Öz
Amaç: Halluks rigidus, birinci metatarsofalangeal (MTF-1) eklemin dejenerasyonu ile karakterize bir hastalıktır. İleri evre halluks rigidus cerrahi tedavisinde artrodez yerine artroplasti seçimi halen tartışmalıdır. Bu çalışmanın amacı ileri evre halluks rigidus nedeniyle yeni nesil üç komponentli press-fit total eklem artroplastisi uygulanan hastaların erken dönem tedavi sonuçlarını bildirmektir.
Gereç ve Yöntemler: Hastalar MTF-1 eklem dorsifleksiyon, plantar fleksiyon ve total eklem hareket açıklığı (EHA) dereceleri, AOFAS, VAS, SF-12 PCS skorları ve memnuniyet anketi sonuçları üzerinden değerlendirildi. Preoperatif ve postoperatif değerler istatistiksel açıdan analiz edildi. Radyolojik olarak ise anteroposteriyor (AP) ve lateral grafiler çekilerek gevşeme, aşınma ve dizilim açısından incelendi.
Bulgular: Çalışmaya 17 hastanın 19 eklemi (14 kadın, 5 erkek) dahil edildi. Ortalama yaş 59 (49–67) olarak hesaplandı. Hastaların ortalama takip süresi 15 (12–22) ay idi. Ortalama dorsifleksiyon derecesi preoperatif 12,7° (2,1°–22,1°), postoperatif 30,1° (11,6°–47,3°); ortalama plantar fleksiyon derecesi preoperatif 16° (7,8°–24,2°), postoperatif 9,2° (2,3°–16,5°) olarak ölçüldü. MTF-1 eklem total hareket açıklığı preoperatif 28,7°’den postoperatif 39,4°’ye çıktı. Ortalama postoperatif AOFAS, VAS ve SF-12 PCS skorları 85,3 (57–96), 1,3 (0–5) ve 57,7 (53,7–59,9) olarak hesaplandı. Hastaların AOFAS ve SF-12 PCS skorlarındaki artış ile VAS skorlarındaki azalma istatistiksel açıdan anlamlı idi.
Tartışma ve Sonuç: İleri evre MTF-1 eklem osteoartriti ciddi ağrı ve hareket kaybına sebep olan bir hastalıktır. Cerrahi tedavide kullanılacak standart yöntem halen tartışmalıdır. Literatürde ciddi komplikasyonlara neden olan eski protetik uygulamaların aksine üç komponentli sementsiz press-fit total protez uygulamalarında tatmin edici sonuçlar elde edildiği bildirilmektedir. Ağrının giderilmesi ve AOFAS skorlarındaki artış tedavinin en başarılı yönleri olarak görülmektedir. Bu çalışmadan edindiğimiz bilgiler neticesinde ileri evre halluks rigidus tedavisinde yeni nesil üç komponentli press-fit total protez uygulamalarının etkili bir tedavi yöntemi olduğunu, uygun hasta seçimi halinde erken dönemde tatmin edici sonuçlar sağladığını düşünmekteyiz.
Anahtar Kelimeler
Kaynakça
- Vanore JV, Christensen JC, Kravitz SR, Schuberth JM, Thomas JL, Weil LS, et al.Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 2: hallux rigidus. J Foot Ankle Surg 2003;42:124–36 doi:http://dx.doi.org/10.1053/jfas.2003.50041.
- Ibrahim T, Taylor GJSC. The new press-fit ceramic Moje metatarsophalangeal joint replacement: short-term outcomes. Foot 2004;14:124–8, doi:http://dx. doi.org/10.1016/j.foot.2004.01.002.
- Brantingham JW, Wood TG. Hallux rigidus. J Chiropr Med. 2002 Winter;1(1):31-7. doi: 10.1016/S0899-3467(07)60025-1.
- Coughlin MJ, Shurnas PS. Hallux rigidus. J Bone Joint Surg Am. 2004;86-A Suppl 1(pt 2):119-130.
- Herrera-Pérez M, Pais-Brito JL, Valderrabano V, Cortés-García P, Déniz-Rodríguez B, Ayala-Rodrigo A. [Treatment algorithm proposed for hallux rigidus]. Acta Ortop Mex. 2014 Jul-Aug;28(4):253-7. Review. Spanish.
- Brage ME, Ball ST. Surgical options for salvage of end-stage hallux rigidus. Foot Ankle Clin. 2002;7(1):49-73
- Keiserman LS, Sammarco VJ, Sammarco GJ. Surgical treatment of the hallux rigidus. Foot Ankle Clin. 2005;10(1): 75-96.
- Fadel G, Abboud R, Rowley D. Implant arthroplasty of the hallux metatarsophalangeal joint. The Foot. 2002;12(1):1-9.
- Schneider T, Dabirrahmani D, Gillies RM, Appleyard RC. Biomechanical comparison of metatarsal head designs in first metatarsophalangeal joint arthroplasty. Foot Ankle Int. 2013;34(6):881-889.
- Raikin SM, Ahmad J, Pour AE, Abidi N. Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint. J Bone Joint Surg Am 2007;89:1979–85, doi:http://dx.doi.org/10.2106/JBJS.F.01385.
- Wenger RJ, Whalley RC. Total replacement of the first metatarsophalangeal joint. J Bone Joint Surg Br 1978;60:88–92.
- Divecha HM, Zubairy AI, Barrie JL, Aithal S, Fischer B, Fanshawe T, Rajpura A. First metatarsophalangeal joint arthrodesis versus proximal phalanx hemiarthroplasty for hallux rigidus: feasibility study for a randomised controlled trial. Trials. 2014 Mar 13;15:79. doi: 10.1186/1745-6215-15-79.
- Polzer H, Polzer S, Brumann M, Mutschler W, Regauer M. Hallux rigidus: Joint preserving alternatives to arthrodesis - a review of the literature. World J Orthop. 2014 Jan 18;5(1):6-13. doi: 10.5312/wjo.v5.i1.6. eCollection 2014 Jan 18. Review.
- Ettl V, Radke S, Gaertner M, Walther M. Arthrodesis in the treatment of hallux rigidus. Int Orthop. 2003;27(6):382-5. Epub 2003 Aug 26.
- Mestiri M, Bouabdellah M, Zarrouk A, Kammoun S, Baccari S, Kooli M, Zlitni M. [Retrospective study of the first metatarsophalangeal joint arthrodesis: 39 cases]. Tunis Med. 2010 Oct;88(10):725-30. French.
- Horisberger M, Haeni D, Henninger HB, Valderrabano V, Barg A. Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux. Foot Ankle Int. 2016 Jul;37(7):755-65. doi: 10.1177/1071100716637901. Epub 2016 Mar 15.
- Kolodziej L, Bohatyrewicz A, Zietek P. First metatarsophalangeal joint replacement with modular three-component press-fit implant. Preliminary report. Acta Chir Orthop Traumatol Cech. 2013;80(1):64-68.
- Wassink S, Burger BJ, Saragas NP, Asunción Márquez J, Trtik L, Harlaar J. A prospective 24 months follow-up of a three component press-fit prosthesis for hallux rigidus. Foot Ankle Surg. 2017 Sep;23(3):157-162. doi: 10.1016/j.fas.2016.08.008. Epub 2016 Sep 9.
- Blair MP, Brown LA. Hallux limitus/rigidus deformity: a new great toe implant. J Foot Ankle Surg. 1993;32(3):257-262.
- Fuhrmann RA, Wagner A, Anders JO. First metatarsophalangeal joint replacement: the method of choice for end-stage hallux rigidus? Foot Ankle Clin. 2003;8(4):711-721.
- Ghalambor N, Cho DR, Goldring SR, Nihal A, Trepman E. Microscopic metallic wear and tissue response in failed titanium hallux metatarsophalangeal implants: two cases. Foot Ankle Int. 2002;23(2):158-162.
- Gibson JN, Thomson CE. Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial. Foot Ankle Int. 2005;26(9):680-690.
- Johnson KA, Buck PG. Total replacement arthroplasty of the first metatarsophalangeal joint. Foot Ankle. 1981;1(6): 307-314.
- Lange J, Merk H, Barz T, Walther C, Follak N. Titanium arthroplasty toe fit plus for the hallux metatarsophalangeal joint [in German]. Z Orthop Unfall. 2008;146(5):609-615.
- Sinha S, Mcnamara P, Bhatia M, Louette L, Stephens I. Survivorship of the bio-action metatarsophalangeal joint arthroplasty for hallux rigidus: 5-year follow-up. Foot Ankle Surg. 2010;16(1):25-27.
- Townley CO, Taranow WS. A metallic hemiarthroplasty resurfacing prosthesis for the hallux metatarsophalangeal joint. Foot Ankle Int. 1994;15(11):575-580.
- Erkocak OF, Senaran H, Altan E, Aydin BK, Acar MA. Short-term functional outcomes of first metatarsophalangeal total joint replacement for hallux rigidus. Foot Ankle Int. 2013;34(11):1569-1579.
- Ess P, Hamalainen M, Leppilahti J. Non-constrained titanium-polyethylene total endoprosthesis in the treatment of hallux rigidus. A prospective clinical 2-year follow-up study. Scand J Surg. 2002;91(2):202-207.
Öz
Aim: Hallux rigidus is a disease characterized by degeneration of the first metatarsophalangeal (MTF-1) joint. The choice of arthroplasty instead of arthrodesis in the surgical treatment of advanced hallux rigidus is still controversial. In this study, we aimed to report the early treatment results of a number of patients who had advanced hallux rigidus and underwent new-generation three-component press-fit total joint arthroplasty.
Materials and Methods: The patients were evaluated in terms of degrees of MTF-1 joint dorsiflexion, plantar flexion, and total joint range of motion (ROM), scores of AOFAS, VAS, SF-12 PCS, and satisfaction survey results. The preoperative and postoperative values were analyzed statistically. Radiologically, anteroposterior (AP) and lateral radiographs were taken and examined for loosening, wear, and alignment.
Results: Nineteen joints (14 female, 5 male) of 17 patients were included in the study. The mean age was 59 (49–67) years. The mean patient follow-up was 15 (12–22) months. The mean dorsiflexion degree was 12.7° (range 2.1°–22.1°) preoperatively and 30.1° (11.6°–47.3°) postoperatively. The mean plantar flexion degree was 16° (7.8°–24.2°) preoperatively and 9.2° (2.3°–16.5°) postoperatively. The total range of motion (ROM) of the MTF-1 joint improved from a preoperative 28.4° to a postoperative 39.4°. The mean postoperative AOFAS, VAS, and SF-12 PCS scores were calculated as 85.3 (57–96), 1.3 (0–5), and 57.7 (53.7–59.9), respectively. The increase in the patients’ AOFAS and SF-12 PCS scores and the decrease in the VAS scores were found to be statistically significant.
Discussion and Conclusion: Advanced MTF-1 joint osteoarthritis is a disease that causes severe pain and loss of motion. The method for a standard surgical treatment is still controversial. It has been reported in the literature that satisfactory results have been achieved in applications of three-component cementless press-fit total prostheses, in contrast to older prosthetic applications that cause serious complications. The pain relief and the increase in AOFAS scores are considered the most successful aspects of the treatment. Based on the information obtained from this study, we think that application of new-generation three-component press-fit total prostheses is an effective method in the treatment of advanced hallux rigidus, and that the early results are satisfactory when it has been applied to appropriate patients.
Anahtar Kelimeler
Kaynakça
- Vanore JV, Christensen JC, Kravitz SR, Schuberth JM, Thomas JL, Weil LS, et al.Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 2: hallux rigidus. J Foot Ankle Surg 2003;42:124–36 doi:http://dx.doi.org/10.1053/jfas.2003.50041.
- Ibrahim T, Taylor GJSC. The new press-fit ceramic Moje metatarsophalangeal joint replacement: short-term outcomes. Foot 2004;14:124–8, doi:http://dx. doi.org/10.1016/j.foot.2004.01.002.
- Brantingham JW, Wood TG. Hallux rigidus. J Chiropr Med. 2002 Winter;1(1):31-7. doi: 10.1016/S0899-3467(07)60025-1.
- Coughlin MJ, Shurnas PS. Hallux rigidus. J Bone Joint Surg Am. 2004;86-A Suppl 1(pt 2):119-130.
- Herrera-Pérez M, Pais-Brito JL, Valderrabano V, Cortés-García P, Déniz-Rodríguez B, Ayala-Rodrigo A. [Treatment algorithm proposed for hallux rigidus]. Acta Ortop Mex. 2014 Jul-Aug;28(4):253-7. Review. Spanish.
- Brage ME, Ball ST. Surgical options for salvage of end-stage hallux rigidus. Foot Ankle Clin. 2002;7(1):49-73
- Keiserman LS, Sammarco VJ, Sammarco GJ. Surgical treatment of the hallux rigidus. Foot Ankle Clin. 2005;10(1): 75-96.
- Fadel G, Abboud R, Rowley D. Implant arthroplasty of the hallux metatarsophalangeal joint. The Foot. 2002;12(1):1-9.
- Schneider T, Dabirrahmani D, Gillies RM, Appleyard RC. Biomechanical comparison of metatarsal head designs in first metatarsophalangeal joint arthroplasty. Foot Ankle Int. 2013;34(6):881-889.
- Raikin SM, Ahmad J, Pour AE, Abidi N. Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint. J Bone Joint Surg Am 2007;89:1979–85, doi:http://dx.doi.org/10.2106/JBJS.F.01385.
- Wenger RJ, Whalley RC. Total replacement of the first metatarsophalangeal joint. J Bone Joint Surg Br 1978;60:88–92.
- Divecha HM, Zubairy AI, Barrie JL, Aithal S, Fischer B, Fanshawe T, Rajpura A. First metatarsophalangeal joint arthrodesis versus proximal phalanx hemiarthroplasty for hallux rigidus: feasibility study for a randomised controlled trial. Trials. 2014 Mar 13;15:79. doi: 10.1186/1745-6215-15-79.
- Polzer H, Polzer S, Brumann M, Mutschler W, Regauer M. Hallux rigidus: Joint preserving alternatives to arthrodesis - a review of the literature. World J Orthop. 2014 Jan 18;5(1):6-13. doi: 10.5312/wjo.v5.i1.6. eCollection 2014 Jan 18. Review.
- Ettl V, Radke S, Gaertner M, Walther M. Arthrodesis in the treatment of hallux rigidus. Int Orthop. 2003;27(6):382-5. Epub 2003 Aug 26.
- Mestiri M, Bouabdellah M, Zarrouk A, Kammoun S, Baccari S, Kooli M, Zlitni M. [Retrospective study of the first metatarsophalangeal joint arthrodesis: 39 cases]. Tunis Med. 2010 Oct;88(10):725-30. French.
- Horisberger M, Haeni D, Henninger HB, Valderrabano V, Barg A. Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux. Foot Ankle Int. 2016 Jul;37(7):755-65. doi: 10.1177/1071100716637901. Epub 2016 Mar 15.
- Kolodziej L, Bohatyrewicz A, Zietek P. First metatarsophalangeal joint replacement with modular three-component press-fit implant. Preliminary report. Acta Chir Orthop Traumatol Cech. 2013;80(1):64-68.
- Wassink S, Burger BJ, Saragas NP, Asunción Márquez J, Trtik L, Harlaar J. A prospective 24 months follow-up of a three component press-fit prosthesis for hallux rigidus. Foot Ankle Surg. 2017 Sep;23(3):157-162. doi: 10.1016/j.fas.2016.08.008. Epub 2016 Sep 9.
- Blair MP, Brown LA. Hallux limitus/rigidus deformity: a new great toe implant. J Foot Ankle Surg. 1993;32(3):257-262.
- Fuhrmann RA, Wagner A, Anders JO. First metatarsophalangeal joint replacement: the method of choice for end-stage hallux rigidus? Foot Ankle Clin. 2003;8(4):711-721.
- Ghalambor N, Cho DR, Goldring SR, Nihal A, Trepman E. Microscopic metallic wear and tissue response in failed titanium hallux metatarsophalangeal implants: two cases. Foot Ankle Int. 2002;23(2):158-162.
- Gibson JN, Thomson CE. Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial. Foot Ankle Int. 2005;26(9):680-690.
- Johnson KA, Buck PG. Total replacement arthroplasty of the first metatarsophalangeal joint. Foot Ankle. 1981;1(6): 307-314.
- Lange J, Merk H, Barz T, Walther C, Follak N. Titanium arthroplasty toe fit plus for the hallux metatarsophalangeal joint [in German]. Z Orthop Unfall. 2008;146(5):609-615.
- Sinha S, Mcnamara P, Bhatia M, Louette L, Stephens I. Survivorship of the bio-action metatarsophalangeal joint arthroplasty for hallux rigidus: 5-year follow-up. Foot Ankle Surg. 2010;16(1):25-27.
- Townley CO, Taranow WS. A metallic hemiarthroplasty resurfacing prosthesis for the hallux metatarsophalangeal joint. Foot Ankle Int. 1994;15(11):575-580.
- Erkocak OF, Senaran H, Altan E, Aydin BK, Acar MA. Short-term functional outcomes of first metatarsophalangeal total joint replacement for hallux rigidus. Foot Ankle Int. 2013;34(11):1569-1579.
- Ess P, Hamalainen M, Leppilahti J. Non-constrained titanium-polyethylene total endoprosthesis in the treatment of hallux rigidus. A prospective clinical 2-year follow-up study. Scand J Surg. 2002;91(2):202-207.
Ayrıntılar
| Konular | Sağlık Kurumları Yönetimi |
|---|---|
| Bölüm | ORJİNAL MAKALE |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Ocak 2018 |
| Kabul Tarihi | 10 Aralık 2017 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 23 Sayı: 1 |
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