The original model of the hemiendoprosthesis of the first metatarsophalangeal joint and the method of its installation in the preparation of hallux rigidus stages 3-4

Relevance. Several methods are currently used to maintain the motion of the first metatarsophalangeal joint in osteoarthritis of stage 3-4. However, the pathology of the sesamoid bones and the metatarsophalangeal joint, in particular, is often ignored. The authors proposed a new method for treating osteoarthritis of the first metatarsophalangeal joint of stage 3-4 with pronounced degenerative changes in the metatarsophalangeal joint.

The aim of the work is to demonstrate an original technique and the results of treating osteoarthritis of the first metatarsophalangeal joint of stage 3-4 with concomitant degenerative changes in the metatarsophalangeal joint by hemiendoprosthetics of the first metatarsophalangeal joint with a ceramic implant in the UK with plastic surgery of the metatarsophalangeal joint with a collagen membrane.

Materials and methods. The surgical technique includes resection of the articular surface of the head of the first metatarsal bone, selection of the size of the hemiendoprosthesis, insertion of a guide pin through the guide followed by formation of a channel using two types of compactors. Resection of the altered articular surface of the head of the first metatarsal bone and its osteoperforation according to Beck are performed. If necessary, resection is performed along the plane of hypertrophied sesamoid bones. Adaptation of the collagen membrane and fixation using fibrin glue or suture material are performed.

Results. In the Foot Surgery Center of the S. S. Yudin City Clinical Hospital, 21 patients were operated on using the described technique with an observation period of more than 12 months. There were 17 women (81.0%) and 4 men (19.0%). The average age of the patients was 61 years ± 7.7 (43-72). There were 12 patients over 60 years old (57.4%). The range of motion of the 1 MTP joint without load: before treatment - 15° ± 3.3 (5°-20°), after 12 months 25° ± 3.8 (15°- 30°). The range of motion of the first MTP joint with physiological load simulating the pre-transfer phase: before treatment - 15° ± 3.0 (10°- 25°), 12 months after surgery - 35° ± 5.2 (25°-45°). Results of the patient questionnaire using the visual analogue scale (VAS): before surgery - 7.7 ± 1.9 (4-10) points, 12 months after the treatment - 1.6 ± 0.8 (0-3) points. Questionnaire using the American Orthopaedic Foot and Ankle Society Hallux Score (AOFAS HS) scale before and 12 months after the treatment - 35.5 ± 10.9 (18-52) and 82.7 ± 5.2 (73-90), respectively. The Foot Function Index (FFI) scores at the time of preoperative examination were 63.5% ± 9.9 (48% - 82%), after 12 months - 10.5% ± 2.5 (7% -16%).

Conclusion. Hemiendoprosthetics of the first metatarsophalangeal joint in combination with plastic surgery of the metatarsophalangeal joint with a collagen membrane allows for the restoration of movement in both the metatarsophalangeal and metatarsophalangeal joints, which allows for a comprehensive approach to the issue of restoring movement.

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