Beruflich Dokumente
Kultur Dokumente
• Indications
• Anatomy
• Treatment Options
• Arthrosurface System
Indications
• Degenerative and Post-
traumatic arthritis in the first
metatarsal joint in the
presence of good bone stock
• Hallux Rigidus / Limitus
• Hallux Valgus*
• Unstable or painful
metatarsal / phalangeal
(MTP) joint
* In combination with corrective
osteotomy
Disarticulated bones of the foot
• From above (The talus and
calcaneus remain articulated)
• 1 Calcaneus
2 Talus
3 Navicular
4 Medial cuneiform
5 Intermediate cuneiform
6 Lateral cuneiform
7 Cuboid
8 First metatarsal
9 Second metatarsal
10 Third metatarsal
11 Fourth metatarsal
12 Fifth metatarsal
13 Proximal phalanx of great toe
14 Distal phalanx of great toe
15 Proximal phalanx of second toe
16 Middle phalanx of second toe
17 Distal phalanx of second toe
Metatarsophalangeal MTP Joint
• The 1st MTP is the most
complex joint of the foot,
where bones, tendons
and ligaments work
together to transmit and
distribute the body’s
weight, especially during
movement.
• First MTP-related
problems occur from
repetitive trauma and
arthritis.
Foot Function– Truss and Tie-Rod
Arthrodesis
(fusion)
Arthroplasty
(implant)
Cheilectomy
• PRO:
– Keeps joint motion
– No implants needed
– Fast and easy to perform
• CON
– Only good in stage I with little joint involvement
– 30% of patients will progress in arthritis
– Quite often x-rays underestimate extent of disease
Cheilectomy
Arthrodesis
(fusion)
Arthroplasty
(implant)
Resection arthroplasty (Keller)
• PRO:
– Good for severe stages of arthritis (sesamoid arthritis)
– Good relief of pain control
– May weight bear immediately
• CON:
– High (40%) risk of deformity (varus/valgus/cock-up)
– Severe loss of push-off strength
– Only indicated for elderly and sedentary patients
Arthrodesis - Fusion
Arthrodesis
• PRO:
– Good relief of pain control
– Good for sesamoid arthritis
• CON:
– Limits shoe wear for women
– Increases stress on next joint
– Hard to get patients to accept fusion
– Long recovery from fusion (awaiting fusion)
– Malpositioning is difficult to deal with
BioPro
Hemiarthroplasty
Implant arthroplasty (hemi)
• PRO:
– Easy to perform
– Good relief of arthritis pain
– May weight bear immediately
• CON:
– Only for the proximal phalanyx
– Does not work in sesamoid arthritis
– Variable success rates
Implant arthroplasty (total)
• PRO:
– Easy to perform
– Good relief of arthritis pain
– Allows immediate weight bearing
– Either silastic or metal
• Reflection – osteomed – accumed
• CON:
– Silastic has high failure rate and complications
– Does not work in sesamoid arthritis, or loss of push
off
– Salvage/fusion is very difficult from bone loss
– Joint subluxation is big problem (soft tissue balance)
– success rates
Interpositional arthroplasty
• PRO:
– Good relief of pain control
– No artificial surfaces
– Allows immediate weight bearing
• CON:
– Not for sesamoid arthritis
– Causes significant stiffness and loss of motion
– Variable success rates
– High risk of postoperative deformity
PRE/POST OP X-RAY
HemiCAP Device
• PRO:
– Good relief of pain control
– Addresses both sides of arthritis
– Allows immediate weight bearing
– Low incidence of postoperative deformity
• CON:
– Does not address sesamoid arthritis
– No long term outcome studies yet
Why this implant?
• Very little bone resection so salvage (fusion) is
much easier if fails.
• Does not affect sesamoid complex so push off is
normal.
• With “Hasselman’s technique” both sides of the
joint are resurfaced.
• Allows women to wear their “other shoes”
without sacrificing strength or pushoff.
• Very easy to perform, no problems with
instability or deformity because of soft tissue
balance
Algorithm by Age
Yes
Remove implant and fixation component, then
bone graft for screw arthrodesis
Future possibility: remove implant and then
use K-wire through fixation component to fuse