Can Calcium Phosphate Bone Cement Aid In Hallux Valgus Repair?
- Volume 21 - Issue 7 - July 2008
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A Step-By-Step Guide To The Surgical Procedure
The integration of the calcium phosphate cement into the surgical procedure for metatarsal osteotomy-type bunionectomies is as follows.
After resecting an appropriate amount of bone from the distal aspect of the first metatarsal and preparing the void in the medullary canal, start preparing the OsteoVation calcium phosphate cement. The preparation period involves one minute of mixing followed by a few minutes for filling the syringe.
Distract the osteotomy to expose to the shaft of the medullary canal. Using a blunt, 14-gauge needle, fill the void with the OsteoVation bone cement. The use of a needle allows one to deliver the calcium phosphate cement in a directed and controlled manner.
Once the cement is in, continue the procedure with K-wire fixation. Following a five-minute setting period, proceed with compression screw fixation and stabilization. At this point, the
cement has hardened sufficiently to allow screws to gain a sufficient hold into the material. After checking the alignment of first ray and that the patient has achieved range of motion, avoid movement of the site to allow the cement to cure further and create a strong interface with the bone.
A Closer Look At The Post-Op Results
The clinical results after utilizing OsteoVation in osteotomy-type hallux valgus repairs have been remarkable. I have used OsteoVation in conjunction with these procedures on over 150 patients.
Typically, patients who undergo osteotomy-type hallux valgus repair are in a cast or walker boot for six to eight weeks. With OsteoVation, my patients are out of the walker boot in approximately two weeks and in an athletic or supported sport sandal within three weeks. Furthermore, female patients are back in low-heeled casual shoes at six weeks and dress shoes by 10 to 12 weeks.They are reporting minimal pain and I have observed significantly less swelling.
I believe we can directly attribute these results to a strong bone/cement interface and the creation of a stable osteotomy site with the calcium phosphate cement. The OsteoVation bone cement essentially functions as a grout in the medullary canal that prevents intraosseous hematoma formation.
As a result of the strong interface and stable osteotomy, as well as a reduction in postoperative edema, I can be more aggressive in achieving early range of motion of the first MPJ complex.This in turn facilitates even less swelling, greater range of motion and a shorter recovery period.
As a result of the mechanical similarity of OsteoVation calcium phosphate bone cement to natural bone, calcium phosphate cement provides skeletal stabilization and is able to sustain compressive loads when one uses it to fill voids within the medullary canal of the first metatarsal.The hallux valgus repair procedure is not hindered in any way as surgeons may use the material in conjunction with internal fixation devices, screws, pins and plates.
The use of calcium phosphate cements removes the risk of potentially harmful complications resulting from polymeric cements, autogenous iliac crest grafts and cadaveric cancellous bone chips. This is due, in part, because the carbonated apatite which the calcium phosphate bone cement converts into is an osteoconductive biomaterial that remodels itself via normal cell-mediated activity and is ultimately replaced by living host bone.
The use of a calcium phosphate bone void filler cement to supplement internal and external fixation devices is effective in maintaining the reduction of deformities by providing increased stabilization, and ultimately a better clinical outcome.
Dr. Zang is a Diplomate of the American Board of Podiatric Surgery and a Fellow of the American College of Foot and Ankle Surgeons.
Dr. Burks is a Fellow of the American College of Foot and Ankle Surgeons, and is board certified in foot and ankle surgery. Dr. Burks practices in Little Rock, Ark.
For a related article, see “How To Treat Severe Bunions” in the August 2005 issue of Podiatry Today.