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MEDICINA E CHIRURGIA DELLA CAVIGLIA E DEL PIEDE
A Journal on Physiopathology and Surgery of the Foot
Indexed/Abstracted in: EMBASE, Scopus
Chirurgia Del Piede 2002 March;26(1):1-8
Interposition arthroplasty with periosteal graft of the lesser metatarsophalangeal joints. First long term results
Parino E., Pisani P. C., Milano L.
Background. Surgery treatment of an isolated arthropathy of the external metatarsophalangeal joint, outside rheumatoid pathology, presents a number of problems that are difficult to resolve. The rigidity of the metatarsophalangeal joint, axial deviations, metatarsalgia and load transfer phenomena to contiguous rays represent the most common disabling sequelae to surgery. The disappointing medium-term results of silicone prostheses prompted us to explore surgical techniques that would preserve joint function without resorting to demolitive surgery. Interposition arthroplasty with periosteal graft appears to achieve to this aim.
Methods. We report the results of a retrospective study of 12 patients treated between 1991 and 2000 with a mean follow-up of 43 months. The pathology causing arthropathy was: surgical sequelae in 6 cases, Koeffier's disease in 4 cases, 2nd metatarsophalangeal joint syndrome in 2 cases, one case of trauma and isolated psoriasic arthropathy respectively. Surgery consisted of the interposition of a periosteal graft taken from the anterior proximal region of the tibia and positioned between the remodelled joint surfaces of the metatarsophalangeal joint and sutured to the joint capsule.
Results. The results were assessed using a AOFAS score card (acc. Kitaoka) with a mean score of 65 out of 100. The best results were obtained in cases suffering sequelae of Koeffier's disease (5 procedures) with 75.5 points. The subjective assessment of surgery was positive in 8 cases, with reserves in 3 cases and negative in 1 case.
Conclusions. The technique is easy to carry out and allows difficult clinical situations to be overcome, preserving function and stability of the external metatarsophalangeal joints, albeit with a little loss of movement.