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GRAND ROUNDS
This PRESENT lecture is brought to you
by the generous sponsorship of
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Use of a Titanium Hemi Implant
for Advanced Hallux Limitus
by Micki Gerdes, DPM
3rd Year Resident
Northwest Medical Center
Margate, Florida
The titanium hemi-implant procedure is technically simple,
especially when compared to the difficult and non-forgiving metal total joint
implants. It can be performed with a metatarsal procedure that re-orients the
articular cartilage and addresses the first metatarsal elevatus. The smooth
surface of the implant allows for pain free range of motion, despite addressing
only one cartilaginous surface. Subchondral drilling of the 1st metatarsal head
creates fibrocartilage which further enhances the ability of the implant to
glide freely.
CASE PRESENTATION
This is a 55-year-old male who presented to the office
with the chief complaint of pain and limitation of motion in the 1st metatarsal
phalangeal joint of the left foot. The patient works for a beer distributor. He
is obligated to be on his feet for extended periods of time. He found himself
compromised in his ability to bear weight on the foot for an eight-hour day.
PAST MEDICAL HISTORY: This
includes hypertension and hypercholesterolemia.
CURRENT MEDICATIONS: He
admits to taking Atenolol and Lipitor.
ALLERGIES: There are no
known allergies.
SOCIAL HISTORY:
He is not a smoker, nor does he consume alcohol.
NEUROVASCULAR EXAMINATION:
The patient’s neurovascular status is intact. Pedal pulses are graded +2/+4
bilateral. Propreoceptive sensoriums are intact.
DERMATOLOGICAL EXAM: The skin
is supple and well hydrated. The nails are normal.
LOWER EXTREMITY EXAMINATION:
Clinically one notes pain and limitation of motion, 1st MPJ left foot. There is
a dorsal medial prominence noted. Restriction of motion is evident. There is
joint crepitation noted.
RADIOLOGICAL EXAM: The
X-rays reviewed demonstrated narrowing of the joint space, subchondral sclerosis
and hyperostoses.
Pre-Operative X-ray
Conservative treatments were discussed
including the use of a rigid shank shoe in conjunction with cortisone injection
therapy.
Surgical options were also discussed with the patient including the use of the
Hemi-Implant and Arthrodesis of the involved joint. The placement of a titanium
Hemi-Implant would provide the patient with improved, pain free range of motion
for sometime even though Arthrodesis may be necessary in the distant future. The
patient and physician agreed to the Hemi-Implant surgery of the 1st MPJ.
Below you will find photographs of this successful surgery.
Intra-Operative picture. Note the
hypertrophic bone, degenerative cartilage, and gouty tophi
Following arthroplasty, stem will be
placed in the central diaphysis
Wright Hemi-Implant 4 was found to be
the correct size for the patient
Broach is used to create square hole for
sizer stem
Subchondral drilling to 1st metatarsal
head cartilage
Placement of the titanium implant
Post-Operative X-ray
OUTCOME:
The patient is ambulating pain free, and is very pleased with the outcome.
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Jay Lieberman, DPM
Editor - PRESENT
Director of
Podiatric Medical Education
Northwest Medical Center
Margate,
Florida
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