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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 14 - 14
1 Sep 2012
Morgan S Jones C Palmer S
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Open cheilectomy is an established surgical treatment for hallux rigidus. Cheilectomy is now being performed using minimally invasive (MIS) techniques. In this prospective study we report the outcome of minimally invasive cheilectomy comparing the results with a matched group who had cheilectomy using standard open procedure

Methods

Prospective study of 47 patients. 22 patients had MIS cheilectomy between March 2009 and September 2010. We compared the outcome with a matched group (25 patients) who had open cheilectomy. Functional outcome was assessed using the Manchester Oxford Foot and ankle questionnaire (MOXFQ). The MOXFQ is a validated questionnaire designed to be self-completed and used as an outcome measure for foot surgery. Patients' satisfaction and complications were recorded.

Results

In the MIS group, the median follow up was 11 months (4–23). The median preoperative MOXFQ score was 34/64(23) and the median postoperative score was 19/64 (p = <0.02). In the open group the median follow up was 17 months (9–27). The median preoperative MOXFQ score was 35/64 and the median postoperative score was 7.5/64 (p = <0.0001). The metric score of the three domains of the MOXFQ showed statistical improvement in both groups. The improvement didn't reach statistical significance between the open and MIS groups. There were three failures in the open group (Fusion) compared to none in the MIS.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 15 - 15
1 Sep 2012
Morgan S Khan K Clough T
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Background

Short term results of silastic implant of first MTPJ are successful. However reservations exist regarding long term results. The aim of this study is to evaluate long term outcome of silastic implant prosthesis in treatment of hallus rigidus.

We reviewed 108 feet in 83 patients who were operated on between 1988 and 2003. Mean age at operation = 55(SD 8.1). Mean follow up = 8.31 years (SD 3.3). Patients were assessed using the American Orthopaedic Foot and Ankle Scoring system (AOFAS). Passive and active arc of motion were measured. To assess patients' satisfaction they are asked if they would repeat the procedure and also using a visual analogue scale (VAS) to express their overall satisfaction with the outcome. All the patients had anteroposterior and oblique views. Radiographs were assessed for loosening and osteolysis.

Results

Median AOFAS = 81(IQR = 15). Median VAS = 8(IQR = 3). Median active arc of motion = 35(IQR 18). Passive arc of motion = 46(IQR = 23). No significant difference in results was found in patients with associated hallux valgus (p value = 0.6). There was significant correlation between the AOFAS and VAS (Pearson correlation = 0.58, p value <.0001). No correlation was found between AOFAS, VAS and radiological changes (P value = 0.8 and 0.9 respectively). In 83 feet (76.9%) patients reported “yes” that they would repeat the procedure and in 22(20.4%) feet patients reported “no”. Prosthesis were removed in three feet at three, five and seven years respectively because of persistent pain. Radiologically, 58% showed cyst formation but didn't correlate with functional outcome.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 67 - 67
1 Sep 2012
Morgan S Roushdi I Benerjee R Palmer S
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Introduction

Symptomatic hallux valgus is a common clinical problem, current trends is towards minimally invasive procedures. The goal of this study is to evaluate the outcome of minimally invasive chevron ostoetomy, comparing it with a matched group who had open chevron osteotomy.

Methods

Prospective study, 54 patients. MIS group 25 patients between October 2009 and November 2010. Open group 29 patients between Feb 2008 and October 2010. Inclusion criteria included, mild to moderate hallux valgus, no previous history of foot surgery, no history of inflammatory arthritis, or MTPJ arthritis. All the operations were performed by the senior author. Functional outcome and pain were evaluated using pre and post operative Manchester Oxford Foot and ankle questionnaire (MOXFQ). IMA and HVA, avascular necrosis and union were assessed. Complications and satisfaction were recorded.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXII | Pages 74 - 74
1 May 2012
Morgan S Footee J
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Introduction

Second ray problems are common, especially chronic MTP joint dislocation, and intractable metatarsalgia caused by a relatively long second ray we describe a new extra-articular technique that allows considerable shortening

Patients

We retrospectively reviewed 19 patients who underwent this type of osteotomy between 2006 and 2008. Mean age at operation was 62 years (43-78). All patients were. The indications for the operation were either MTP joint dislocation, or metatarsalgia caused by a relatively long metatarsal. This in turn was usually due to length lost on the first ray. Functional outcome was evaluated using the Manchester-Oxford foot and ankle score (MOXF), which is a validated outcome measure, the score being from zero to 64. A low numerical score indicates a good outcome. It assesses three main domains, walking, pain and social interaction. Range of motion, patient satisfaction and complication rates were also recorded. All patients had AP and lateral weight bearing radiographs.