Interpositional arthrodesis of the first metatarsophalangeal joint using an iliac crest bone graft

Transcription

1 Interpositional arthrodesis of the first metatarsophalangeal joint using an iliac crest bone graft L. Claassen 1, J. Schlebbe 1, M. Ettinger 1, H. Waizy 2, K. Daniilidis, C 1. Stukenborg-Colsman 1, C. Plaass 1 1 Orthopedic department, Hannover Medical School 2 Clinic for Foot and Ancle Surgery, Hessing Foundation, Augsburg, Germany IFFAS and AOFAS meeting 2014 in Chicago

2 Interpositional arthrodesis of the first metatarsophalangeal joint using an iliac crest bone graft L. Claassen, J. Schlebbe, M. Ettinger, H. Waizy, K. Daniilidis, C. Stukenborg- Colsman, C. Plaass Our disclosure is in the final AOFAS Mobile App. We have a potential conflict with this presentation due to: One or more of the authors are paid consultants or got financial support direct or to their institution by the following companies: Medartis, DePuySynthes, Albrecht C, Extremity Medical, Stryker, Arthrex, Wrigth Medical One or more of the authors are board members, of the following institutions: German Foot and Ankle Society

3 Background Functional insufficiency after resection arthroplasty or failed MTP I prosthesis can be treated with a MTP I interpositional arthrodesis. (1+2) A MTP I interpositional arthrodesis can restore the length of the first ray after resection arthroplasty. (2) MTP I interpositional arthrodesis leads to a stable and resilient first ray. (3) Published nonunion rate: asymptomatic nonunion in 1/12 patients (4) 5/24 nonunions with 60% being symptomatic and revised (5) Published clinical results: postoperative AOFAS score of 70 points (maximum 90 points) (4) no patient was absolutely pain free postoperatively (4) postoperative AOFAS score of 79 points (maximum 95 points) (5) postoperative FAAM-Score for ADL/sports 97.3/91.3% for MTP I arthrodesis (6) The present study was conducted to evaluate the clinical and functional outcome after interpositional arthrodesis of the first metatarsophalangeal joint using an iliac crest bone graft.

4 Material and methods Retrospective study with a follow-up examination 22 patients were included, 21 female, 1 male, age 63 ± 9.4 years Inclusion criteria: patients who received a MTP I interpositional arthrodesis with an iliac crest bone graft period January 2007 to June 2013 Analysis of charts and x-ray images Follow-up examination 34.6 ± 18.4 month postoperatively including clinical and pedobarographical examination Evaluation of AOFAS Score, FAAM Score and pain level (NRS)

5 Results Indication for MTP I interpositional arthrodesis: resection arthroplasty (45.5%) failed MTP I arthrodesis (22.7%) failed MTP I prosthesis (9.1%) Complications: 20/22 patients (90.9%) showed a clinical and radiological union, two patients had an asymptomatic nonunion. 1/22 patient (4.5%) developed a wound infection of the iliac crest with consecutively antibiotic therapy.

6 Results Mean AOFAS score was 74.1 ± 13.6 points of a maximum of 90 FAAM score for daily activities was 77% ± 19.8 FAAM score for physical activity was 66% ± 35.9 Eight patients reported a normal function of the foot, seven an almost normal, six a slightly abnormal and three a severely abnormal foot function (due to restricted motion of the MTP I joint)

7 Results Pedobarographic results: Peak pressure under MTP I: operated foot 50.5 N/cm 2 ± 18.4 contralateral foot 51.3 N/cm 2 ± 23.0 Peak pressure under MTP II: operated foot 52.7 N/cm 2 ± 17.9 contralateral foot 55.3 N/cm 2 ± 22.8 differences were not significant

8 Conclusions Low complication rate compared to literature But: three patients (13.6%) described a severely limited function of the food, despite bony healing Comparable AOFAS-Score to the literature The FAAM score was lower compared to primary MTP I arthrodesis Comparable load bearing characteristics to the opposite foot

9 References: (1) Whalen JL. Clinical tip: interpositional bone graft for first MP fusion. Foot Ankle Int (2), pp (2) Bhosale A, Munoruth A, Blundell C, Flowers MJ, Jones S, Davies MB. Complex primary arthrodesis of the first metatarsophalangeal joint after bone loss. Foot Ankle Int (10), pp (3) Vienne P, Sukthankar A, Favre P, Werner CM, Baumer A, Zingg PO. Metatarsophalangeal joint arthrodesis after failed Keller-Brandes procedure. Foot Ankle Int (11), pp (4) Brodsky JW, Ptaszek AJ, Morris SG. Salvage first MTP arthrodesis utilizing ICBG: clinical evaluation and outcome. Foot Ankle Int Apr;21(4): (5) Myerson MS, Schon LC, McGuigan FX, Oznur A.Result of arthrodesis of the hallux metatarsophalangeal joint using bone graft for restoration of length. Foot Ankle Int Apr;21(4): (6) Garras DN, Durinka JB, Bercik M, Miller AG, Raikin SM.Conversion arthrodesis for failed first metatarsophalangeal joint hemiarthroplasty. Foot Ankle Int Sep;34(9): doi: / Epub 2013 Apr 23. Authors: