Tendon arthroplasty for basal fourth and fifth metatarsal arthritis
Department of Research Services, Miller Orthopaedic Clinic, Charlotte, NC 28203, USA. Foot & Ankle International
(Impact Factor: 1.51).
Arthritis of the fourth and fifth tarsometatarsal joints, recalcitrant to nonoperative treatment, presents a difficult clinical situation. As part of the lateral rays, these joints have considerable motion, making fusion a very disabling operation. Between 1990 and 1998, 12 patients, who had failed nonoperative treatment, underwent resection arthroplasty of the base of the fifth or fourth and fifth metatarsals with tendon interposition. Preoperative differential injections had confirmed the source of pain in eight cases. Patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale; a visual analogue scale to assess perception of pain and disability; a satisfaction index; and, where possible, a comprehensive physical examination. At an average of 25 months follow-up, the average AOFAS score was 64.5. On the visual analogue scale, pain improved an average of 35% and disability improved 10%. Six of the eight patients who participated in this study were satisfied with the operation and would undergo the procedure again for similar symptoms. Patients with a higher postoperative score on the AOFAS midfoot rating scale were statistically more likely to have had a positive differential injection preoperatively. We believe a lateral column tarsometatarsal resection arthroplasty is an effective salvage operation when lateral column midfoot arthritis is confirmed by differential injection and nonoperative measures have provided inadequate relief.
Available from: David Russell
- "While some centres may be continuing to collate this information within their institution for future publication, treatment of lateral column arthralgia refractory to all attempted conservative management is probably most reliably treated by fusion. Evidence for this procedure is based on the largest patient group of all the discussed operative interventions, and achieves a higher postoperative VAS score than that reported following interpositional procedures    . It is widely agreed that careful attention to surgical technique and reduction of the columns are mandatory in achieving a good result   . "
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ABSTRACT: Osteoarthritis of the lateral tarsometatarsal joints is less common than that which is seen in the 1st-3rd tarsometatarsal joints. Despite a suspected increase in incidence of tarsometatarsal arthritis and consequently the burden of disability and economic impact, guidelines for treatment and decision making remain scarce. When conservative treatment fails, lateral column osteoarthritis can severely limit a patient's mobility, lifestyle, and present a difficult management problem for the foot and ankle specialist. Evidence for the surgical techniques used in treatment of lateral column osteoarthritis is limited and sporadic within the literature. This article aims to summarise and compare the evidence for these surgical management options. This article looks at aetiology and epidemiology, with a summary of the biomechanics of the region and a comprehensive review of the literature regarding surgical treatment options.
Foot and Ankle Surgery 12/2013; 19(4):207-211. DOI:10.1016/j.fas.2013.06.002
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ABSTRACT: This update summarizes recent research pertaining to orthopaedic foot and ankle surgery that was published or presented between August 2011 and July 2012. The sources of these studies include The Journal of Bone and Joint Surgery (American and British Volumes); Foot and Ankle International; and the proceedings of Specialty Day at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS), on February 11, 2012, in San Francisco, California, and the summer meeting of the American Orthopaedic Foot & Ankle Society (AOFAS), on June 20 through 23, 2012, in San Diego, California.
The Journal of Bone and Joint Surgery 04/2003; 85-A(3):576-82. DOI:10.2106/JBJS.M.00048 · 5.28 Impact Factor
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ABSTRACT: Purpose of review: Midfoot and forefoot arthrosis are relatively common clinical entities seen by physicians evaluating foot and ankle pathology. The symptoms are often mild and may be treated by a variety of nonsurgical modalities. However, more advanced involvement may affect the function of the metatarsophalangeal joints, midfoot joints, or the transverse or longitudinal arch of the foot, which may lead to disabling symptoms. This article discusses recent trends in the surgical management of these often challenging problems.
Recent findings: In patients with mild or moderate hallux rigidus, especially those with extra-articular symptoms, a cheilectomy remains the preferred surgical approach. In patients with advanced changes, particularly patients who have failed to respond to a previous cheilectomy, the optimal approach is somewhat more controversial. At present, elderly, low-demand patients may be considered for a Keller resection arthroplasty because it provides pain relief without a demanding postoperative course. In young, active patients, the gold standard remains arthrodesis. The optimal role of interpositional arthroplasty is still not completely elucidated, but results are promising. Prosthetic arthroplasty has lacked popular support because of problems with wear-related issues and suboptimal durability. Recent experience with double-stemmed, hinged silastic implants with protective metal grommets and metallic hemiarthroplasty implants has been very encouraging. Patients with midfoot arthrosis are best treated by arthrodesis. Corrective osteotomies are usually required to achieve a multiplanar reconstruction. Patients with tarsometatarsal injuries are best treated by open reduction with rigid, temporary internal fixation. It is clear that outcomes may be suboptimal even when the goal of anatomic alignment is achieved, particularly in patients with purely ligamentous injuries.
Current Opinion in Orthopaedics 03/2004; 15(2):55-61. DOI:10.1097/00001433-200404000-00003
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