Mehmet ERDİL, Kerem BİLSEL, Yunus İMREN, Serhat MUTLU, OLCAY GÜLER, Volkan GÜRKAN, NUH MEHMET ELMADAĞ, İbrahim TUNCAY

Metatarsal head resurfacing hemiarthroplasty in the treatment of advanced stage hallux rigidus: outcomes in the short-term

Amaç: Bu çalışmadaki amaç ileri evre halluks rijidusu olan hastalara uyguladığımız metatars başı yüzey değiştirici metal yüzeyli hemiartroplastinin erken dönemdeki sonuçlarını değerlendirmekti. Çalışma planı: 2007-2010 yılları arasında ileri evre halluks rijidus tanısıyla 12 hastanın (10 kadın, 2 erkek; ortalama yaş: 63±5, dağılım: 55-71) 14 ayağına (4 sol, 10 sağ) metatars başı yüzey değiştirici metal yüzeyli hemiartroplasti (HemiCAP®) uygulandı. İmplant uygulamasının yanında, kapsüler gevşetme ve eklem çevresi osteofit debridmanı yapıldı. Evreleme, Coughlin ve Shurnas’ın halluks rijidus klinik ve radyografik evreleme sistemine göre yapıldı. Hastaların ameliyat öncesi ve sonrası radyolojik değerlendirmede ayakta basarak çekilen ön-arka ve yan grafilerinde halluks valgus açısı ve intermetatarsal açı ölçüldü. Klinik değerlendirmeler 1. metatarsofalangeal eklem hareket açıklığı ölçümü, AOFAS (American Orthopaedic Foot and Ankle Society) halluks metatarsofalangeal-interfalangeal skalası ve memnuniyet düzeyleri ile yapıldı. Bulgular: Hastaların ortalama takip süresi 19.5 (dağılım: 14-26) ay idi. İki hastada iki taraflı tutulum vardı. Dokuz ayak Evre 3, beş ayak Evre 4 idi. AOFAS skalasına göre, son takipte sekiz ayakta (%57.1) mükemmel, dört ayakta (%28.6) iyi, iki ayakta (%14.3) orta sonuç elde edildi. Ameliyat sonrasında AOFAS skorunda ortalama 26.2 puanlık artış sağlandı (p

İleri evre halluks rijidus tedavisinde metatars başı yüzey değiştirici hemiartroplasti: Erken dönem sonuçları

Objective: The aim of this study was to evaluate the short-term outcomes of metatarsal head metal resurfacing hemiarthroplasty in patients with advanced stage hallux rigidus. Methods: The study included 14 feet (4 left, 10 right) of 12 patients (10 female, 2 male; mean age: 63±5; range: 55 to 71 years) who underwent metatarsal head metal resurfacing hemiarthroplasty (HemiCAP®) between 2007 and 2010. Additionally, capsular release and periarticular osteophyte debridement were performed. Staging was made according to Coughlin and Shurnas’ clinical and radiological grading system. Hallux valgus and intermetatarsal angles were measured using pre and postoperative standing AP and lateral foot views. Clinical assessment was made with first metatarsophalangeal joint range of motion, the AOFAS (American Orthopaedic Foot and Ankle Society) hallux metatarsophalangeal-interphalangeal scale and satisfaction level. Results: Mean follow up was 19.5 (range: 14 to 26) months. Two patients had bilateral involvement. According to Coughlin and Shurnas’ clinical and radiological grading system, nine feet were Stage 3 and five feet were Stage 4. According to the AOFAS scale, results of eight feet (57.1%) were excellent, four feet (28.6%) were good and two feet (14.3%) were moderate. Mean total AOFAS score increased by 26.2 points postoperatively (p<0.05). Mean range of motion of the first metatarsophalangeal joint improved significantly from a preoperative 22.2±5.6 (range: 10 to 28) degrees to a postoperative 56.3±9.6 degrees (p<0.05). Mean hallux valgus angle decreased from a preoperative 14.3 (range: 9 to 17) degrees to a postoperative 11.1 (range: 4 to 13) degrees and the mean intermetatarsal angle increased from a preoperative 10.5 (range: 8 to 14) degrees to a postoperative 10.8 (range: 8 to 15) degrees. Patient satisfaction levels were very good in 10 feet (71.4%), good in 3 (21.4%), and moderate in one (7.2%). Complications included metatarsalgia aggravated by long walks in one patient and hypoesthesia of the great toe in three patients. Push-off power of the great toes was measured as 4/5 in three cases, and 5/5 in others. Conclusion: Metatarsal head metal resurfacing hemiarthroplasty provides high patient satisfaction level and good functional outcome in the short-term, in the surgical treatment of advanced stage hallux rigidus refractory to conservative treatment options.

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