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General Orthopaedics

MID-TERM RESULTS OF A FIRST METATARSO-PHALANGEAL JOINT REPLACEMENT

12th Combined Meeting of the Orthopaedic Associations (AAOS, AOA, AOA, BOA, COA, NZOA, SAOA)



Abstract

Background

There are reports of good early results in small numbers of patients implanted with the ‘Moje’ ceramic prosthesis. Published evidence thus far involves only small groups of patients with short-term follow-up. The purpose of this prospective study was to evaluate the emerging mid-term clinical and radiological results from our centre.

Methods

We describe our single-surgeon experience of 63 components in 48 patients at a mean follow-up of 44 months. Patient satisfaction was assessed by questionnaire and radiographic assessment was performed immediately post-operatively and at the maximum follow-up.

Results

Mean American Orthopaedic Foot and Ankle Society (AOFAS) Hallux score increased from 56 to 72 (p< 0.01) and mean satisfaction score was 7.6 (scale 1-10). 67% reported minimal or no pain. Five implants have been removed (8%), four because of pain associated with implant loosening and subsidence, and one because of deep infection. 57% of metatarsal and 56% of phalangeal components had subsided and we found radiographic evidence of loosening in 58% of x-rays analysed at the maximum follow-up. Presence of prosthesis subsidence was associated with greater margin of uncovered bone under the prosthesis (P=0.05 for metatarsal, P=0.03 for proximal phalanx component) and longer time to follow-up (P< 0.001).

Conclusion

In spite of the good clinical outcome at the mid-term stage with 91% implant survival, given the widespread loosening and subsidence encountered in our study, the long-term outcome following this procedure is uncertain.


I McGraw, 15 Swift Place, East Kilbride, Glasgow G75 8RT, UK