Reversión de una artrodesis en la primera articulación metatarso-falángica mediante implante total

Abstract

We present a clinical case of revision of failed arthrodesis of the first metatarsophalangeal joint with conversion to a total metatarsophalangeal prothesis. The patient was a 63 years old woman who underwent two previous failed interventions due to hallux rigidus with arthrodesis at the first metatarsophalangeal articulation. The patient had persistent pain at Chopart's joint and at the external malleolus that worsened with gait. She referred pain at the lateral ligaments of the ankle with direct palpation and pain on the talonavicularis and calneus-cuboid joints with forced inversion of the foot. The present paper describes a novel technique to reverse an arthrodesis of the first metatarsophalangeal joint to a total joint replacement with Toefit-Plus™ implant thus restoring joint mobility. Pain relief was achieved and mobility of the first metatarsophalangeal joint was restored within its normal range of motion with a hypermobility of the first ray that required post-surgical treatment with plantar orthoses to improve functionality. At clinical evaluation patient presented active range of motion up to 40̊of dorsiflexion, achieved due to the restoration of functionality of the extensor hallucis longus after the intervention. A better knowledge of advantages and disadvantages of this surgical technique would allow an improved selection of the patients who would benefit from this technique after a failed arthrodesis of first metatarsophalangeal joint. Further studies are needed for a better understanding of the beneficts of this surgery through more clinical studies.