İleri evre halluks rijiduslu hastalarda yerli üretim total eklem artroplastisi ile tedavi sonuçlarımız

Year 2019, Volume: 12 Issue: 2, 215 - 224, 28.05.2019

Turan Cihan Dülgeroğlu , Nihat Demirhan Demirkıran , Mehmet Erduran

https://doi.org/10.31362/patd.465511

Abstract

Giriş: Bu çalışmada ileri evre halluks rijiduslu hastalarda uyguladığımız 1. Metatarso-falangeal eklem total artroplastisi tedavi sonuçları değerlendirilmiştir. 

Gereç ve Yöntem: Coughlin ve Shurnas sınıflamasına göre evre 3 ve 4 halluks rijidus tanılı 18 hastaya yerli üretim total başparmak artroplastisi uygulanmıştır. Ameliyat sonrası en az 12 ay takipli ve yeterli verisi bulunan hastalarda retrospektif olarak eklem hareket açıklığı, görsel analog ağrı göstergesi (VAS) ve Amerikan Ortopedik Ayak ve Ayak Bileği Cemiyeti (AOFAS) skorları ile değerlendirme yapılmıştır. 

Bulgular: Çalışmaya kabul edilen hastaların yaş ortalaması (64,44 ±7,16) idi. Ortalama takip süresi 18,4±2.43 aydı. 1.metatarso-falangeal eklem total artroplastisi yapılan hastalarda eklem hareket açıklığı (p=0,001), VAS (p<0,001) ve AOFAS (p=0,001) skorlarında ameliyat öncesine göre anlamlı düzelme gözlendi.Takip süreleri boyunca implant yetmezliği, kırık oluşumu, ciddi enfeksiyon vb. komplikasyonlar gözlenmedi. 

Sonuç: İleri evre halluks rijidus hastaları için güncel bir tedavi olarak total eklem artroplastisi eklem hareket açıklığında sağladığı artış ve ağrıyı azaltması sayesinde umut vadetmektedir.

Keywords

Halluks rijidus, dejeneratif artrit, eklem artroplastisi

Our results with local production total arthroplasty in patients with advanced stage hallux rijidus

Abstract

Objective: In this study, we evaluated
the treatment results of the 1. metatarsophalangeal joint total arthroplasty in
patients with advanced stage of hallux rigidus.

Materials and
Methods:
Total joint arthroplasty was applied to 18 patients with stage 3 and 4 hallux
rigidus according to Coughlin and Shurnas classification. Range of motion,
visual analogue scale (VAS) and American Orthopedic Foot and Ankle Association
(AOFAS) scores were evaluated retrospectively twelve months after surgery.

Results: The average age of the
patients was 64.44±7.16. The mean follow-up period was 18.4±2.43 months.
Significant improvement was observed in the range of motion degrees (p=0,001), VAS (p<0,001) and AOFAS (p=0,001)
scores in patients with metatarsophalangeal joint total arthroplasty.
Complications such as implant failure, fracture, severe infection were not
observed during follow-up periods.

Conclusion: Total joint arthroplasty as
a current treatment for advanced-stage hallux rigidus patients is promising
with good results.

Keywords

hallux rigidus, degenerative arthritis, arthroplasty

References

• 1. Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK. Reliability and validity of the subjective component of the American Orthopedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg, 2007; 46:65–74.2. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994;15:349–353.3. Coughlin MJ, Shurnas PS. Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int. 2003;24:731-743.4. Valentini R, De Fabrizio G, Piovan G. First metatarsophalangeal joint replacement with total arthroplasty in the surgical treatment of the hallux rigidus. Acta Biomed. 2014 Jul 22;85 Suppl 2:113–117.5. Coughlin MJ, Shurnas PS. Hallux rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg Am.2003;85-A(11):2072–2088.6. Hasselman CT, Shields N. Resurfacing of the first metatarsal head in the treatment of hallux rigidus. Tech Foot Ankle Surg.2008;7:31–407. Kennedy JG, Chow FY, Dines J, Gardner M, Bohne WH. Outcomes after interpositional arthroplasty for treatment of hallux rigidus. Clin Orthop Relat Res. 2006;445:210–215.8. Fitzgerald JA, Wilkinson JM. Arthrodesis of the metatarsophalangeal joint of the great toe. Clin Orthop Relat Res. 1981;(157):70–77.9. Yetkin H, Kanatlı U, Songür M. Current treatment methods in hallux rigidus. TOTBID Dergisi 2006 ;(5): 3–4,95–100.10. Yee G, Lau J. Current concepts review: Hallux rigidus. Foot Ankle Int .2008 Jun;29(6):637– 646.11. Lundeberg T, Lund I, Dahlin L, Borg E, Gustafsson C, Sandin L, Rosen A, Kowalski J, Eriksson SV. Reliability and responsiveness of three different pain assessments. J Rehabil Med, 2001; 33:279–283.12.Raikin SM, Ahmad J, Pour AE, Abidi N. Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint. J Bone Joint Surg Am. 2007;89(9):1979–1985.13. Berlet GC, Hyer CF, Glover J. A retrospective review of immediate weightbearing after first metatarsophalangeal joint arthrodesis. Foot and Ankle Specialist .2008;1(1):24–28.14. Hyer CF, Glover JP, Berlet GC, Lee TH. Cost comparison of crossed screws versus dorsal plate construct for first metatarsophalangeal joint arthrodesis. Journal of Foot and Ankle Surgery 2008;47(1):13–18.15. Kumar S, Pradhan R, Rosenfeld PF. First metatarsophalangeal arthrodesis using a dorsal plate and a compression screw. Foot and Ankle International. 2010;31(9): 797–801. 16. Ter Keurs EW, Wassink S, Burger BJ. First metatarsophalangeal joint replacement: Long-term results of a double-stemmed flexible silicone prosthesis. Foot Ankle Surg. 2011 Dec;17(4):224–7.17. Vallier GT, Peterson SA, LaGrone MO. Keller resection arthroplasty: A 13-yearexperience. Foot and Ankle International. 1991;11(4):187–194.18. Hamilton WG, O’Malley MJ, Thompson FM, Kovatis PE. Capsular interposition arthroplasty for severe hallux rigidus. Foot Ankle Int. 1997 Feb; 18(2):68–70.19. Akkurt MO, Şeşen H, Özdemir M, Çatma MF, Demirkale İ. Reduced postoperative functional length ratio influences patient satisfaction in first metatarsophalangeal joint replacement. J Foot Ankle Surg. 2016 Jul-Aug;55(4):743–74720. Meriç G, Erduran M, Atik A, Köse Ö, Ulusal AE, Akseki D. Short-term clinical outcomes after first metatarsal head resurfacing hemiarthroplasty for late stage hallux rigidus. J Foot Ankle Surg.2015;54:173-178.21. Duncan NS, Farrar NG, Rajan RA. Early results of first metatarsophalangeal joint replacement using the ToeFit-Plus™ prosthesis. J Foot Ankle Surg. 2014 May-Jun;53(3):265–268.22. Redfern DJ. Early failure of the Moje screw-fit ceramic metatarsophalangeal joint replacement. Foot 2003; 13(4):204–208.23. Nagy MT, Walker CR, Sirikonda SP. Second-generation ceramic first metatarsophalangeal joint replacement for hallux rigidus. Foot Ankle Int. 2014 Jul;35(7):690–698.24. Erdil M, Bilsel K, Imren Y, Mutlu S, Güler O, Gürkan V, Elmadağ NM, Tuncay I. . Metatarsal head resurfacing hemiarthroplasty in the treatment of advanced stage hallux rigidus: outcomes in the short-term. Acta Orthop Traumatol Turc. 2012;46:281-285.25. Titchener AG, Duncan NS, Rajan RA. Outcome following first metatarsophalangeal joint replacement using TOEFIT-PLUS™: A mid-term alert. Foot Ankle Surg. 2015 Jun;21(2):119–12426. Cook E, Cook J, Rosenblum B, Landsman A, Giurini J, Basile P. Meta-analysis of first metatarsophalangeal joint implant arthroplasty. J Foot Ankle Surg. 2009; 48(2):180–90.27. Chee YH, Clement N, Ahmed I, Thomson CE, Gibson JN. Functional outcomes followingceramic total joint replacement for hallux rigidus. Foot Ankle Surg. 2011 ;17(1):8-12. 28. Gibson JN, Thomson CE. Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial. Foot Ankle Int. 2005 Sep;26(9):680-90.29. Erdil M, Elmadağ NM, Polat G, Tunçer N, Bilsel K, Uçan V, Erkoçak OF, Sen C. Comparison of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in the treatment of advanced hallux rigidus. J Foot Ankle Surg. 2013 Sep-Oct;52(5):588-93.