Flexible hinge toe implant arthroplasty for rheumatoid arthritis of the first metatarsophalangeal joint: long-term results

• Published in: Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2001-04, Vol.6 (2), p.141-147
• Main Authors: Hanyu, Tadamasa, Yamazaki, Hideshi, Ishikawa, Hajime, Arai, Katsumitsu, Tohyama, Chikako T., Nakazono, Kiyoshi, Murasawa, Akira
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - surgery; Arthroplasty; Biological and medical sciences; Humans; Joint prosthesis; Joint surgery; Medical sciences; Metatarsophalangeal joint; Metatarsophalangeal Joint - diagnostic imaging; Metatarsophalangeal Joint - surgery; Middle Aged; Orthopedic surgery; Prostheses and Implants; Radiography; Rheumatoid arthritis; Silicone Elastomers; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Toes - diagnostic imaging; Toes - surgery; Transplants & implants; Treatment Outcome
• ISSN: 0949-2658; 1436-2023
• DOI: 10.1007/s007760100062

We report the long-term clinical results and survival rate of the implant in flexible hinge toe implant arthroplasty of the first metatarsophalangeal joint, combined with a shortening oblique osteotomy of the metatarsal neck in the lateral toes, in patients with rheumatoid arthritis. Between 1983 and 1990, arthroplasty was performed on 97 feet in 66 patients. Twenty-seven patients died; follow-up information was available for 60 feet in the remaining 39 patients, who were followed for an average of 12 years. Twenty-nine patients (74%) were satisfied with the outcome after surgery, 7 were satisfied but had some pain or recurrent deformities, and 3 were unsatisfied. Radiologically, visible fracture was identified in nine implants. Four implants were removed because of infection (n=2) or recurrent deformity (n=2); no implant was removed because silicone synovitis developed. With revision as the endpoint, the implant survival rate was 93% at 10 years, and with radiographic implant fracture as the endpoint, the implant survival rate was 87% at 10 years. Shortening oblique osteotomy of the lateral toes appeared to decrease the rate of implant fracture and should be performed concomitantly with implantation when rheumatoid forefoot deformities are being reconstructed.