title: Flexible hinge toe implant arthroplasty for rheumatoid arthritis of the first metatarsophalangeal joint: long-term results.
abstract: 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.
authors.affiliation: Department of Orthopedic Surgery, Niigata University School of Medicine, 1 Asahimachi-dori, Niigata 951-8510, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hanyu
authors.forename: H
authors.initials: H
authors.lastname: Yamazaki
authors.forename: H
authors.initials: H
authors.lastname: Ishikawa
authors.forename: K
authors.initials: K
authors.lastname: Arai
authors.forename: C T
authors.initials: CT
authors.lastname: Tohyama
authors.forename: K
authors.initials: K
authors.lastname: Nakazono
authors.forename: A
authors.initials: A
authors.lastname: Murasawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000601:surgery*; D001178:Arthroplasty; D006801:Humans; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D019736:Prostheses and Implants; D011859:Radiography; D012826:Silicone Elastomers; D014034:Toes / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D012826:Silicone Elastomers