The Journal of Bone and Joint Surgery, Vol 73, Issue 10 1453-1459, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Use of a hinged silicone prosthesis for replacement arthroplasty of the first metatarsophalangeal joint
WM Granberry, PC Noble, JO Bishop and HS Tullos
Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas.
A series of ninety consecutive total joint replacements of the first
metatarsophalangeal joint with a flexible hinged prosthesis was reviewed
after an average duration of follow-up of three years (range, twenty-four
to sixty-one months). Although subjectively the results were satisfactory
in most of the patients, and pain, the most common preoperative symptom,
was reduced, mechanical failure of the implant was common, as determined
radiographically. The frequency of failure of the implant and the extent to
which it failed were related to the length of time that the implant had
been in place. The range of motion of the metatarsophalangeal joint was
decreased from normal. Dorsiflexion averaged 26 degrees and plantar
flexion, 18 degrees. Callosities under at least one metatarsophalangeal
joint were noted in fifty (69 per cent) of the feet that had a physical
examination. Pedobarographic analysis of the distribution of plantar
pressure revealed that none of the patients exerted weight-bearing
pressures on the affected great toe. However, the subjective results were
not significantly associated with radiographic evidence of failure of the
implant. Despite its success in relieving the symptoms in our patients, we
have abandoned this procedure because of the high and increasing rate of
failure of the implant, as demonstrated radiographically.
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