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

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. However, given the average length of time (9.1 years) since the implants were placed, we felt this type of questioning would be sufficient to demonstrate either the success or failure of the implant.

Step-By-Step Pearls For Using The Bio-Action Implant
To begin, make a dorsal curvilinear incision over the first MPJ, exposing the head of the metatarsal and the base of the proximal phalanx. Perform a dorsal capsulotomy according to one’s preference. Once the head of the first metatarsal and the base of the proximal phalanx are exposed, one may remove the hypertrophic changes about the first metatarsal head and rasp the remaining bone smooth. A key component to the success of the Bio-Action Implant is the position of the metatarsal component relative to the second metatarsal head. One must remove enough bone from the metatarsal in order to preserve and/or restore the natural metatarsal parabola.

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