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Polyvinyl Alcohol Hemiarthroplasty for First Metatarsophalangeal Arthritis


Indications

  • Symptomatic first metatarsophalangeal (MTP) joint arthritis

  • Maintenance of functional motion of the first MTP joint

  • Minimal first ray deformity (valgus, varus, elevation)

  • Arthritis of appropriate severity (K–L grades III or IV)

Indications Pitfalls

  • A plantar flexed first MTP joint will likely not be able to move into dorsiflexion

  • Sepsis

  • Charcot arthropathy with risk of bone collapse

  • Bone loss unable to support the implant

Indications Controversies

  • Realignment of the first ray may allow a hemiarthroplasty to be used in a deformity.

  • Freiberg disease may be treatable by a hemiarthroplasty.

  • In the Food and Drug Administration study (Baumhauer et al., 2016), the revision rate to fusion was just under 10% at 2 years. The outcome measures are equivalent to fusion, with fusion giving slightly better pain relief, and the implant providing better range of motion.

Examination and Imaging

  • A preoperative x-ray of suitable degenerative change to consider a hemiarthroplasty ( Fig. 11.1 )

    FIG. 11.1

  • Arthritis too severe to consider a hemiarthroplasty with sesamoid to metatarsal head involvement ( Fig. 11.2 )

    FIG. 11.2

  • A first ray too deformed with bone loss to be appropriate for a hemiarthroplasty ( Fig. 11.3 )

    FIG. 11.3

Surgical Anatomy

  • The first ray is approached from the dorsal side as presented in Fig. 11.4 .

    FIG. 11.4

  • The medial and lateral dorsal digital nerves have to be avoided in dissection.

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