<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Little is known about the rate and reasons for revision after prim...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Little is known about the rate and reasons for revision after primary Metatarsophalangeal (MTP1) arthrodesis with </span><span style="font-family:Verdana;"><span style="font-family:Verdana;">the </span></span><span style="font-family:Verdana;">latest implants. While it is commonly assumed that nonunion accounts for most reoperations, we hypothesized that malposition is the leading cause of revision. The aim of this study was to determine the rate and reasons for revision after MTP1 arthrodesis using cup- and cone-reamers and </span><span style="font-family:Verdana;"><span style="font-family:Verdana;">the </span></span><span style="font-family:Verdana;">latest locking plate technology. </span><b><span style="font-family:Verdana;">Method:</span></b><span style="font-family:Verdana;"> Between 2015 and 2017, 120 consecutive MTP1 fusions in 114 patients were performed with a low profile, pre</span><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span><span style="font-family:Verdana;">contoured titanium dorsal locking plate and a plantar metatarsophalangeal screw. The rate and reasons for revision within a minimum one</span><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span><span style="font-family:Verdana;">year follow-up period (</span><span style="font-family:Verdana;">average </span><span style="font-family:Verdana;">16 months</span><span style="font-family:Verdana;"> [12</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">26]</span><span style="font-family:Verdana;">) after index procedure</span><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span><span style="font-family:Verdana;"> were </span><span style="font-family:Verdana;">documented </span><span style="font-family:Verdana;">and analyzed. </span><span style="font-family:Verdana;"><span style="font-family:Verdana;">The </span></span><span style="font-family:Verdana;">revision was defined as any reoperation following the index procedure excluding hardware removal.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Seventeen of 120 feet (14%) underwent revision. Four patients developed a nonunion (3.3%) and needed revision, and 11 feet (9%) required revision for painful malposition;insufficient extension and excessive valgus accounted for the majority. Two patients required medial sesamoidectomy. No infection or wound healing problems occurred. Twelve patients </span><span style="font-family:Verdana;">requested hardware removal.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Nonunion revision rate after</span><span style="font-family:Verdana;"> MTP1 fusion with </span><span style="font-family:Verdana;"><span style="font-family:Verdana;">the </span></span><span style="font-family:Verdana;">latest locking plate technology is low. The leading cause of revision is malposition followed by nonunion. Excessive valgus and insufficient extension account for most symptomatic malposition. A recommendation of 0</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">10 degrees of valgus in the horizontal plane may contribute to diminishing revision rates;no conclusions could be drawn regarding an optimal position in the sagittal plane.展开更多
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Little is known about the rate and reasons for revision after primary Metatarsophalangeal (MTP1) arthrodesis with </span><span style="font-family:Verdana;"><span style="font-family:Verdana;">the </span></span><span style="font-family:Verdana;">latest implants. While it is commonly assumed that nonunion accounts for most reoperations, we hypothesized that malposition is the leading cause of revision. The aim of this study was to determine the rate and reasons for revision after MTP1 arthrodesis using cup- and cone-reamers and </span><span style="font-family:Verdana;"><span style="font-family:Verdana;">the </span></span><span style="font-family:Verdana;">latest locking plate technology. </span><b><span style="font-family:Verdana;">Method:</span></b><span style="font-family:Verdana;"> Between 2015 and 2017, 120 consecutive MTP1 fusions in 114 patients were performed with a low profile, pre</span><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span><span style="font-family:Verdana;">contoured titanium dorsal locking plate and a plantar metatarsophalangeal screw. The rate and reasons for revision within a minimum one</span><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span><span style="font-family:Verdana;">year follow-up period (</span><span style="font-family:Verdana;">average </span><span style="font-family:Verdana;">16 months</span><span style="font-family:Verdana;"> [12</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">26]</span><span style="font-family:Verdana;">) after index procedure</span><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span><span style="font-family:Verdana;"> were </span><span style="font-family:Verdana;">documented </span><span style="font-family:Verdana;">and analyzed. </span><span style="font-family:Verdana;"><span style="font-family:Verdana;">The </span></span><span style="font-family:Verdana;">revision was defined as any reoperation following the index procedure excluding hardware removal.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Seventeen of 120 feet (14%) underwent revision. Four patients developed a nonunion (3.3%) and needed revision, and 11 feet (9%) required revision for painful malposition;insufficient extension and excessive valgus accounted for the majority. Two patients required medial sesamoidectomy. No infection or wound healing problems occurred. Twelve patients </span><span style="font-family:Verdana;">requested hardware removal.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Nonunion revision rate after</span><span style="font-family:Verdana;"> MTP1 fusion with </span><span style="font-family:Verdana;"><span style="font-family:Verdana;">the </span></span><span style="font-family:Verdana;">latest locking plate technology is low. The leading cause of revision is malposition followed by nonunion. Excessive valgus and insufficient extension account for most symptomatic malposition. A recommendation of 0</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">10 degrees of valgus in the horizontal plane may contribute to diminishing revision rates;no conclusions could be drawn regarding an optimal position in the sagittal plane.