The use of the endoprosthesis of the first plusnephalanx joint of the original design (clinical case)

Background. Currently, the replacement surgery of the first metatarsophalangeal joint (MTP joint) is considered to be one of the effective, invasive method for treating severe forms of osteoarthritis of the MTP joint. However, there are a number of postoperative complications that may be caused by the prosthesis itself. Research in this area can provide valuable information that will assist specialists in making decisions regarding the most suitable implant for each patient. Additionally, improvements in the design of implants for MTP joint replacement and further studies will help make them more effective, durable, and biocompatible.
The aim. To present a clinical case of osteoarthritis of the first metatarsophalangeal joint (Hallux rigidus) treated surgically by conducting total joint replacement with a monolithic ceramic implant featuring an optimal stem design.
Materials and methods. A clinical case is a 47-year-old patient presenting with deforming osteoarthritis of the 1st MTP joint. It was managed by arthroplasty of 1st MTP joint using an all-ceramic endoprosthesis with an optimal leg (RU № 226697).
Results. Three months after the operation, the pronounced significant increase in the range of movement and pain reduction in the 1st MTP joint were observed. Positive dynamics was preserved 6 and 12 months postoperatively.
Conclusion. The results of the surgery indicate that the replacement of the first metatarsophalangeal joint replacement using a monolithic ceramic implant with an optimal stem design is efficient surgical intervention. This approach significantly not only alleviates pain, but improves the quality of life for patients overall. However, to fully assess the long-term results and sustainability of the achieved effects, further studies are needed to analyze the distant outcomes of this intervention.

1. Butler JJ, Hartman H, Mener A, Mercer NP, et al. Limited evidence to support the use of intra-articular injection of hyaluronic acid for the management of Hallux Rigidus: a systematic review. Foot Ankle Orthop. 2024; 9(3): 24730114241265109. doi: 10.1177/24730114241265109

2. Lam A, Chan JJ, Surace MF, Vulcano E. Hallux rigidus: how do i approach it? World J Orthop. 2017; 8(5): 364–371. doi: 10.5312/wjo.v8.i5.364

3. Galois L, Hemmer J, Ray V, Sirveaux F. Surgical options for hallux rigidus: state of the art and review of the literature. European Journal of Orthop Surg Traumatology. 2020; 30(1): 57–65. doi: 10.1007/s00590-019-02528-x

4. Givissis P, Kitridis D, Daskalakis DN, Symeonidis P. Minimal resection interposition arthroplasty of the first metatarsophalangeal joint. The Foot. 2017; 32: 1-7. doi: 10.1016/j.foot.2017.03.004

5. Saxena А, Shou L. A novel technique to treat Hallux Rigidus in athletic patients with central osteochondral defects: preliminary report on 12 cases. The Journal of Foot and Ankle Surgery. 2021; 60(4): 845-849. doi: 10.1053/j.jfas.2019.11.011

6. Lamm BM. First MTP Joint Distraction. In: Rozbruch SR, Hamdy RC, Fragomen AT, Bernstein M. (eds) Limb Lengthening and Reconstruction Surgery Case Atlas. Springer, Cham. 2024. doi: 10.1007/978-3-031-77361-7_113

7. Anderson MR, Ho BS, Baumhauer JF. Current Concepts Review: Hallux Rigidus. Foot and Ankle Orthopaedics. 2018; 3(2): 247301141876446. doi: 10.1177/2473011418764461

8. Coughlin MJ, Shurnas PS. Hallux rigidus: Grading and long-term results of operative treatment. J Bone Joint Surg (Am). 2003; 85(11): 2072–2088.

9. De Bot TAL, Veldman HD, Eurlings R, Stevens J, Hermus JPS, Witlox AM. Metallic hemiarthroplasty or arthrodesis of the first metatarsophalangeal joint as treatment for hallux rigidus: a systematic review and meta-analysis. Foot and Ankle Surgery. 2022; 28(2): 139-152. doi: 10.1016/j.fas.2021.03.004

10. Gupta S, Masud S. Long term results of the Toefit-Plus replacement for first metatarsophalangeal joint arthritis. The Foot. 2017; 31: 67-71. doi: 10.1016/j.foot.2017.04.006

11. Goryakin MV, Ulyanov VYu, Frolenkov AV. Case study of the first metatarsophalangeal joint total replacement. Saratov Journal of Medical Scientific Research. 2019; 15(3): 633–636 (In Russ.).

12. Kolsanov AV, Nikolaenko AN, Ivanov VV, et al. Biomechanics of the first metatarsophalangeal joint after replacement. Pirogov Russian Journal of Surgery. 2023; (5): 58-64. (In Russ.). doi: 10.17116/hirurgia202305158

13. Koutsouradis P, Savvidou OD, Stamatis ЕD. Arthrodesis of the first metatarsophalangeal joint: The “when and how”. World J Orthop. 2021; 12(7): 485–494. doi: 10.5312/wjo.v12.i7.485

14. Lui TH. Arthroscopic arthrodesis of the first metatarsophalangeal joint in hallux valgus deformity. Arthrosc Tech. 2017; 6: e1481–e1487. doi: 10.1016/j.eats.2017.06.004

15. Asif M, Qasim SN, Kannan S, Bhatia M. A consecutive case series of 166 first metatarsophalangeal joint fusions using a combination of cup and cone reamers and crossed cannulated screws. J Foot Ankle Surg. 2018; 57: 462–465. doi: 10.1053/j.jfas.2017.10.026

16. Majeed H. Silastic replacement of the first metatarsophalangeal joint: historical evolution, modern concepts and a systematic review of the literature. EFORT Open Reviews. 2019; 4(3): 77-84. doi: 10.1302/2058-5241.4.180055

17. Dawson-Bowling S, Adimonye A, Cohen A, et al. MOJE ceramic metatarsophalangeal arthroplasty: disappointing clinical results at two to eight years. Foot Ankle Int. 2012; 33(7): 560-564. doi: 10.3113/FAI.2012.0000

18. Moghadasi K, Isa MSМ, Ariffin MA, Mohd MZ. A review on biomedical implant materials and the effect of friction stir based techniques on their mechanical and tribological properties. Journal of Materials Research and Technology. 2022; 17: 1054-1121. doi: 10.1016/j.jmrt.2022.01.050

19. Ess P, Hämäläinen M, Leppilahti J. Non-constrained titanium-polyethylene total endoprosthesis in the treatment of hallux rigidus. A prospective clinical 2-year follow-up study. Scand J Surg. 2002; 91(2): 202-207. doi: 10.1177/145749690209100213

20. Giza E, Sullivan M, Ocel D, Lundeen G, Mitchell M, Frizzell L. First metatarsophalangeal hemiarthroplasty for hallux rigidus. Int Orthop. 2010; 34(8): 1193-1198. doi: 10.1007/s00264-010-1012-x

21. Sung W, Weil L, Weil LS, Stark T. Total first metatarsophalangeal joint implant Arthroplasty: A 30-year retrospective. Clinics Podiatric Med Surg. 2011; 28(4): 755–761. doi: 10.1016/j.cpm.2011.08.005