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

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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)

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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
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