Clinical and Radiologic Outcomes of Metatarsophalangeal Hemiarthroplasty: A Review of 12 Consecutive Cases.

This study examined function, pain, satisfaction, and radiologic outcomes among patients treated with first metatarsophalangeal hemiarthroplasty. Patients were invited to participate in an outcome study conducted with questionnaires on subjective and objective outcomes and clinical and radiographic follow-up. A total of 12 patients (12 feet; mean patient age, 58.8±12.3 years) agreed to participate. Mean follow-up was 22.3±19.8 months. Of these patients, 7 were satisfied with the postoperative result. The mean visual analog scale pain score decreased significantly from 7.0±2.3 preoperatively to 3.5±3.3 postoperatively (P=.024). Mean passive range of motion of the first metatarsophalangeal joint was 32°±10° preoperatively, 93°±18° intraoperatively after implantation of the prosthesis and closure of the joint capsule, and 38°±19° at final follow-up (P=.26). Mean American Orthopaedic Foot and Ankle Society forefoot score increased significantly from 47.3±14.7 preoperatively to 71.8±15.2 at last follow-up (P=.033). During the follow-up period, 6 patients underwent additional procedures: 5 therapeutic joint infiltrations and 1 arthrodesis. No patients had radiologic loosening of the implant at final follow-up. Osseous dysplastic changes at the base of the proximal phalanx were noted among 6 of 11 patients (12 total cases) at final follow-up. Although first metatarsophalangeal hemiarthroplasty provided significant pain reduction at mean follow-up of 22.3 months, range of motion of the first metatarsophalangeal joint was not restored to anticipated levels and there were high rates of patient dissatisfaction and secondary interventions. [Orthopedics. 2018; 41(1):e64-e69.].

Early recoil after balloon angioplasty of tibial artery obstructions in patients with critical limb ischemia.

PURPOSE: To assess the extent of early recoil in patients with critical limb ischemia (CLI) undergoing conventional tibial balloon angioplasty. METHODS: Our hypothesis was that early recoil, defined as lumen compromise >10%, is frequent and accounts for considerable luminal narrowing after tibial angioplasty, promoting restenosis. To test this theory, 30 consecutive CLI patients (18 men; mean age 76.2±12.1 years) were angiographically evaluated immediately after tibial balloon angioplasty and 15 minutes later. Half the patients were diabetics. Target lesions included anterior and posterior tibial arteries and the peroneal artery with / without the tibioperoneal trunk. Mean tibial lesion length was 83.8 mm. Early elastic recoil was determined on the basis of minimal lumen diameter (MLD) measurements at baseline (MLDbaseline), immediately after tibial balloon angioplasty (MLDpostdilation), and 15 minutes thereafter (MLD15min). RESULTS: Elastic recoil was observed in 29 (97%) patients with a mean luminal compromise of 29% according to MLD measurements (MLDbaseline 0.23 mm, MLD postdilation 2.0 mm, and MLD15min 1.47 mm). CONCLUSION: Early recoil is frequently observed in CLI patients undergoing tibial angioplasty and may significantly contribute to restenosis. These findings support the role of dedicated mechanical scaffolding approaches for the prevention of restenosis in tibial arteries.