Calcaneal Autograft: Can It Facilitate Salvage Of A Failed First MPJ Implant?

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Author(s): 
Kenneth Seiter, DPM

In Conclusion

   Historically, foot and ankle surgeons have had to rely upon peripheral resources to obtain bone graft to re-establish the length of a failed double-stemmed silicone prosthesis of the first MPJ. The prospect of obtaining a graft from the foot will enable podiatric surgeons, who were previously limited to iliac crest or allogenic graft sources, to perform reconstruction of these potentially disabling deformities with less difficulty and higher rates of union. Surgeons have successfully demonstrated that, in most circumstances, the calcaneus has ample amounts of graft available to obtain proper functional length and a cosmetically pleasing effect.

   Additionally, with the advent of low-profile locking plates, surgeons can achieve rigid internal fixation without hardware irritation or failure. While debate regarding the functionality of an arthrodesis is inevitable, this surgical technique continues to be a viable salvage procedure for foot and ankle surgeons across the country.2

Dr. Seiter is an Associate of the American College of Foot and Ankle Surgeons. He is in a multispecialty practice and serves as Co-Chair of Podiatric Surgery at Sparks Regional Medical Center in Fort Smith, Ark. Dr. Seiter was a previous Reconstructive Surgery Fellow at American Health Network in Indianapolis.




References:

1. Hecht PJ. Arthrodesis of the first metatarsophalangeal joint to salvage failed silicone implant arthroplasty. Foot Ankle Int 1997; 18(7):383-390.
2. Hamilton GA. How to salvage a failed first MPJ implant. Podiatry Today 2005; 18(5):36-42.
3. Hansen ST. Functional Reconstruction of the Foot and Ankle. Lippincott Williams & Wilkins, Philadelphia, 2000, chapter 23, pp. 492-3.
4. Coughlin MJ. Arthrodesis of the first metatarsophalangeal joint with mini-fragment plate fixation. Orthopedics 1990; 13(9):1037-1044.
5. Myerson MS, Schon LC, McGuigan FX, Oznur A. Results of arthrodesis of the hallux metatarsophalangeal joint using bone graft for restoration of length. Foot Ankle Int 2000; 21(4):297-307.
6. Mulier T, Dereymaeker G. Revision of failed Keller arthroplasty with intercalary bone graft. Techniques Foot Ankle Surg 2007; 6(2):130-135.




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