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I know arthrodesis is gold standard but have patient who would like to regain motion of joint has anyone ever reverted an arthrodesis to implant arthroplasty and if so what type of results??

 

EA.....
How long since the fusion?
How was the original fusion performed (i.e., how much head & base were resected, fusion technique)
Also, what was the etiology of the original pathology (trauma, biomechanical, gout, etc..)
Age and sex.
Age is important, whether or not they have sex really doesn't matter!!!! (my attempt at humor)

Steve

 

The patient initally had a hemi implant on the base of the proximal phalanx that was removed due to impingement, the patient states that when the doctor removed the implant he also removed the tibial sesamoid (by xray evaluation) at that time patient also under went an arthroplasty of the 2nd PIPJ and fusion. That was about 8 months ago. The patient then stated had pain secondary to hardware, this was then removed and fixated with kwires. Then patient states the alignment of toe shift to creat an approxiamte angle of 40 degree of DF of proximal phalanx to the metatarsal head. Now the second digit is deviating medially under the hallux and patient has pain on the dorsal aspect of hallux and walks on his second digit that now resides under the hallux.
I had initially spoken to patient about realigning the hallux with arthrodesis and bone graft. Patient wishes to have motion of the 1st MTPJ even for a short time. At this time patient has undergone 3 surgeries and my concerns are two fold. The amount of scar tissue, initial surgeries were done from a medial approach and work has been done previously about the 2nd MTPJ noted scar line on inside of second digit. Vascular compromise, stretching of soft tissue structure to allow fit of implant.

 

Hi TS:
No simple solution, and you are correct in worrying about the "law of decreasing returns" when it comes to repeated procedures on the same joint.

How is the ankle dorsiflexion? Are the other MTPJs normal in their ROM?

IF you decide to implant this I wouldn't over promise. I would also use a classic dorsal incision and most likely perform a tendon lengthening to the EHL. I think your goal should be to bring the MTPJ (hallux) down with as much dorsiflexion as you can get. I would also consider a more "sturdy" implant such as the Lawrence design total (futura). A two piece will not work.

The 2nd MTPJ should be addressed as well. Hopefully you can get by with soft tissue correction, although I have a feeling he now has a relatively long second ray which may need to be shortened.

Good luck.

Steve

 

Thank you for the input,

 

thank you for your input will make sure to evaluate ankle, and ehl