How To Salvage A Failed First MPJ Implant

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Here is a preoperative radiograph of a symptomatic failed silastic implant with varus subluxation of the hallux on the second and third digits. This anterior-posterior view shows extensive cystic change of the proximal phalanx and the first metatarsal hea
These intraoperative photographs show the first metatarsophalangeal joint with the silicone implant removed. Note the erosion of the proximal phalanx and the first metatarsal head.
This intraoperative photograph shows the structural tricortical iliac crest graft.
This intraoperative photo shows the graft in place with internal fixation.
These intraoperative photographs show the first metatarsophalangeal joint with the silicone implant removed. Note the erosion of the proximal phalanx and the first metatarsal head.
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Author(s): 
By Graham A. Hamilton, DPM

In Conclusion

   Although surgical correction of the failed silicone implant in the first metatarsophalangeal joint can be technically difficult, three surgical treatment options are available: implant removal, implant replacement with a new device and bone block arthrodesis. Distraction arthrodesis is the only option that affords first metatarsophalangeal joint stability and a biomechanically sound first ray, and is the best option for an active person. With careful preoperative and postoperative management, one can achieve optimal outcomes with this procedure.

Dr. Hamilton is affiliated with the Department of Orthopedics and Podiatric Surgery at the Kaiser Permanente Medical Centers in Oakland and Richmond, Calif. He is the Director of Education at the San Francisco Bay Area Foot and Ankle Residency Program, and is a Fellow of the American College of Foot and Ankle Surgeons. The author thanks the Kaiser Foundation Hospital’s Department of Medical Editing for its assistance with this article.

Editor’s Note: For related articles, check out the archives at www.podiatrytoday.com.




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