Hallux Rigidus & Silastic Total Implants Rigidus Sylastic Total Implants... · Septic arthritis...
Transcript of Hallux Rigidus & Silastic Total Implants Rigidus Sylastic Total Implants... · Septic arthritis...
Hallux Rigidus & Silastic
Total ImplantsJOSHUA L. MOORE, DPM FACFAS
ASSISTANT DEAN OF EDUCATIONAL AFFAIRS – TUSPM
CLINICAL ASSISTANT PROFESSOR OF SURGERY
Definitions
Hallux Limitus – 1st MTPJ range of
motion less than 65 degrees in the
sagittal plane.
Hallux Rigidus - Absent motion of the 1st
MTPJ
*Normal gait requires 65-75 degrees of dorsiflexion.
Definitions
Functional: Decreased 1st MTPJ motion when foot loaded or in functioning
position.
Responds well to orthosis
Structural: Decreased hallux motion while foot is loaded or unloaded.
Etiology
Long 1st ray
1st Ray elevatus
Hypermobile 1st ray
DJD
Septic arthritis
Systemic arthridities
Weak or absent peroneus longus
Iatrogenic
Trauma
Neoplasms
Presentation
Pain to joint with palpation & ROM
Palpable exostosis
1st ray elevatus
Callus plantar IPJ
Metatarsalgia
Bursitis to 1st MTPJ
Radiographic findings
Flattening of 1st met head
Dorsal exostosis
Loose bodies
Joint space narrowing
1st metatarsal elevatus
Conservative treatments
NSAIDS
Injections
Physical therapy modalities
Orthosis – Morton’s extension, 1st ray
cut out
Surgical considerations
Joint salvage
Reserved for limitus
Excision of ossicles/exostosis
Joint destructive
Implants
Interpositional implant
Resection arthroplasty with placement of spacer
Total joint replacement
Total resurfacing and joint replacement
Benefits
Immediate weight bearing usually allowed
Maintain some function
Typically less healing time
Room for other procedures in the future
Implant Indications/Goals
Indications
Hallux Rigidus
Crepitus & pain with ROM
Revisional Surgery
Systemic arthridities
DJD
Osteochondral fractures
Goals
Reduce pain
Gain/Restore motion
Correct deformity
Long term results
Maintain stability
Total Implants
Hinged silastic
Maintains position, stability and motion
>30 years of successful clinical outcomes
May use grommets to prevent implant breakdown and erosion
Pre Op Considerations
Patient awareness!!
May break down and need replaced or require fusion
May have a dull pain
May not gain much motion
Does the patient have adequate bone stock?
Normal alignment of 1st ray (sagittal and frontal planes)
Length of lesser metatarsals
Complications
Infection
Lack of hallux purchase
Painful/limited ROM
Fracture of metatarsal &/or phalanx
Loosening of prosthesis
Metatarsalgia
Stress fractures lesser metatarsals
Interference of sesamoid position and gliding
Complications
Foreign body reaction
Osteolysis
Implant destruction
Ectopic bone formation
Chronic edema
Subchondral cysts
Telescoping of bone
Complications
Infection
Normally 105 whereas with an implant it is 102
Reported infection rates from 1-2%
Do not let pain and inflammation fool you.
Implant destruction
Fatigue fracturing – implant fractures due to fatigue
Breakdown caused by cutting or modifying implant.
Subchondral cyst formation
75% of all patients
Only problematic if fracture or collapse
Complications
Reactive synovitis and metallosis
Dendritic synovitis!!!
Giant cell & inflammatory reaction to silicone.
Microfragments formed through abrasion of bone on implant
Often require implant removal
Ectopic bone formation
Bony proliferation around implant
Cause limited & painful ROM
Pearls
Minimal incision for reduced adhesions and scarring
dorsally
Use of rotary burr to prepare medullary canal
Remove a small plantar wedge from metatarsal head
Do not touch the implant with your hands
Do not cut or compromise the implant
Begin immediate weight bearing and ROM exercises
Resect as little bone as possible
References
Morgan S, Ng A, Clough T. The long-term outcome of silastic implant arthroplasty of the first metatarsophalangeal joint: a retrospective analysis of one hundred and eight feet. Int
Orthop. 2012 Sep;36(9):1865-9.
Sullivan MR. Hallux Rigidus: MTP Implant Arthroplasty. Foot Ankle Clin. 2009 Mar;14(1):33-42.
Brage ME, Ball ST. Surgical options for salvage of end-stage hallux rigidus. Foot Ankle Clin. 2002 Mar;7(1):49-73.
Bonet J, Taylor DT, Lam AT, Williams E, Keane LA. Retrospective analysis of Silastic implant arthroplasty of the first metatarsophalangeal joint. J Foot Ankle Surgery. 1998 Mar-Apr;37(2):128-34.
Lemon B, Pupp GR. Long-term efficacy of total SILASTIC implants: a subjective analysis. J Foot Ankle Surgery. 1997 Sep-Oct;36(5):341-6.