Preliminary experience of metatarsophalangeal arthroplasty with silicon Swanson prosthesis / 中华骨科杂志

ABSTRACT

Objective To evaluate the short-term results of total metatarsophalangeal arthroplasty (TMPA) for OA, RA, hallux valgus with severe OA, hallux rigidus, and osteonecrosis of metatarsal heads. Methods From March 2002 to March 2005, total metatarsophalangeal arthroplasty was performed in 30 patients (11 males and 19 females, age from 33 to 77 years old, average 62.5 years old) and 47 feet. Fifteen were bilateral. The preoperative underlying diagnosis was RA in 7, hallux rigidus in 5, hallux valgus with severe OA in 21, avascular osteonecrosis in second metatarsal head in 6, old metatarsophalangeal dislocation in 2, complications after McBride operation in 2 feet. Totally, 33 first metatarsoplangeal joints, 11 second metatarsophalangeal joints, 2 third metatarsophalangeal joints and 1 fourth metatarsophalangeal joint were replaced with metal bushed silicon Swanson prostheses. Two patients (4 feet) with abnormal first-second intermetetarsal angle (19?-20?) received simultaneous proximal metatarsal osteotomy. The osteotomed metatarsal were fixed with Biofix absorbable screws. Two patients (3 feet) received simultaneous metatarsal head (2-5) resection arthroplasty. Twenty-nine (46 feet) were followed-up for average 26.5 (3-36) months with Maryland metatarsal joint scoring system. Oriented by the Maryland scoring system, pain, joint function, and objective messurements were recorded and scored. Results The preoperative and postoperatvie Maryland score was 72 (55-82) and 91 (67-96), respectively. Excellent result was achieved in 41 feet (89.13%), good in 2 feet(4.35%), fair in 2 feet(4.35%), and poor in 1 foot(2.17%). The good-excellent result rate in this group was 93.48%. The complications included delayed wound union in 2 feet, implant dislocation in 1 foot, reactive synovitis in 1 foot. Conclusion The short-term result of total metatarsophalangeal arthroplasty for treatment of OA, RA, hallux rigidus, old dislocation of metatarsophalangeal and avascular osteonecrosis of metatarsal heads is satisfying.