ABSTRACT
BACKGROUND: In a retrospective study, we evaluated the effect of the addition of a decompressive osteotomy to hemiarthroplasty of the great toe in terms of clinical and radiographic outcomes. MATERIAL AND METHODS: Twenty-one consecutive patients affected by Grade III hallux rigidus underwent distal oblique osteotomy of the first metatarsal and hemiarthroplasty of the hallux metatarsophalageal joint. Clinical evaluation included the American Orthopaedic Foot and Ankle Society scoring system (AOFAS) and the Short Form 36 questionnaire (SF-36), preoperatively and at followup visits. Standard weightbearing radiographs were performed to assess implant alignment, loosening, and bone loss. The mean followup was 26.4 (range, 16 to 29) months. RESULTS: The mean AOFAS score improved from 47.5 ± 11.5 preoperatively to 76.0 ± 15.5 postoperatively (p < 0.01). At the last followup the SF-36 subscales Physical functioning, Bodily pain and Emotional role scores were increased from baseline. At the last followup, six patients (28.5%) were very satisfied with the outcome, ten patients (47.6%) were satisfied and five patients (23.8%) were dissatisfied. In the dissatisfied group, two patients had persistent joint pain with stiffness and subluxation of the prosthesis. Dorsal subsidence of the implant was present in ten patients at the last radiographic followup. CONCLUSION: Hemiarthroplasty of the proximal phalanx and distal oblique metatarsal osteotomy for Grade III hallux rigidus at 2-years followup yielded mixed patient satisfaction and unsatisfactory radiographic outcome.
Subject(s)
Arthroplasty, Replacement/methods , Hallux Rigidus/surgery , Metatarsal Bones/surgery , Osteotomy , Aged , Female , Hallux Rigidus/classification , Hallux Rigidus/diagnostic imaging , Humans , Male , Metatarsal Bones/diagnostic imaging , Middle Aged , Patient Satisfaction , Radiography , Treatment OutcomeABSTRACT
Triplanar distal osteotomy is a safe procedure for mild-to-moderate hallux valgus deformity. It allows shortening and plantar displacement of the first metatarsal while correcting the intermetatarsal angle. However, complications such as dorsiflexion and excessive shortening of the first metatarsal have been associated with distal osteotomy. We describe a new device, designed by one of the authors (P.R.), that enables precise positioning of the Kirschner guide wire for the osteotomy cuts.
Subject(s)
Hallux Valgus/surgery , Osteotomy/instrumentation , Equipment Design , Humans , Treatment OutcomeABSTRACT
BACKGROUND: Boc's modification of the Austin procedure is a triplane distal osteotomy that achieves shortening and plantarflexion of the first metatarsal with a lateral translation of the metatarsal head. The clinical results and influence of the Austin and Boc osteotomies on plantar pressure have been compared retrospectively. MATERIALS AND METHODS: The patients were divided into two groups: 30 Austin and 30 Boc osteotomies were performed with a mean followup of 37 (range, 29 to 56) months. RESULTS: Sixty patients with mild hallux valgus deformities and central metatarsalgia, took part in the study. Pressure measurements were performed with a Diagnostic Support system footplate. The average postoperative American Orthopaedic Foot and Ankle Society score of the Austin group was 81.9 and 86.4 for the Boc group. The pressure distributions under the fourth and fifth metatarsal head were comparable in both groups (p>0.05). The Austin group showed decreased load bearing under the hallux and the first metatarsal head (p<0.01), consistent with a persistent overloading of the second and third metatarsal head (p>0.05). The Boc group showed decreased weightbearing under the hallux with better load distribution beneath the second and the third metatarsal head (p<0.05). Correlation of the American Orthopaedic Foot and Ankle Society scores and pressure variables confirmed a significant negative correlation with altered hallux and central metatarsal head loading (p<0.01). CONCLUSION: The Boc triplane osteotomy seems to restore more physiologic loading of the forefoot in comparison to the Austin procedure, reducing the incidence of painful callus under the second and third metatarsal head.
