Purpose of the study: Osteotomy of the first metatarsal has become the gold standard treatment for hallux valgus. We report a study on the changes in radiographic findings as a function of the degree of translation of the distal fragment of the metatarsal during scarf distal wedge osteotomy.

Material and methods: From the cohort of patients who underwent hallux valgus surgery in our unit, we collected 118 anteroposterior x-rays of the forefoot. Computer-assisted image processing established a trigonometric analysis of each forefoot before and after standardised virtual surgery. Variations in standard morphological measurements (phalangeal valgus: M1P1; metatarsal varus: M1M2; orientation of the joint surfaces of the first metatarsal: proximally (PMAA) and distally (DMAA).

Results: The successive translations significantly modified all of the morphological measurements. For M1M2, intermediary translation corrected the metatarsal varus (< 5) in 72% of the cases, maximal translation in 97%. For the M1P1 angle, intermediary translation only corrected the phalangeal valgus (< 8) in 44% of cases, maximal translation in 31%. For the DMAA angle, intermediary translation corrected the distal articular orientation (< 6) in 66%, maximal translation in 97%. Distal translation of the first metatarsal aggravated the obliquity of the proximal joint surface from a mean 1.57±4.5 to 7.7±4.7, with intermediary translation and to 13.92±4.9 with maximal translation.

Discussion: Considering the large number of techniques proposed, the choice of one osetotomy model is reductive, but it does demonstrate via a geometric application the limits of osteotomy translation of the first metatarsal for the correction of hallux valgus.

Purpose of the study: We analysed the clinical and radiographic outcomes of 113 cemented total knee arthroplasties (TKA) with resurfaced patella implanted in 83 patients with rheumatoid arthritis who were reviewed 1 to 12 years after implantation. Mean follow-up was 5.86 years. All implants were posterior stabilised (HLS) implanted by one operator using the same procedure.

Material and methods: One hundred seventy-two rheumatic arthritis patients underwent TKA from 1996 to 2007. At last follow-up, 68 could not be contacted, 11 had died, 9 declined review. The review was conducted in 2008 for 83 patients, 113 TKA. Female gender predominated (86.4%) and 29 patients (32.6%) had two TKA. Mean age at revision was 67.6 years.

Results: Seventy patients (84.4%) were satisfied or very satisfied with their prosthesis. The knee score (IKS) improved from 31.58 (0–63) preoperatively to 86.21 (59–99) postoperatively; the function score (IKS) improved from 31.7 (0–100) preoperatively to 77.12 (0–100) postoperatively. The improvement was significant for both scores. Men preoperative flexion was 97 (35–125) versus 112.1 (30–130) postoperatively. Ten knees presented anterior pain at revision (8.8%). The postoperative femorotibial mechanical angle was 180.72 (173–192). The mean femoral mechanical angle was 91.3 (78–99); the mean tibial mechanical angle was 89.4 (52–110). Men postoperative patellar height was 0.79 (0.24–2) measured with the Blackburn index. The patella was centred for 87.6% (99 knees) and subluxated laterally for 12.1% (14 knees). There were no loosening. Two arthroplasties had to be revised surgically (1.8%): one for infection (two-phase replacement with a hinged prosthesis) and one for patellar fracture treat by osteosynthesis. Two patients developed a postoperative phlebitis (2.4%).

Discussion: This study demonstrates the good mid-term outcomes achieved with a cemented posterior stabilised TKA in patients with rheumatoid arthritis. These results are nevertheless slightly less satisfactory than with TKA implanted for degenerative disease: this might be explained generally by disease-related impact on the functional result. Prosthetic surgery of the knee remains the treatment of choice for advanced arthritic degeneration.

Purpose: The morphology and mechanical function of the metatarsosesamoid joint plays an important role in metatarsal head stability. The position of the sesamoids during the development of hallux valgus was evaluated by Inges, Haines and Tourne who distinguished three stages. Cartilage lesions in the context of hallux valgus have not been analysed with precision. The purpose of our work was to identify metatarsosesamoid lesions on anatomic specimens in patients who had undergone hallux valgus surgery.

Material and methods: We dissected 12 metatarsosesa-moid joints (4 right, 13 left) from laboratory specimens and evaluated the degenerative lesions. For each specimen, we noted the metatarsophalangial angle and the AADM. We also examined 17 metatarsal specimens to determine the persistence or absence of the median crest as a sign of wear. Using the same protocol, we examined the joints surfaces and determined degenerative lesions during 20 SCARF procedures for hallus valgus.

Results: For the twelve laboratory specimens, we observed: for the plantar joint surface of M1, the joint surfaces were perfectly intact in 2 specimens, the sagittal crest was worn away in 4, degenerative lesions appeared on the medial surface in 4, and on the lateral surface in 2. For the sesamoids, the degenerative lesions involved both sesamoids in 1 specimen, the lateral sesamoid in 2, the medial sesamoid in 4, and none in 3. Lesions of the metatarsophalangial joint were diffuse in 1 case, localised in 5 and absent in 6. For the 17 metatarsals, for an AADM between 4 and 12, no lesion was found in 6 cases, degenerative lesions involving both sesamoids in 1, the lateral sesamoid in 1 and the medial sesamoid in 2. For an AADM greater than 12, the metatarso-sesamoid joints surfaces were intact in 1 case, the sagittal crest was worn off in 4, and degenerative lesions involved the medial surface in 4 and the lateral surface in 1.

Conclusion: This anatomy study demonstrated the precise topography of degenerative lesions of the metata-sosesamoid joint. This data base should be useful for evaluating functional outcome as a function of the meta-tarsosesamoid lesions in the treatment of hallux valgus.