Case-control Study on 2nd Hammertoe Deformity Correction Techniques
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Transcript of Case-control Study on 2nd Hammertoe Deformity Correction Techniques
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Surgical Outcomes for Hammertoe Correction: A Case-Control Study
• Presenter: Wenjay Sung, DPM
• Authors: Wenjay Sung, DPM, Lowell Weil, Jr., DPM, Lowell Scott Weil, Sr., DPM, and Ernie P. Luczkowski, BS .
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Disclosures
I have nothing to disclose LSW is a consultant for Wright Medical
Technologies and receives royalties from the Weil Hammertoe Implant.
LWJ is a consultant for Wright Medical Technologies
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Overview
Purpose Methods Statistical Analysis Results Discussion Conclusions
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Purpose
The purpose of this study was to compare the long-term outcomes of second hammertoe deformities that underwent proximal interphalangeal (PIP) joint correction using arthroplasty, arthrodesis or interpositional implant arthroplasty.
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Purpose
Retrospective Case-Control Study EBM Level of evidence: III (Therapeutic)
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Purpose
BACKGROUND
Indications for surgical correction of hammertoe8
Pain Pressure over the
dorsal aspect of the PIP joint
Hypertrophic callus on the dorsum of the digit.
There are many reports regarding the outcomes PIP joint interpositional implant arthroplasty1-
3, PIP joint arthrodesis4-6, and PIP joint arthroplasty7 for hammer toe deformity.
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Purpose
However there are no studies that compare the outcomes of all three with significant follow-up.
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Methods
Medical records from patients who underwent second PIP joint correction between January 1998 to December 2008 were retrospectively reviewed.
A total of 114 patients (136 cases) were included in the study that had complete medical records and anterior-posterior (AP) and lateral (LAT) radiographic views pre-operatively and post-operatively.
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Methods
Separated into three groups Arthroplasty Arthrodesis Interposition
Implant Arthroplasty (Implant)
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Methods
Visual analog pain scale (VAS)
Revision surgeries Second PIP joint
angle was measured on AP and LAT views.
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Methods
ANTERIOR-POSTERIOR LATERAL
Pre-operative
Post-operative
Pre-operative
Post-operative
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Statistical Analysis
All statistical analyses were performed with SPSS version 14.0 for a personal computer (SPSS Science Inc, Chicago, Ill).
We used a two-way repeated measures analysis of variance (ANOVA). Inferential statistics included paired two-tailed t tests for continuous variables.
The a priori α level was .05 for all statistical tests.
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Results
DEMOGRAPHICS
39 patients/ 45 cases with an average age of 62.7
34 patients/ 43 cases with an average age of 55.5
41 patients/ 48 cases with an average age of 67.4
Arthroplasty Group
Arthrodesis Group
Implant Group
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Results
DEMOGRAPHICS
Average follow-up of 45.3 months
Average follow-up of 47.8 months
Average follow-up of 67.4 months
Arthroplasty Group
Arthrodesis Group
Implant Group
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Results
ARTHROPLASTY
• Average pre-operative VAS scores was 7.1 vs 1.0 post-operatively (P<0.01).
• Average pre-operative AP was 8.20 vs 11.40 post-operative (P < 0.05).
• Average pre-operative LAT was 46.90 vs 31.50 post-operative (P<0.01).
• Seventeen (37.8%) cases elected revision surgery.
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Results
ARTHRODESIS
• Average pre-operative VAS scores was 8.0 vs 1.9 post-operatively (P<0.01).
• Average pre-operative AP was 7.20 vs 5.40 post-operative (P = 0.59).
• Average pre-operative LAT was 46.40 vs 24.70
post-operative (P<0.01).• Six (14.6%) cases
elected revision surgery.
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Results
IMPLANT
• Average pre-operative VAS scores was 8.2 vs 1.3 post-operatively (P<0.01).
• Average pre-operative AP was 7.80 vs 2.90 post-operative (P < 0.01).
• Average pre-operative LAT was 49.10 vs 24.20
post-operative (P<0.01).• Four (10.4%) cases
elected revision surgery.
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Results
Table 1 Mean Pre-operative VAS (SD)
Mean Post-operative VAS (SD)
Paired T-test P value
Arthroplasty (N=45) 7.1 (2.1) 1.0 (1.2) <0.01Arthrodesis (N=43) 8.0 (2.0) 1.9 (1.6) <0.01
Implant (N=48) 8.2 (1.8) 1.3 (1.4) <0.01ANOVA Not enough variance Not enough variance
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Results
Table 2 Mean Pre-operative AP (SD)
Mean Post-operative AP (SD)
Paired T-test P value
Arthroplasty (N=45) 8.2 (7.9) 11.4 (7.7) <0.05Arthrodesis (N=43) 7.2 (7.8) 5.4 (8.0) 0.59
Implant (N=48) 7.8 (7.9) 2.9 (5.5) <0.01ANOVA Not enough variance Significant Variance
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Results
Table 3 Mean Pre-operative LAT (SD)
Mean Post-operative LAT (SD)
Paired T-test P value
Arthroplasty (N=45) 46.9 (17.8) 31.5 (11.7) <0.01
Arthrodesis (N=43) 46.4 (17.1) 24.7 (14.1) <0.01
Implant (N=48) 49.1 (14.3) 24.2 (5.7) <0.01
ANOVA Not enough variance Not enough variance
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Discussion
Our study demonstrates that all three techniques Significantly improve pain Significantly corrects in the sagittal plane
(LAT).
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Discussion
However, only the implant group significantly corrected the deformity in the axial plane (AP). Moreover, surgical revisions were lower in this
group.
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Discussion
There are many studies that demonstrate great results of different techniques1-7, however, this study is the first to compare the results of three popular hammertoe treatments with long-term follow-up.
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Discussion
STRENGTH WEAKNESS
Case-Control Statistical analysis Follow-up
Observer bias Variability in patient
selection. Underpowered to
determine variance
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Conclusions
In conclusion, our study confirms that all three techniques provide adequate pain relief and sagittal plane correction.
However, interpositional implant arthroplasty provides significant correction in the axial plane with less chance for revision surgery.
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References
1. Sollitto RJ et al. A preliminary report on the status of implants for the lesser toes. J Foot Surg. 1985 Nov-Dec: 24 (6): 435-6
2. Sgarlato TE. Digital implant arthroplasty. Clin Podiatr Med Surg 1996 Apr;13(2):255-62.
3. Mednick DL et al. Comparison of total hinged and total nonhinged implants for the lesser digits. J Foot Surg. 1985 May-Jun;24(3):215-8.
4. Edwards WH et al. Interphalangeal joint arthrodesis of the lesser toes. Foot Ankle Clin. 2002 Mar;7(1):43-8.
5. Ohm OW et al. Digital arthrodesis: an alternate method for correction of hammer toe deformity. J Foot Surg 1990 May-Jun;29(3):207-11.
6. Co AY et al. Radiographic analysis of transverse plane digital alignment after surgical repair of the second metatarsophalangeal joint. J Foot Ankle Surg. 2006 Nov-Dec;45(6):380-99.
7. Rice JR. Digital arthroplasty by power surgery with minimal incision. J Am Podiatry Assoc. 1977 Nov;67(11):811-4.
8. Coughlin MJ. Lesser toe abnormalities. Instr Course Lect. 2003;52:421-44.
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Thank You