First Metatarsal Pathology: Can An Implant Provide A Long-Term Solution?

Author(s): 
By Kerry Zang, DPM, Shahram Askari, DPM, A’Nedra Fuller, DPM, and Chris Seuferling, DPM
Made of titanium and cobalt chrome, the implant’s components act as intramedullary endoprostheses with the roughened stems applied into medullary bone. The implant, which also features an ultra-high molecular weight polyethylene interface in the phalangeal component, replicates normal physiologic first MPJ biomechanics without sacrificing excessive articular cartilage or osseous contours. Utilizing the implant also does not require secondary fixation techniques. The implant requires minimal osseous resection, preserves the flexor/extensor apparatus and does not interfere with the sesamoid apparatus. It maintains stable hallucal ground purchase and provides unaltered plantar articular surfaces to facilitate immediate postoperative motion and ambulation. In the event of implant failure, surgeons are not left with a first metatarsal that is excessively short or extensively modified. Accordingly, one has options available for a successful joint salvage procedure. These options include the interposition of capsular tissue in the event of removal of both components or the use of the metatarsal component alone as an endoprosthesis, also utilizing the interposition of soft tissue. Arthrodesis of the first metatarsophalangeal joint with bone graft remains an option as well. This system is designed to provide unchallenged, stress-free motion in all three cardinal planes for the following conditions and scenarios: • hallux limitus or rigidus with degenerative joint disease; • hallux abductovalgus with associated arthritis; • rheumatoid arthritis with inflammatory joint disease; • osteoarthritis; • repair of subluxation and/or dislocation of the joint in conjunction with a repositional osteotomy and/or fusion of the first ray to repair metatarsus primus varus; • a painful or unstable joint from prior surgery; • revision of failed silicone arthroplasty; and • difficult management situations in which clinical experience indicates that continued conservative efforts are likely to render unsatisfactory results. The Bio-Action Implant is contraindicated in the presence of infection, inadequate vascularity, severe osteopenia, physiological or psychological patient compromise or irreparable tendon system function. Assessing Long-Term Outcomes In a randomized retrospective review of 11 patients who received the Bio-Action implant between 1991 and 1994, we found encouraging long-term outcomes. The average implant age was 9.1 years. The mean patient age was 74.6 years with the patients ranging in age between 51 and 82. Eight of the patients were female and three were male. Ten of 11 patients or 91 percent reported that they were satisfied with the joint replacement surgery. The average pain level prior to surgery was reported as 4.63 out of 5 with 5 being the highest. After surgery, the pain level was reported as 1.45 out of 5. The average subjective range of motion within the first MPJ before the surgery was stated as 1.27 out of 5 (with 5 being a full range of motion). At the time of the interview, patients related an average range of motion of 4.63 out of 5. Prior to surgery, 45.5 percent of the patients described themselves as sedentary, 45.5 percent said they were moderately active and 9 percent stated they were highly active. At the time of the interview, only 9 percent described themselves as sedentary, 45.5 percent were moderately active and 45.5 percent were highly active. The interviews of 11 patients reveal that eight regularly wear closed toe or dress shoes, nine regularly wear sandals and 10 regularly wear athletic shoes. Further questioning revealed that three of eight female patients are able to wear high-heeled shoes and the average age of these patients is 70. After more than nine years, the patients in this retrospective study report a decrease in pain from 91 percent (preoperative) to 27 percent (postoperative). When one also considers the maintained restoration of range of motion, this indicates that the Bio-Action Implant has a proven history of durability. Granted, these statistics may be affected by the inability of patients to measure their pain and range of motion accurately and objectively. For precisely this reason, we made the questionnaire as simple as possible. By allowing the patients to assess their own relative conditions, the study naturally acquires a selective perspective.

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