Halluks Rigidus Tedavisinde Üç-Komponentli Total Artroplastisi Erken Dönem Fonksiyonel Sonuçları

Year 2018, Volume: 23 Issue: 1, 34 - 41, 29.01.2018

Kayahan Karaytuğ , Eren Yıldız , Sefa Giray Batıbay

https://doi.org/10.21673/anadoluklin.341051

Abstract

Amaç: Halluks rigidus, birinci metatarsofalangeal (MTF-1) eklemin dejenerasyonu ile karakterize bir hastalıktır. İleri evre halluks rigidus cerrahi tedavisinde artrodez yerine artroplasti seçimi halen tartışmalıdır. Bu çalışmanın amacı ileri evre halluks rigidus nedeniyle yeni nesil üç komponentli press-fit total eklem artroplastisi uygulanan hastaların erken dönem tedavi sonuçlarını bildirmektir.

Gereç ve Yöntemler: Hastalar MTF-1 eklem dorsifleksiyon, plantar fleksiyon ve total eklem hareket açıklığı (EHA) dereceleri, AOFAS, VAS, SF-12 PCS skorları ve memnuniyet anketi sonuçları üzerinden değerlendirildi. Preoperatif ve postoperatif değerler istatistiksel açıdan analiz edildi. Radyolojik olarak ise anteroposteriyor (AP) ve lateral grafiler çekilerek gevşeme, aşınma ve dizilim açısından incelendi.

Bulgular: Çalışmaya 17 hastanın 19 eklemi (14 kadın, 5 erkek) dahil edildi. Ortalama yaş 59 (49–67) olarak hesaplandı. Hastaların ortalama takip süresi 15 (12–22) ay idi. Ortalama dorsifleksiyon derecesi preoperatif 12,7° (2,1°–22,1°), postoperatif 30,1° (11,6°–47,3°); ortalama plantar fleksiyon derecesi preoperatif 16° (7,8°–24,2°), postoperatif 9,2° (2,3°–16,5°) olarak ölçüldü. MTF-1 eklem total hareket açıklığı preoperatif 28,7°’den postoperatif 39,4°’ye çıktı. Ortalama postoperatif AOFAS, VAS ve SF-12 PCS skorları 85,3 (57–96), 1,3 (0–5) ve 57,7 (53,7–59,9) olarak hesaplandı. Hastaların AOFAS ve SF-12 PCS skorlarındaki artış ile VAS skorlarındaki azalma istatistiksel açıdan anlamlı idi.

Tartışma ve Sonuç: İleri evre MTF-1 eklem osteoartriti ciddi ağrı ve hareket kaybına sebep olan bir hastalıktır. Cerrahi tedavide kullanılacak standart yöntem halen tartışmalıdır. Literatürde ciddi komplikasyonlara neden olan eski protetik uygulamaların aksine üç komponentli sementsiz press-fit total protez uygulamalarında tatmin edici sonuçlar elde edildiği bildirilmektedir. Ağrının giderilmesi ve AOFAS skorlarındaki artış tedavinin en başarılı yönleri olarak görülmektedir. Bu çalışmadan edindiğimiz bilgiler neticesinde ileri evre halluks rigidus tedavisinde yeni nesil üç komponentli press-fit total protez uygulamalarının etkili bir tedavi yöntemi olduğunu, uygun hasta seçimi halinde erken dönemde tatmin edici sonuçlar sağladığını düşünmekteyiz.

Keywords

Halluks rigidus, osteoartrit, total protez

Early Functional Results of Three-Component Total Arthroplasty in the Treatment of Hallux Rigidus

Abstract

Aim: Hallux rigidus is a disease characterized by degeneration of the first metatarsophalangeal (MTF-1) joint. The choice of arthroplasty instead of arthrodesis in the surgical treatment of advanced hallux rigidus is still controversial. In this study, we aimed to report the early treatment results of a number of patients who had advanced hallux rigidus and underwent new-generation three-component press-fit total joint arthroplasty.

Materials and Methods: The patients were evaluated in terms of degrees of MTF-1 joint dorsiflexion, plantar flexion, and total joint range of motion (ROM), scores of AOFAS, VAS, SF-12 PCS, and satisfaction survey results. The preoperative and postoperative values were analyzed statistically. Radiologically, anteroposterior (AP) and lateral radiographs were taken and examined for loosening, wear, and alignment.

Results: Nineteen joints (14 female, 5 male) of 17 patients were included in the study. The mean age was 59 (49–67) years. The mean patient follow-up was 15 (12–22) months. The mean dorsiflexion degree was 12.7° (range 2.1°–22.1°) preoperatively and 30.1° (11.6°–47.3°) postoperatively. The mean plantar flexion degree was 16° (7.8°–24.2°) preoperatively and 9.2° (2.3°–16.5°) postoperatively. The total range of motion (ROM) of the MTF-1 joint improved from a preoperative 28.4° to a postoperative 39.4°. The mean postoperative AOFAS, VAS, and SF-12 PCS scores were calculated as 85.3 (57–96), 1.3 (0–5), and 57.7 (53.7–59.9), respectively. The increase in the patients’ AOFAS and SF-12 PCS scores and the decrease in the VAS scores were found to be statistically significant.

Discussion and Conclusion: Advanced MTF-1 joint osteoarthritis is a disease that causes severe pain and loss of motion. The method for a standard surgical treatment is still controversial. It has been reported in the literature that satisfactory results have been achieved in applications of three-component cementless press-fit total prostheses, in contrast to older prosthetic applications that cause serious complications. The pain relief and the increase in AOFAS scores are considered the most successful aspects of the treatment. Based on the information obtained from this study, we think that application of new-generation three-component press-fit total prostheses is an effective method in the treatment of advanced hallux rigidus, and that the early results are satisfactory when it has been applied to appropriate patients.

Keywords

Halluks rigidus, osteoarthritis, total prosthesis

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