44 females, 27 male, 10 bilateral; mean age, 58 [range, 45–82]) were implanted at the St. Vincent Hospital Vienna (Austria). The indication for surgery was persistent MTPJ pain after failed conservative treatment combined with radiologic evidence of osteoarthritis (advanced hallux rigidus grade II-IV). Patients were clinically examined using the American Orthopaedic Foot and Ankle Society (AOFAS) score before surgery and at the final follow-up visit. Patient's satisfaction with the treatment was recorded. Radiological results were evaluated using standard x-rays and revision surgeries were documented. The mean preoperative AOFAS Scores significantly increased from 51 to 88 points after an average follow-up duration of 5 years (p<0.001). Most patients (76%) were either very satisfied or satisfied with the procedure. Radiological assessment showed some kind of radiolucencies on the base plate, whereas the stem of the prosthesis was well integrated in most of the cases; however clinical outcome was not affected by minor radiolucent lines on the base plate. In the majority of patients the implant was in situ at last follow-up. If revision surgery, due postoperative pain or implant loosening, was required; it occurred within 12 to 36 months. According to our promising mid-term results with a MTPJ-hemiprostheses, we conclude that MTPJ-arthroplasty is an effective alternative treatment modality for anatomical reconstruction of the first MTPJ with the benefit to reduce pain and maintain mobility


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_13 | Pages 3 - 3
1 Nov 2019
Papachristos IV Dalal RB Rachha R
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Short scarf osteotomy (SSO) retains the versatility of standard scarf in treating moderate and severe hallux valgus deformity with the added benefit of less invasiveness translated into less soft-tissue stripping, reduced exposure, less metalwork, less operative time and reduced cost. We present our medium-term clinical, radiographic and patient satisfaction results. All patients who underwent SSO between January 2015 and December 2017 were eligible (98). Exclusion criteria were: follow up less than a year, additional 1st ray procedures, inflammatory arthropathy, infection, peripheral vascular disease and hallux rigidus. Eighty-four patients (94 feet) were included: 80 females / 4 males with average age of 51-year-old (24–81). Minimum follow up was 12 months (12–28). Weight-bearing x-rays and AOFAS score were compared pre- and postoperatively. Non-parametric Mann-Whitney U test assessed statistical significance of our results. Hallux valgus angle (HVA) improved from preoperative mean of 30.8° (17.4°–46.8°) to 12° (4°–30°) postoperatively (p=0.0001). Intermetatarsal angle (IMA) improved from preoperative mean of 15.1° (10.3°–21.1°) to 7.1° (4°–15.1°) postoperatively (p=0.0001). Average sesamoid coverage according to Reynold's tibial sesamoid position improved from average grade 2.18 (1–3) to 0.57 (0–2) (p=0.0001). Average AOFAS score improved from 51.26 (32–88) to 91.1 (72–100) (p=0.0001). Ninety percent of patients were satisfied and 83% wound recommend the surgery. No troughing phenomenon or fractures. Four overcorrections were found 3 of which did not require surgery. One recurrence at 18 months was treated with standard scarf. We believe that this technique offers a safer, quicker and equally versatile way of dealing with Hallux Valgus


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_13 | Pages 2 - 2
1 Nov 2019
Kannan S Bennett A Chong H Hilley A Kakwani R Bhatia M
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First Metatarsophalangeal joint fusion has been successfully used to treat Hallux rigidus. We have attempted to evaluate commonly used methods of fixation and joint preparation. To the best of our knowledge, this is the single largest comparative study on first MTPJ fusion. We aimed to evaluate the radiological union and revision rates. We included 409 consecutive MTPJ fusions performed in 385 patients. We collected demographic, comorbidities and complication data. We evaluated the radiographs for the status of the union. Logistic regression was used to calculate the Odds ratio (OR) of non-union for the collected variables. Our union rate was 91.4% (34/409). 29.4% of our non-unions were symptomatic (10/34). Hallux valgus showed a statistically significant relation to non-union (Odds ratio 9.33, p-value 0.017). Other potential contributing factors like sex (OR1.9, p-value 0.44), diabetes (OR 0, p-value 0.99), steroid use (OR 2.07, p-value 0.44), inflammatory arthritis (OR 0, p-value 0.99) and smoking (OR 2.69, p-value 0.34) did not attain statistical significance. Further, the methods of fixation like solid screws (OR 0, p-value 0.99), plate (OR 3.6, p-value 0.187) or cannulated screws (OR 0.09, p-value 0.06) showed no correlation with non-union. We compared two techniques of joint preparation and found no significant difference in union rates (Chi-Square 1.0426, p-value 0.30). Our crude cost comparison showed the average saving to the trust per year could be 33,442.50£ by choosing screws over plate. Only Hallux Valgus had a statistically significant relation to non-union. Solid screw could be economically the most viable option and a valid alternative


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_6 | Pages 14 - 14
1 May 2015
Yassin M Daoud M Giurea M
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There are many types of arthroplasties for the 1st MTPJ, but still the treatment of advance Hallux rigidus remains controversial. In this study we are reporting the outcome of the North Star hemicap at 6 months. A series of patients under the care of a single surgeon were followed using the Manchester - Oxford Foot Questionnaire (MOXFQ) at 6months post operation, and a satisfaction question was asked. The operations were between August 2011 and August 2013. A total of forty five arthroplasties were implanted in 44 patients. Thirty four of them were female and 9 were male. The average age was 56 years (range 37–77 years). Twenty six out of them (59%) needed an MUA + a local anaesthetic and steroid injection of the prosthetic joint at 2 to 14 months (average 6 months) post implantation. In these patients the MOXFQ was filled at 6months post the MUA and injection. Four of them were left out of the study because they were less than 6months post MUA. One patient had his implant removed and changed to fusion at his request at 14 months post implantation. Forty one patients were satisfied and would recommend the operation, 2 were disappointed with the degree of movement but would still recommend the operation and one had it revised to fusion. The average MOXFQ was 12/64. In conclusion, high percentage of patients needed a second operation, but the scores are reasonably low and almost all patients would recommend it. Further follow up of these patients is needed for at least 5years but the early results are showing it to be a good alternative for fusion


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLI | Pages 93 - 93
1 Sep 2012
Morgan S Jones C Palmer S
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Open cheilectomy is an established surgical treatment for hallux rigidus. Cheilectomy is now being performed using minimally invasive(MIS) techniques. In this prospective study we report the outcome of minimally invasive cheilectomy comparing the results with a matched group who had cheilectomy using standard open procedure. Prospective study of 47 patients. 22 patients had MIS cheilectomy between March 2009 and September 2010. We compared the outcome with a matched group (25 patients) who had open cheilectomy. Functional outcome was assessed using the Manchester Oxford Foot and ankle questionnaire (MOXFQ). The MOXFQ is a validated 16-item, patient-generated questionnaire designed to be self-completed and used as an outcome measure for foot surgery. It comprises three domains foot pain, walking and standing problems and social interaction. Total score ranges from 0 (best score) to 64 (worst score). Patients completed preoperative and postoperative questionnaires. Patients’ satisfaction and complications were recorded. In the MIS group, the median follow up was 11 months (4–23. The median preoperative MOXFQ score was 34/64(23) and the median postoperative score was 19/64 (p value <0.02) In the open group the median follow up was 17 months (9–27). The median preoperative MOXFQ score was 35/64 and the median postoperative score was 7.5/64 and this difference was statistically significant (<0.0001). There were three failures in the open group (Fusion) compared to none in the MIS. MIS cheilectomy is an effective alternative procedure with satisfactory functional outcome and high patient satisfaction. Results are comparable to the standard open cheilectomy with a lower apparent failure rate. The results of our randomised controlled trial comparing MIS cheilectomy to open cheilectomy are awaited


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XIX | Pages 18 - 18
1 May 2012
Dawe E Ball T Annamalai S Davis J
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Introduction. Minimally Invasive foot surgery remains controversial. Potential benefits include a reduced incidence of wound complications, faster return to employment and normal footwear. There are no studies published regarding the results of minimally invasive dorsal cheilectomy. Patients and Methods. Thirty eight patients with painful grade I hallux rigidus underwent dorsal cheilectomy between April 2006 and June 2010. Minimally invasive cheilectomy (MIC) was introduced in August 2009. AOFAS scores, satisfaction, return to normal shoes and employment were assessed. Results. Twenty two patients had open cheilectomy (OC) whilst 16 had MIC. Mean follow-up was 6 months for the MIC group and 35 months for the OC group. Mean AOFAS score was 75/100 (SD 17) in the MIC group and 70/100 (SD 18). Patients rated their satisfaction as 9.1/10 for MIC and 8.6/10 for OC. There was no significant difference in time to return to normal shoes (P = 0.32) or employment (P = 0.07). Two patients (one MIS, one OC) had a superficial wound infection which resolved with oral antibiotics. One patient had a first metatarsophalangeal joint fusion in the MIS group. Two patients in the OC group went on to have a first metatarsophalangeal joint fusion and one underwent joint resurfacing. Discussion. These results suggest MIC has comparable early results to OC. Larger studies are required to further establish the benefits of MIC. Conclusion. Minimally invasive dorsal cheilectomy seems to offer a safe alternative to open cheilectomy with promising early results. Patient satisfaction with this procedure is very high


Introduction. Arthrodesis of the 1st metatarso-phalangeal joint (MTPJ) is a common procedure in forefoot surgery for hallux rigidus and severe hallux valgus. Debate persists on two issues - the best preparation method for the articular surfaces, and the optimal technique for operative stabilisation of the joint. Methods. We performed 1. st. MTPJ arthrodesis in 100 patients randomized into two equal groups. In the first group, the articular surfaces were prepared using cup-and-cone reamers, whilst in the second group, ‘flat cut’ osteotomies were performed with an oscillating saw. In all other respects, their treatment was identical. Fixation was secured using a plantar double compression Fixos™ screw and dorsal Anchorage™ plate. Full weight-bearing was allowed on the first post-operative day. Patients completed self-administered satisfaction questionnaires, including an AOFAS and SF-36 score pre-operatively and at two and six months post-operatively. Clinical examination and radiographs were compared at zero, two and six months. Statistical analysis was performed using Instat. Results. Radiographic union of the 1. st. MTPJ was documented in 45/50 patients in the reamer group and 42/50 in the ‘flat-cut’ group at two months and in all patients at six months. The AOFAS score improved from a mean of 46 +/− 15 pre-operatively to 72 +/−8 (out of 90) at two months and 83 +/− 4 (out of 90) at six months. SF-36 subscales for bodily pain and for physical function increased from 42.4 +/− 16.1 and 37.3 +/− 12.8 respectively pre-operatively to 82.2 +/− 11.2 and 84.6 +/− 9.3 respectively at six months. There was no statistically significant difference between groups. Conclusions. Arthrodesis of the 1. st. MTPJ with the Anchorage™ plate and compression screw gives excellent clinical and radiographic results. Preparation method does not affect early outcomes but may influence important technical points such as length of the first ray or inter-phalangeal angle