title: Second-Generation Ceramic First Metatarsophalangeal Joint Replacement for Hallux Rigidus.
abstract: BACKGROUND
  Ceramic first metatarsophalangeal (MP) joint replacement has been reported for treatment of hallux rigidus, but there are no published mid- or long-term studies available. We present our midterm results using a second-generation ceramic first MP joint implant.
  
  
  METHODS
  A retrospective review of clinical data and radiographs was performed for 31 feet (24 women; mean age at surgery, 55 ± 6 years) who had first MP joint replacement with a second-generation ceramic prosthesis (primary, 29 feet; revision, 2 feet). Mean follow-up was 81 ± 27 months after surgery
  
  
  RESULTS
  Mean first MP passive range of motion was 32 ± 17 degrees (dorsi- and plantarflexion). Mean AOFAS score was 72 ± 19 points and Foot Function Index was 27 ± 26 points (all 31 feet). Clinical rating for 29 feet that had surgery as a primary procedure was excellent in 5 feet (17%), good in 8 feet (28%), fair in 3 feet (10%), and poor in 13 feet (45%). Patients were satisfied with the outcome in 24 feet (77%). Follow-up radiographs showed that radiolucency, change in angulation, sinkage, and malalignment of the metatarsal or proximal phalanx components were common. Complications included 1 superficial wound infection, and revision was performed in 5 feet (16%) because of loosening, sinkage, subluxation, pain, or fractured prosthesis. Implant survival was 92% at 5 years, 85% at 7 years, and 68% at 9 years.
  
  
  CONCLUSIONS
  The results of second-generation ceramic first MP joint replacement in our series demonstrated poor clinical and radiological results with a high revision rate.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Foot and Ankle Unit, Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK dr.nagy@gmx.net.
authors.forename: Mathias Thomas
authors.initials: MT
authors.lastname: Nagy
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Foot and Ankle Unit, Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK.
authors.forename: Christopher Richard
authors.initials: CR
authors.lastname: Walker
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Foot and Ankle Unit, Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK.
authors.forename: Siva Prasad
authors.initials: SP
authors.lastname: Sirikonda
mesh_terms: D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods*; D002516:Ceramics; D005260:Female; D020859:Hallux Rigidus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: arthritis; arthroplasty; hallux; prosthesis