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Mid Foot Arthroplasty

Discussion in 'Foot Surgery' started by Dieter Fellner, Dec 8, 2005.

  1. Dieter Fellner

    Dieter Fellner Well-Known Member


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    Has anyone experience of arthroplasty with isolated Lis Francs O / A? e.g. 2nd metatrsal cuneiform joint.

    Conventional wisdom dictates such a joint should be fused, but ....
     
  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Here in Brisbane, Australia we tend to only perform arthrodesis of Lisfranc's joint, 1 through to 5. Some of our other colleagues in the ACPS will look to do arthroplasty of 4 and 5, but never to 1,2 or 3. This is a similar trend with the foot and ankle orthopedists whose work I have seen.

    The 2nd is in a keystone position, so I think it would be tempting fate to consider an arthroplasty of this TMT joint...?
     
  3. Dieter Fellner

    Dieter Fellner Well-Known Member

    Certainly this is the conventional wisdom but based on what experience ?
     
  4. B.Yates

    B.Yates Welcome New Poster

    Hi Dieter
    I assume you mean by arthroplasty to remove the prominent osteophytes/radical ostectomy and wash out the joint(s)?
    I would do this for mild arthritis without night pain or instability (ie no lisfranc injury) and have had good results. As yet I have not had to take anyone back to revise it to a fusion.
    If the arthritis is more severe/ or unstable/ or I am doing a lapidus due to OA/severe HAV and they have OA of the 2/3 TMT joints I would fuse them as they are going to be in a cast 6 weeks NWB anyway. Again I have had good results with this.
    I have not fused 4/5 met cuboid joints and would definitely avoid this unless the OA is very severe as it leaves the midfoot very stiff.
    hope this helps
    Ben
     
  5. Dieter Fellner

    Dieter Fellner Well-Known Member

    Lis Francs Fusion

    Ben

    Thank you for taking the time to share your modus operandii. I question the 'need' always to fuse this joint, other than perhaps the 1st MTCJ, when arthroplasty appears useful for other arthritic joints.

    Aware that most foot surgeons would choose to fuse, I am unable to find in the literature the evidence base for this, and would tentatively challenge conventional wisdom, on the assumption this is a practice historically passed on from master to trainee, but possibly could lack the benefit of sound scientific evaluation.

    Since fusions can and do fail, I speculate that others must have some experience to know if the resulting arthroplasty e.g. 2nd or 3rd MCJ causes problems?

    I have not yet had the courage to test this out!

    Dieter
     
  6. B.Yates

    B.Yates Welcome New Poster

    Hi Dieter
    I have not seen any papers on non-union of 2/3 TMT joints. As you know the lapidus non-union rates vary in the literature with most between 2-15%. However some of the papers report some of the non-unions as painless only appearing on radiographic follow-up with no symptoms. I have seen 4 non-unions performed by other surgeons (2 painless and 2 painful that I re-fused) So do you have to fuse?
    With regard to 2/3 TMT OA if you are going to do an arthroplasty then I would suggest being radical and producing a dorsal "V" at the joint to prevent recurrence of the ostephytes.
    Ben
     
  7. John Spina

    John Spina Active Member

    For what indications would we be doing an arthroplasty of this joint?Ulcers.....but most of the plantar ulcers that I see are way more distal.Arthritis?Have other methods been tried?I have never heard of this procedure or seen anything in the literature.
     
  8. Dieter Fellner

    Dieter Fellner Well-Known Member

    Js

    In the context of my post, most commonly for degenerative joint disease causing pain and joint enlargment with osteophytes affecting the tarsal-metatarsal joints 2-3 as a rule.

    Ben also was disucssing fusion of the 1st TMJ for treating DJD or hypermobility, hallux valgus etc. Foot surgery texts will discuss this further.
     
  9. B.Yates

    B.Yates Welcome New Poster

    John
    As Dieter said in the majority of cases this would be dorsal midfoot pain due to arthritis. Some people will also complain of parasthesia due to compression of the deep peroneal nerve or superficial peroneal nerve from the enlarged bone margins or soft tissue swelling. Also patients may get an adventitious bursa in this area again due to the bony prominences.
    ben
     
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