Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (4): 726-729. doi: 10.19723/j.issn.1671-167X.2020.04.025

Previous Articles     Next Articles

Evaluation of therapeutic efficacy of arthroplasty with Swanson prosthesis in the surgical treatment of 2-5 metatarsophalangeal joint diseases

Zhong-di LIU,Hao LU,Yu-song YUAN,Hai-lin XU()   

  1. Department of Trauma and Orthopedics, Trauma Medical Center, Peking University People’s Hospital, Beijing 100044, China
  • Received:2019-01-27 Online:2020-08-18 Published:2020-08-06
  • Contact: Hai-lin XU E-mail:hailinxu66@qq.com
  • Supported by:
    Beijing Science and Technology Plan Project(Z181100001718159);Research and Development Fund of Peking University People’s Hospital(RDH20127-01)

RICH HTML

 10   

PDF (PC)

136

Abstract:

Objective: Metatarsophalangeal joint is an important joint for daily weight-bearing walking. Osteoarthritis, osteochondrosis of the metatarsal head, rheumatoid arthritis can often cause the destruction of 2-5 metatarsophalangeal joint, leading to pain, limited joint movement and toe deformities, severely affecting the forefoot function. The purpose of this study is to report the results of middle-long term follow-up after performing Swanson double-stem silicon implant arthroplasty in patients with diseases of 2-5 metatarsophalangeal joint. Methods: From January 2010 to October 2015, 21 patients with 2-5 metatarsophalangeal joint replacement were performed with Swanson double-stem silicone prosthesis. In the study, 16 cases were successfully followed up,2 men and 14 women with an average age (66.7±5.5) years. There were 9 cases diagnosed with rheumatoid arthritis, 5 cases with severe osteoarthritis and 2 cases with osteochondrosis of the metatarsal head. The American Association of foot and ankle surgery Maryland foot scoring system and visual analogue score (VAS) were used to evaluate the walking function, metatarsophalangeal joint mobility and pain degree before and after surgery. Results: The follow-up time ranged from 17 months to 5 years, with an average of 3.2 years. According to Maryland foot scoring system of the American Association of foot and ankle surgery, the preoperative score was (60.69±6.12) points and postoperative score was (88.13±5.84) points. Range of motion of metatarsophalangeal joint: preoperative: back extension 5.4°±3.1°, plantar flexion 4.4°±2.7°; postoperative: back extension 15.7°±4.5°, plantar flexion 12.2°±4.3°, the motion of 2-5 metatarsophalangeal joint after operation was significantly improved compared with that before operation (P<0.01). The preoperative VAS was (6.8±0.9) points and the last follow-up was (2.3±0.8) points, the pain symptom of metatarsophalangeal joint was improved obviously after operation. The postoperative score was significantly higher than the preoperative score according to Maryland foot scoring system (P<0.01), the excellent rate was 81.3%. Conclusion: With the advantages of alleviating pain, preserving the length and alignment of metatarsophalangeal joint, improving the function of walking, and correcting the deformity, Swanson double-stem silicon implant arthroplasty is a reproducible and safe option for the reconstruction of the 2-5 metatarsophalangeal joint. However, there is still some probability of adverse reactions and still room for improvement.

Key words: Metatarsophalangeal joint, Arthroplasty, Silicon implant

CLC Number: 

  • R649.9

Figure 1

Case: arthritis of the second metatarsophalangeal joint in a 60-year-old male,accepted joint replacement with Swanson double-stem silicone prosthesis A, left foot preoperative X-ray; B, appearance of left foot; C, expose metatarsophalangeal joint with a longitudinal incision and perform osteotomy; D, intraoperative prosthesis trial model; E, appropriate size prosthesis implantation; F, postoperative X-ray examination."

Table 1

Comparison of data before and after Swanson prosthesis replacement"

Items Preoperation Postoperation t value P value
Range of motion of 2-5 metatarsophalangeal joints, x?±s
Back extension 5.4°±3.1° 15.7°±4.5° -9.68 <0.01
Plantar flexion 4.4°±2.7° 12.2°±4.3° -6.84 <0.01
Maryland foot score, x?±s 60.69±6.12 88.13±5.84 -11.64 <0.01
VAS score, x?±s 6.81±0.91 2.25±0.77 12.92 <0.01
[1] Nery C, Baumfeld D. Lesser metatarsophalangeal joint instability: Treatment with tendon transfers[J]. Foot Ankle Clin, 2018,23(1):103-126.
pmid: 29362027
[2] Swanson AB, de Groot Swanson G. Use of grommets for flexible hinge implant arthroplasty of the great toe[J]. Clin Orthop Relat Res, 1997(340):87-94.
[3] Phisitkul P. Managing complications of lesser toe and metatarsophalangeal joint surgery[J]. Foot Ankle Clin, 2018,23(1):145-156.
pmid: 29362029
[4] Davies MS, Saxby TS. Metatarsal neck osteotomy with rigid internal fixation for the treatment of lesser toe metatarsophalangeal joint pathology[J]. Foot Ankle Int, 1999,20(10):630-635.
[5] Stevens J, de Bot R, Hermus J, et al. Clinical outcome following total joint replacement and arthrodesis for hallux rigidus: A systematic review[J]. JBJS Rev, 2017,5(11):e2.
pmid: 29135720
[6] Erdil M, Elmadaǧ NM, Polat G, et al. Comparison of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in the treatment of advanced hallux rigidus[J]. J Foot Ankle Surg, 2013,52(5):588-593.
doi: 10.1053/j.jfas.2013.03.014 pmid: 23659913
[7] O'Malley MJ, Basran HS, Gu Y, et al. Treatment of advanced stages of hallux rigidus with cheilectomy and phalangeal osteotomy[J]. J Bone Joint Surg Am, 2013,95(7):606-610.
[8] Swanson AB, Lumsden RM, Swanson GD. Silicone implant arthroplasty of the great toe. A review of single stem and flexible hinge implants[J]. Clin Orthop Relat Res, 1979, (142):30-43.
pmid: 387324
[9] Moeckel BH, Sculco TP, Alexiades MM, et al. The double-stemmed silicone-rubber implant for rheumatoid arthritis of the first metatarsophalangeal joint. Long-term results[J]. J Bone Joint Surg Am, 1992,74(4):564-570.
pmid: 1583051
[10] Peace RA, Hamilton GA. End-stage hallux rigidus: cheilectomy, implant, or arthrodesis?[J]. Clin Podiatr Med Surg, 2012,29(3):341-353.
pmid: 22727376
[11] Valentini R, de Fabrizio G, Piovan G. First metatarsophalangeal joint replacement with total arthroplasty in the surgical treatment of the hallux rigidus[J]. Acta Biomed, 2014,85(Suppl 2):113-117.
[12] Stone OD, Ray R, Thomson CE, et al. Long-term follow-up of arthrodesis vs total joint arthroplasty for hallux rigidus[J]. Foot Ankle Int, 2017,38(4):375-380.
doi: 10.1177/1071100716682994 pmid: 28367694
[13] Brewster M. Does total joint replacement or arthrodesis of the first metatarsophalangeal joint yield better functional results? A syste-matic review of the literature[J]. J Foot Ankle Surg, 2010,49(6):546-552.
doi: 10.1053/j.jfas.2010.07.003 pmid: 20833566
[14] Shereff MJ, Jahss MH. Complications of silastic implant arthroplasty in the hallux[J]. Foot Ankle, 1980,1(2):95-101.
pmid: 7274905
[15] Erkocak OF, Senaran H, Altan E, et al. Short-term functional outcomes of first metatarsophalangeal total joint replacement for hallux rigidus[J]. Foot Ankle Int, 2013,34(11):1569-1579.
doi: 10.1177/1071100713496770 pmid: 23877170
[1] Silan AN,Qunyi ZHENG,Kai WANG,Shan GAO. Characteristics and influencing factors of early pain in patients after total knee arthroplasty [J]. Journal of Peking University (Health Sciences), 2024, 56(1): 167-173.
[2] Ran ZHAO,Yan-qing LIU,Hua TIAN. Cumulative sum control chart analysis of soft tissue balance in total knee replacement assisted by electronic pressure sensor [J]. Journal of Peking University (Health Sciences), 2023, 55(4): 658-664.
[3] Yi-lin YE,Heng LIU,Li-ping PAN,Wei-bing CHAI. Periprosthetic gout flare after total knee arthroplasty: A misdiagnostic case report [J]. Journal of Peking University (Health Sciences), 2023, 55(2): 362-365.
[4] LI Zhi-chang,HOU Yun-fei,ZHOU Zhi-wei,JIANG Long,ZHANG Shu,LIN Jian-hao. Patient factors influencing preoperative expectations of patients undergoing total knee arthroplasty [J]. Journal of Peking University (Health Sciences), 2022, 54(1): 170-176.
[5] Hao WU,Li-ping PAN,Heng LIU,Hong-bin WANG,Tai-guo NING,Yong-ping CAO. Effect of posterior tibial slope on the short-term outcome in mobile-bearing unicompartmental knee arthroplasty [J]. Journal of Peking University (Health Sciences), 2021, 53(5): 877-882.
[6] WANG Xin-guang,GENG Xiao,LI Yang,WU Tian-chen,LI Zi-jian,TIAN Hua. Comparison of alignment and operative time between portable accelerometer-based navigation device and computer assisted surgery in total knee arthroplasty [J]. Journal of Peking University (Health Sciences), 2021, 53(4): 728-733.
[7] JI Song-jie,HUANG Ye,WANG Xing-shan,LIU Jian,DOU Yong,JIANG Xu,ZHOU Yi-xin. Multivariate analysis of varus after Oxford unicompartmental knee arthroplasty [J]. Journal of Peking University (Health Sciences), 2021, 53(2): 293-297.
[8] KE Yan,ZHANG Qiang,MA Yun-qing,LI Ru-jun,TAO Ke,GUI Xian-ge,LI Ke-peng,ZHANG Hong,LIN Jian-hao. Short-term outcomes of total hip arthroplasty in the treatment of Tönnis grade 3 hip osteoarthritis in patients with spondyloepiphyseal dysplasia [J]. Journal of Peking University (Health Sciences), 2021, 53(1): 175-182.
[9] Sen-lei LI,Xian-teng YANG,Xiao-bin TIAN,Li SUN. Early functional recovery of direct anterior approach versus anterolateral approach for total hip arthroplasty [J]. Journal of Peking University(Health Sciences), 2019, 51(2): 268-272.
[10] LIU Heng, LI Zhuo-yang, CAO Yong-ping, CUI Yun-peng, WU Hao. Measurement of the tibial alignment after total knee replacement without the extramedullary cutting guide [J]. Journal of Peking University(Health Sciences), 2018, 50(5): 850-854.
[11] LI Yang, LI Bang-guo, ZHAO Ran, TIAN Hua, ZHANG Ke. Effect of autologous blood transfusion device on preventing blood loss in primary total knee arthroplasty using comprehensive hemostatic methods [J]. Journal of Peking University(Health Sciences), 2018, 50(4): 651-656.
[12] WANG Jun-feng, LI Zhao, ZHANG Ke-shi, YUAN Feng, LI Ru-jun, ZHONG Qun-jie, GUAN Zhen-peng. Unilateral patellar resurfacing in bilateral total knee arthroplasty: a randomized controlled study [J]. Journal of Peking University(Health Sciences), 2017, 49(5): 861-866.
[13] LI Yang, LI Zi-jian, ZHANG Ke, TIAN Hua, LIU Yan-qing, CAI Hong, LI Feng, ZHAO Min-wei. Analysis on the causes of unscheduled suspensions of knee and hip arthroplasty [J]. Journal of Peking University(Health Sciences), 2017, 49(2): 231-235.
[14] TANG Jing, LV Ming, ZHOU Yi-xin, ZHANG Ji. Application of bilateral direct anterior approach total hip arthroplasty: a report of 22 cases [J]. Journal of Peking University(Health Sciences), 2017, 49(2): 221-225.
[15] XU Jie， ZHUANG Wei-da， LI Xin-wei， YU Guo-yu， LIN Yuan， LUO Fen-qi， XIAO Yu-hua. Comparison of the effects of total hip arthroplasty via direct anterior approach and posterolateral piriformis-sparing approach [J]. Journal of Peking University(Health Sciences), 2017, 49(2): 214-220.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 225 -328 .
[2] . [J]. Journal of Peking University(Health Sciences), 2001, 33(6): 565 .
[3] . [J]. Journal of Peking University(Health Sciences), 2008, 40(1): 39 -42 .
[4] . [J]. Journal of Peking University(Health Sciences), 2008, 40(6): 600 -602 .
[5] . [J]. Journal of Peking University(Health Sciences), 2009, 41(1): 90 -94 .
[6] . [J]. Journal of Peking University(Health Sciences), 2007, 39(5): 498 -502 .
[7] . [J]. Journal of Peking University(Health Sciences), 2001, 33(6): 559 -561 .
[8] . [J]. Journal of Peking University(Health Sciences), 2003, 35(5): 499 -502 .
[9] . [J]. Journal of Peking University(Health Sciences), 2005, 37(6): 599 -602 .
[10] . [J]. Journal of Peking University(Health Sciences), 2006, 38(2): 197 -200 .
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd