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Metatarso-sesamoid Osteoarthritis as a Cause of Pain After First Metatarsophalangeal Joint Fusion: Case Report

Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, 399 Bathurst Street, 1 East Wing - 438, Toronto, Ontario Canada M5T 2S8.
Foot & Ankle International (Impact Factor: 1.51). 08/2011; 32(8):822-5. DOI: 10.3113/FAI.2011.0822
Source: PubMed

ABSTRACT

Level of Evidence: V, Expert Opinion

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    ABSTRACT: End stage arthritis of the first metatarsophalangeal joint has been treated surgically in the past by fusion and replacement. Fusion has remained the most commonly performed procedure and gives excellent pain relief but may interfere with activities in some patients. Joint replacement previously has had limited success. Problems include loosening, osteolysis, subsidence, and failure to regain motion. Osteolysis associated with wear debris has limited the success of silastic replacements. Polyvinyl alcohol (PVA) has shown promise as a material for hemiarthroplasty in the great toe. The material has better wear patterns than silastic and does not fragment. The hemiarthroplasty is inserted through a dorsal incision into a reamed bed in the first metatarsal head. The implant is available in two sizes, 8 mm and 10 mm. The PVA hemiarthroplasty has been the subject of a randomized controlled trial compared with fusion, with the results as yet to be published. Limited results to date have shown promise for this arthroplasty as an alternative to fusion for patients wishing to maintain joint motion and may avoid the fragmentation and loosening seen in prior replacements.
    No preview · Article · Sep 2013 · Current Orthopaedic Practice
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    ABSTRACT: Joint replacements of the first metatarsophalangeal (MTP) joint have traditionally had limited success. Joint replacements designed to date can be subdivided into hemiarthroplasties and total joint replacements. Despite ongoing requests from patients to have a joint replacement to preserve shoe wear options, many have failed to meet expectations because of loosening, implant wear, osteolysis, or loss of motion. Fusion has therefore remained the gold standard for treatment of end-stage MTP joint arthritis. A polyvinyl alcohol hydrogel implant shows promise. The Cartiva implant is a 8 or 10 mm disk of durable hydrogel material shown to resist compression and shear with exceptional wear characteristics. It is implanted with approximately 1 to 1.5 mm protrusion and acts as a spacer for the first MTP joint. This implant is commercially available in Europe and Canada. A prospective, randomized, multicenter clinical trial is underway in the United Kingdom and Canada to assess outcomes with this implant. This article outlines the indications for surgery, surgical technique, and potential complications for hemiarthroplasty of the great toe.
    No preview · Article · Sep 2013 · Techniques in Foot & Ankle Surgery