Hallux valgus

02561 THE SCARF OSTEOTOMY IN HALLUX VALGUS - A RETROSPECTIVE STUDY, CLINICAL AND RADIOLOGICAL RESULTS

R. Girtler, W. Fertschak, W. Schwägerl.

Orthopaedic Center, OWS Hospital, Vienna, Austria; Ludwig Boltzmann Institute for Rheumatic Surgery

Aims: In this study we want to show that the osteotomy according to scarf is a stable and joint maintaining surgical treatment in patients with hallux valgus, lacking strong signs of arthrosis. The scarf osteotomy is a long z-formed osteotomy of the metatarsal hone, fixed with two titanium screws. Methods: In this retrospective study 106 osteotomies according to scarf were examined. The average follow up period was 33.5 months, the operations were carried out over a period between January 1995 and August 1999. Pre- and post operatively the MTP I, and the IM angles were measured and special attention was paid to the development of arthrosis in the MTP 1 joint. Subjectively, the VAS score was used for evaluation. Results: The hallux valgus angle was reduced from 29 degrees pre operatively to 16.1 degrees post operatively. average pre operative IM angle was reduced from 15 degrees to 9.6 degrees post operatively. All patients had clinical pain in the MTP I joint pre operatively and shoe conflict, after the operation only 7 patients were dissatisfied. Post operatively there was a reduction of the VAS score (pre op 85, post op 18). Only in 9 cases was there a worsening of the arthrosis in the MTP I joint. Conclusions: The scarf osteotomy is a technically challenging but very safe osteotomy with immediate exercising stability. It offers good possibilities of correction of MTP I and IM angle.

O2562 LONG TERM RESULTS OF SILASTIC IMPLANT ARTHROPLASTY OF THE FIRST METATARSOPHALANGEAL JOINT

S.K. Singh, R. Bombireddy. P. Sharma, H. Deo, M. EI-Kadafi, M. Rowntree.

Queen Mary 's Hospital, Sidcup, Great Britain

Aim: To assess long-term outcome of Silastic Joint Replacement of the first metatarsophalangeal joint. Methods: 32 patients (42 feet) with double stem silicons implant arthroplasty of the 1st MTPJ were reviewed at average 8 years (range 4-19 years). Surgery was for Hallux rigidus in 25 cases and for Hallux valgus with degenerative osteoarthritis in 17 cases. Patients with Rheumatoid arthritis were excluded. Mean patient age was 64 years. Results: 28 of the 32 patients were very satisfied with the procedure. No patients were dissatisfied. Pain relief was subjectively excellent or good in 28 patients. Three of the four patients with fair or poor relief of pain had surgery for Hallux Valgus with degenerative osteoarthritis. Radiographs showed sclerosis around all prostheses with cysts with bony erosions in 17 cases. 12 had clinical features of silicone synovitis in the early postoperative period but this was not present at final review despite radiological findings of new bone formation (57%) and localised osteolysis (40%). Two patients had transfer melatarsalgia with a stress fracture. No patients required revision surgery. Conclusion: Our long-term study shows patients to have very good subjective and objective results despite poor radiological results. There is a role for double stemmed silicone implant arthroplasty in low demand patients.

O2563 JOINT CONSERVING PROCEDURES AFTER RECURRENCES IN BUNION SURGERY

A. Rochwerger. G. Curvale, CA. Sbihi, P. Groulier.

Université de la méditeranée, Marseille, France

Aims: The results of arthrodesis of the first metatarsophalangeal joint as salvage procedures after failure in bunion surgery are well documented in the medical literature. Usually, the results may be equivalent to those of primary arthrodeses. On the other hand, joint conserving methods in case of recurrence have not the same reputation in respect to arthrodesis which appears as the gold standard

Methods: We reviewed 27 patients (28 feet) with a mean follow-up of 6.5 years (range: 1-18 years) after treatment for recurrence after bunion surgery. The patients were submitted to a joint conserving procedure on grounds of absence of degenerative condition on the metatarsophalangeal joint. The procedure corrected point by point all the characteristics of the deformity: lateral release, mobilisation of the joint, tightening of the medial capsule and osteotomies on the first ray.

Results: Preoperatively valgus of the great toe was on average of 38.9°. At time of follow-up (6.5 years on average) after revisional procedure, valgus of the great toe was on average 21.3°. Postoperatively 23 out of 27 patients were satisfied. The result was considered as good in 20 cases, fair in one, and poor in 7 cases.

Conclusions: In spite of technical difficulties, these results can equal those of primary bunion procedure, if all the morphological disorders are corrected. Conservative methods may be rational when the joint remains flexible with no pain and when the morphological particularities on the forefoot are sufficiently indisputable so that their correction could cure the patient

02564 LATER RESULTS OF MITCHELL CORRECTIVE METATARSAL OSTEOTOMY IN THE TREATMENT OF HALLUX VALGUS

M. Madjarevic, R. Kolundzic. K. Korzinek.

Department of Orthopaedic Surgery, University of Zagreb, Croatia

Aims: The aim of the study is to present later results in the treatment of hallux valgus with Mitchell corrective metatarsal osteotomy. Materials and methods: In the period from 1982 to 1991. 238 patients (230 females and 8 males) and 380 foots were operated. The patients were followed from 11 to 20 years. The age of the patients varied from 13 up to 55 years (the median value of around 36 years). Indications for the Mitchell corrective metatarsal osteotomy were, in the first place, the angel of hallux valgus bigger then 20 degrease, intermetatarsal angle bigger then 10 degrease, pain due to shoe pressure over the medial side of metatarsophalangeal joint, cosmetics appearance. In this study 130 patients with 230 foots were evaluated (radiological, clinical and subjective evaluation). Results The angel of hallux valgus was 20 to 52 degrease (mean-34,5 degres) before operation and was 8 to 36 (mean - 16,1 degrease) after operation. Intermetatarsal angle was 10 to 25 (median - 15 degrease) before operation and was 7 to 22 degrease (mean - 8 degrease) after operation. Shortening of first metatarsal bone was 2 to 6 mm (mean - 3 mm)Conclusion:The study shows that Mitchell corrective metatarsal osteotomy in treatment of hallux valgus is method of selection in younger patients and with distinctive intermetatarsal angle.

O2565 TITANEUM HEMIARTHROPLASTY FORTHEHALLUX METATARSOPHALENGEAL JOINT

P. Meda. B. Machani, J. Auchinclouss.

Maccelsfield general hospital, U.K.

Aim: To evaluate the clinical outcome of Tilaneum hemiarthroplasty in the management of hallux metatarsophalangeal joint arthritis. Methods: 55 joints in 46 patients were treated surgically with Titaneum implant for arthritic hallux metatarsophaelangeal joints.There were 35 women and 11 men.The pathological indications were hallux rigidus (74%). rheumatoid arthritis (10%) and degenerative changes associated with hallux valgus (16%). 6 cases were done as a revision of sialastic to titanium prosthesis due to severe silicone synovitis. Results: The mean age was 60 (range 43-76) years, and the mean follow up was 56 (range 28-86) months. The mean time taken to get back to normal activities is 36.6 (range 21-90) days. The mean range of motion achieved was 32 (range 20-64) degrees and the relief of pain was excellent or good in 86% of the patients. There were no surgical complications in the form of infection, osteolysis or instability. The synovitis in the revision group has subsided. Conclusions: The clinical results of Titaneum hemiarthroplasty were good. The advantages of this procedure were preservation of joint movement and good pain relief.

O2566 MINIMALLY INVASIVE DISTAL METATARSAL OSTEOTOMY FOR ' SURGICAL TREATMENT OF HALLUX VALGUS

S. Giannini, F. Ceccarelli, C. Faldini, F. Vannini.

Bologna University, Istitulo Ortopedico Rizzoli, Bologna, Italy

Aims: The purpouse of the study is to review a series of hallux valgus treated by minimally invasive distal metatarsal osteotomy with a simple, effective, rapid, inexpensive (SERI) technique. Methods: 54 consecutive feet in 37 patients, aged 48 ± 23 years affected by hallux valgus deformity less than 40° with an intermetatarsal angle up to 20" were reviewed at 5 years follow up. Surgical technique consisted of a 1 cm medial incision at the metatarsal neck, then an osteotomy was performed using an oscillating saw. With a direct line of vision, all characteristics of the deformity (HVA. IMA. DMAA) were corrected by lateral displacement of the metatarsal head; contemporary plantar or dorsal displacement was performed according to insufficiency or overloading of the first ray. The osteotomy was stabilized by a 2 mm Kirschner wire. All patients were clinically (AOFAS score) and radiographically checked at an average follow up of 5 years. Results: The clinical score at follow up was (91±12). The pre-op hallux valgus angle was 32.5±9, while post-op it was 22±7 (p

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