JBJS welcomes reader comments on published articles. Letters to the Editor are reviewed by JBJS editors but are not peer-reviewed. To submit your letter, please follow the "submit a response" link that appears in the content box at the upper right of the full text of the article.

Letters to the Editor to:

Scientific Articles:
Steven M. Raikin, Jamal Ahmad, Aidin Eslam Pour, and Nicholas Abidi
Comparison of Arthrodesis and Metallic Hemiarthroplasty of the Hallux Metatarsophalangeal Joint
J Bone Joint Surg Am 2007; 89: 1979-1985 [Abstract] [Full text] [PDF]
*Letters to the Editor: Submit a response to this article

Electronic letters published:

[Read Letter to the Editor] Dr. Ahmad et al. respond to Mr. Mrak.
Jamal Ahmad, M.D., Steven M. Raikin, M.D., Aidin Eslam Pour, M.D., and Nicholas Abidi, M.D.   (13 November 2007)
[Read Letter to the Editor] Metallic Hemiarthroplasty of the Hallux Metatarsophalangeal Joint
David Mrak   (13 November 2007)

Dr. Ahmad et al. respond to Mr. Mrak. 13 November 2007
Previous Letter to the Editor Top
Jamal Ahmad, M.D.,
Orthopaedic Surgeon
Rothman Institute Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA,
Steven M. Raikin, M.D., Aidin Eslam Pour, M.D., and Nicholas Abidi, M.D.

Send letter to journal:
Re: Dr. Ahmad et al. respond to Mr. Mrak.

jamal.ahmad{at}rothmaninstitute.com Jamal Ahmad, M.D., et al.

We thank Mr.Mrak for his critique of our study(1).

After careful review of Figures 2a and 2b, he is indeed correct that these images are of two different implants in two different patients. This was an oversight on our part as many different patients developed implant subsidence dorsally. Upon final postoperative follow-up, these two images were inadvertently mismatched. We apologize for any confusion with the initial and final post-operative position of the metallic hemiarthroplasty in the paper.

While Mr. Mrak refers to additional papers (2-5) regarding the metallic hemiarthroplasty, we did not include these in our text as they are not truly peer-reviewed studies. The second reference was not published in a peer-reviewed orthopaedic journal, but rather in a periodical discussing operative techniques solely. The third through fifth references are co-authored by Dr. Townley, Dr. Taranow, or both. As these two surgeons helped to design the metallic hemiarthroplasty, these three papers may have inherent bias. In our independent and unbiased study, we were unable to reproduce the excellent results that Drs. Taranow and Townley have previously reported with use of the metallic hemiarthroplasty.

Thank you for your critical analysis of our study. We look forward to any future discussion.

References:

1. Steven M. Raikin, Jamal Ahmad, Aidin Eslam Pour, and Nicholas Abidi Comparison of Arthrodesis and Metallic Hemiarthroplasty of the Hallux Metatarsophalangeal Joint J Bone Joint Surg Am 2007; 89: 1979-1985.

2. Giza E, Sullivan MR. First Metatarsophalangeal Hemiarthroplasty for Grade III and IV Hallux Rigidus Techniques in Foot and Ankle Surgery 4(1):10-17,2005.

3. Roukis TS, Townley CO. BIOPRO resurfacing endoprosthesis osteotomy for hallux rigidus: short-term follow-up Journal of Foot & Ankle Surgery 2003;42(6):350-8.

4. Taranow WS, Townley CO. Metallic proximal phalangeal hemiarthroplasty for hallux rigidus. Operative Techniques in Orthopaedics 1999;9(1):33-6.

5. Contemporary Approaches to Stage II and III Hallux Rigidus: The Role of Metallic Hemiarthroplasty of the Proximal Phalanx Warren S. Taranow, DO,*, Michael J. Moutsatson, DO, Jonathan M. Cooper, DO Foot Ankle Clin N Am 10 (2005) 713– 728
Metallic Hemiarthroplasty of the Hallux Metatarsophalangeal Joint 13 November 2007
Next Letter to the Editor Top
David Mrak,
Director of Product Development
BioPro, Inc. Port Huron, MI

Send letter to journal:
Re: Metallic Hemiarthroplasty of the Hallux Metatarsophalangeal Joint

mrakd{at}bioproimplants.com David Mrak

To The Editor:

In the recent article “Comparison of Arthrodesis and Metallic Hemiarthroplasty of the Hallux Metatarsophalangeal Joint”(1),the authors state that Fig 2-A is an initial post operative x-ray and that Fig 2-B is "the final evaluation" radiograph taken at 72 months post-operatively showing that the implant has subsided over time and is no longer perpendicular to the phalanx. However, upon inspection, one will notice that the implant in figure 2-A is porous coated. The coating on the stem is visible and the thickness of the implant is greater. In contrast, in figure 2-B, the implant is a non-porous coated implant. It is apparent to me that these are two different implants. Therefore, it is inaccurate to state that the implant has shifted when clearly the x-rays are from two different patients.

In considering just figure 2B, it is possible that the implant was initially implanted at an incorrect angle, which is a technical error that may occur if the initial cut is not made perpendicular to the axis of the phalanx, but I do not believe that it can be concluded that the implant did shift from its initial position based on the x-rays provided.

Also, there are additional peer reviewed studies published about this prosthesis that were not included in the references but which report substantially different results than those found in this study(2-5).

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (BioPro). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

References:

1. Steven M. Raikin, Jamal Ahmad, Aidin Eslam Pour, and Nicholas Abidi Comparison of Arthrodesis and Metallic Hemiarthroplasty of the Hallux Metatarsophalangeal Joint J Bone Joint Surg Am 2007; 89: 1979-1985

2. Giza E, Sullivan MR. First Metatarsophalangeal Hemiarthroplasty for Grade III and IV Hallux Rigidus Techniques in Foot and Ankle Surgery 4(1):10-17,2005

3. Roukis TS, Townley CO. BIOPRO resurfacing endoprosthesis osteotomy for hallux rigidus: short-term follow-up Journal of Foot & Ankle Surgery 2003;42(6):350-8

4. Taranow WS, Townley CO. Metallic proximal phalangeal hemiarthroplasty for hallux rigidus. Operative Techniques in Orthopaedics 1999;9(1):33-6

5. Contemporary Approaches to Stage II and III Hallux Rigidus: The Role of Metallic Hemiarthroplasty of the Proximal Phalanx Warren S. Taranow, DO,*, Michael J. Moutsatson, DO, Jonathan M. Cooper, DO Foot Ankle Clin N Am 10 (2005) 713– 728