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Mini-Implantate am Fuß- und Sprunggelenk: Eine Alternative zur Vollprothese oder Versteifung

Mini implants in foot and ankle surgery: an alternative to total joint replacement or joint fusion

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Zusammenfassung

Mini-Implantate in der Fuß- und Sprunggelenkchirurgie werden zunehmend eingesetzt. Ziel der Implantate ist der Erhalt der Funktion der Gelenke, unter Berücksichtigung der Biologie und der Rückzugsmöglichkeiten. Frühe Versuche mit Mini-Implantaten im Sinne von silastischen Implantaten oder Teilprothesen brachten nicht den erhofften Erfolg. Mit Einführung eines modernen metallischen Mini-Implantats konnten die ersten Erfolge am MTP‑I sowie dem oberen Sprunggelenk (OSG) erzielt werden. Seit wenigen Jahren steht ein Implantat aus Polyvinylalkohol zur Versorgung des arthrotischen MTP‑I zur Verfügung. Implantate aus Polylactid können als Interpositionsarthroplastiken bei Arthrosen der Lisfranc-Gelenkreihe oder des MTP‑I zum Einsatz kommen. Eine neue Technik ohne Langzeiterfahrung bei therapierefraktären Defekten des Talus stellt die Versorgung mittels Hemiprothese dar. Dieser Artikel gibt einen Überblick über die momentan verfügbaren Mini-Implantate. Der Einsatz als mögliche Alternative zur Vollprothese oder Versteifung wird vor dem Hintergrund der aktuell verfügbaren Literatur kritisch beleuchtet.

Abstract

Mini implants are increasingly used in foot and ankle surgery. They preserve the joints’ functions, are easy to insert and easy to convert to an alternative treatment. Early surgical attempts using silastic implants did not bring the expected success. First achievements where reached with modern metallic mini implants in the first metatarsophalangeal (MTP) joint and the ankle joint. For a few years now, a polyvinyl alcohol implant has been used to treat the arthritic first MTP joint. Even severe arthritic joints can be treated with an implant made of polylactide. This implant can also be used in the treatment of Lisfranc joint pathologies. To address severe osteochondral defects of the talus, an innovative hemiarthroplasty implant has been suggested. This article gives a summary of currently used mini implants. Their application as possible alternatives to total joint replacement or joint fusion are critically reviewed in the light of the current literature.

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Abbreviations

MTP:

Metatarsophalangealgelenk

OCD :

Osteochondrale Defekte

OSG :

Oberes Sprunggelenk

TMT :

Tarsometatarsalgelenk

Literatur

  1. Akoh CC, Chen J, Kadakia R et al (2020) Adverse events involving hallux metatarsophalangeal joint implants: analysis of the United States food and drug administration data from 2010 to 2018. Foot Ankle Surg 18:1268–7731

    Google Scholar 

  2. Aurich M, Albrecht D, Angele P et al (2017) Treatment of osteochondral lesions in the ankle: a guideline from the group “clinical tissue regeneration” of the German Society of Orthopaedics and Traumatology (DGOU). Z Orthop Unfall 155:92–99

    CAS  PubMed  Google Scholar 

  3. Baumhauer JF, Singh D, Glazebrook M et al (2016) Prospective, randomized, multi-centered clinical trial assessing safety and efficacy of a synthetic cartilage implant versus first metatarsophalangeal arthrodesis in advanced hallux rigidus. Foot Ankle Int 37:457–469

    Article  PubMed  Google Scholar 

  4. Cassinelli SJ, Chen S, Charlton TP et al (2019) Early outcomes and complications of synthetic cartilage implant for treatment of Hallux Rigidus in the United States. Foot Ankle Int 40:1140–1148

    Article  PubMed  Google Scholar 

  5. Chrea B, Day J, Eble SK et al (2020) Outcomes of polyvinyl alcohol hydrogel implant of the lesser metatarsals. Foot Ankle Int 41:1092–1098

    Article  PubMed  Google Scholar 

  6. Cracchiolo A 3rd, Weltmer JB Jr., Lian G et al (1992) Arthroplasty of the first metatarsophalangeal joint with a double-stem silicone implant. Results in patients who have degenerative joint disease failure of previous operations, or rheumatoid arthritis. J Bone Joint Surg Am 74:552–563

    Article  PubMed  Google Scholar 

  7. Cracknell R (2010) The ageing population. Key issues for the new parliament. House of commons library research, S 44–45

    Google Scholar 

  8. D’ambrosi R, Usuelli FG (2018) Osteochondral lesions of the talus: are we ready for metal? Ann Transl Med 6:S19

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dawson-Bowling S, Adimonye A, Cohen A et al (2012) MOJE ceramic metatarsophalangeal arthroplasty: disappointing clinical results at two to eight years. Foot Ankle Int 33:560–564

    Article  PubMed  Google Scholar 

  10. Ebskov LB, Hegnet Andersen K, Bro Rasmussen P et al (2019) Mid-term results after treatment of complex talus osteochondral defects with HemiCAP implantation. Foot Ankle Surg 26:384–390

  11. Ettinger S, Stukenborg-Colsman C, Waizy H et al (2017) Results of HemiCAP((R)) implantation as a salvage procedure for osteochondral lesions of the talus. J Foot Ankle Surg 56:788–792

    Article  PubMed  Google Scholar 

  12. Gheorghiu D, Coles C, Ballester J (2015) Hemiarthroplasty for Hallux Rigidus: mid-term results. J Foot Ankle Surg 54:591–593

    Article  PubMed  Google Scholar 

  13. Glazebrook M, Baumhauer JF, Blundell C et al (2019) Letter regarding: early outcomes and complications of synthetic cartilage implant for treatment of Hallux Rigidus in the United States. Foot Ankle Int 40:1149–1151

    Article  PubMed  Google Scholar 

  14. Glazebrook M, Blundell CM, O’dowd D et al (2019) Midterm outcomes of a synthetic cartilage implant for the first metatarsophalangeal joint in advanced Hallux Rigidus. Foot Ankle Int 40:374–383

    Article  PubMed  Google Scholar 

  15. Glazebrook M, Morash J, Alhadhoud M et al (2019) Preliminary experience with polyvinyl alcohol hydrogel implant for pathology of the second metatarsal head. Foot Ankle Int 40:1304–1308

    Article  PubMed  Google Scholar 

  16. Gross CE, Hsu AR, Lin J et al (2013) Revision MTP arthrodesis for failed MTP arthroplasty. Foot Ankle Spec 6:471–478

    Article  PubMed  Google Scholar 

  17. Hassel KM, Mai S, Mai B (2015) Five years results with a new bioreplaceable implant for MTP joints. A prospective randomized study. OUP 9:442–447

    Google Scholar 

  18. Hilario H, Garrett A, Motley T et al (2017) Ten-year follow-up of metatarsal head resurfacing implants for treatment of Hallux Rigidus. J Foot Ankle Surg 56:1052–1057

    Article  PubMed  Google Scholar 

  19. Ho B, Baumhauer J (2017) Hallux rigidus. EFORT Open Rev 2:13–20

    Article  PubMed  PubMed Central  Google Scholar 

  20. Komenda GA, Myerson MS, Biddinger KR (1996) Results of arthrodesis of the tarsometatarsal joints after traumatic injury. J Bone Joint Surg Am 78:1665–1676

    Article  CAS  PubMed  Google Scholar 

  21. Konkel KF, Menger AG (2006) Mid-term results of titanium hemi-great toe implants. Foot Ankle Int 27:922–929

    Article  PubMed  Google Scholar 

  22. Lam A, Chan JJ, Surace MF et al (2017) Hallux rigidus: how do I approach it? World J Orthop 8:364–371

    Article  PubMed  PubMed Central  Google Scholar 

  23. Maiorano E, Bianchi A, Hosseinzadeh MK et al (2020) HemiCAP(R) implantation after failed previous surgery for osteochondral lesions of the talus. Foot Ankle Surg 20:1268–7731

    Google Scholar 

  24. Mermerkaya MU, Adli H (2016) A comparison between metatarsal head-resurfacing hemiarthroplasty and total metatarsophalangeal joint arthroplasty as surgical treatments for hallux rigidus: a retrospective study with short- to midterm follow-up. Clin Interv Aging 11:1805–1813

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mermerkaya MU, Alkan E, Ayvaz M (2018) Evaluation of metatarsal head resurfacing hemiarthroplasty in the surgical treatment of Hallux Rigidus: a retrospective study and mid- to long-term follow-up. Foot Ankle Spec 11:22–31

    Article  PubMed  Google Scholar 

  26. Morgan S, Ng A, Clough T (2012) The long-term outcome of silastic implant arthroplasty of the first metatarsophalangeal joint: a retrospective analysis of one hundred and eight feet. Int Orthop 36:1865–1869

    Article  PubMed  PubMed Central  Google Scholar 

  27. Nagy MT, Walker CR, Sirikonda SP (2014) Second-generation ceramic first metatarsophalangeal joint replacement for Hallux Rigidus. Foot Ankle Int 35:690–698

    Article  PubMed  Google Scholar 

  28. Ouzounian TJ, Shereff MJ (1989) In vitro determination of midfoot motion. Foot Ankle 10:140–146

    Article  CAS  PubMed  Google Scholar 

  29. Park DS, Schram AJ, Stone NM (2000) Isolated lateral tarsometatarsal joint arthrodesis: a case report. J Foot Ankle Surg 39:239–243

    Article  CAS  PubMed  Google Scholar 

  30. Partio N, Ponkilainen VT, Rinkinen V et al (2019) Interpositional arthroplasty of the first metatarsophalangeal joint with bioresorbable Pldla implant in the treatment of Hallux Rigidus and arthritic Hallux Valgus: a 9‑year case series follow-up. Scand J Surg. https://doi.org/10.1177/1457496919893597

    Article  PubMed  Google Scholar 

  31. Raikin SM, Ahmad J, Pour AE et al (2007) Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint. J Bone Joint Surg Am 89:1979–1985

    Article  PubMed  Google Scholar 

  32. Raikin SM, Schon LC (2003) Arthrodesis of the fourth and fifth tarsometatarsal joints of the midfoot. Foot Ankle Int 24:584–590

    Article  PubMed  Google Scholar 

  33. Rammelt S, Panzner I, Mittlmeier T (2015) Metatarsophalangeal joint fusion: why and how? Foot Ankle Clin 20:465–477

    Article  PubMed  Google Scholar 

  34. Russell DF, Ferdinand RD (2013) Review of the evidence: surgical management of 4th and 5th tarsometatarsal joint osteoarthritis. Foot Ankle Surg 19:207–211

    Article  PubMed  Google Scholar 

  35. Shawen SB, Anderson RB, Cohen BE et al (2007) Spherical ceramic interpositional arthroplasty for basal fourth and fifth metatarsal arthritis. Foot Ankle Int 28:896–901

    Article  PubMed  Google Scholar 

  36. Shih CL, Chen SJ, Huang PJ (2020) Clinical outcomes of total ankle arthroplasty versus ankle arthrodesis for the treatment of end-stage ankle arthritis in the last decade: a systematic review and meta-analysis. J Foot Ankle Surg 59:1032–1039

    Article  PubMed  Google Scholar 

  37. Tiihonen R, Skytta ET, Ikavalko M et al (2010) Comparison of bioreplaceable interposition arthroplasty with metatarsal head resection of the rheumatoid forefoot. Foot Ankle Int 31:505–510

    Article  PubMed  Google Scholar 

  38. Trivedi B, Marshall M, Belcher J et al (2010) A systematic review of radiographic definitions of foot osteoarthritis in population-based studies. Osteoarthr Cartil 18:1027–1035

    Article  CAS  Google Scholar 

  39. Van Dijk CN, Reilingh ML, Zengerink M et al (2010) Osteochondral defects in the ankle: why painful? Knee Surg Sports Traumatol Arthrosc 18:570–580

    Article  PubMed  PubMed Central  Google Scholar 

  40. Viens NA, Adams SB Jr., Nunley JA 2nd (2012) Ceramic interpositional arthroplasty for fourth and fifth tarsometatarsal joint arthritis. J Surg Orthop Adv 21:126–131

    Article  PubMed  Google Scholar 

  41. Vuurberg G, Reilingh ML, Van Bergen CJA et al (2019) Metal resurfacing inlay implant for osteochondral talar defects after failed previous surgery: a midterm prospective follow-up study: response. Am J Sports Med 47:NP19–NP20

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopädische Klinik der Medizinischen Hochschule Hannover im DIAKOVERE Annastift, Anna-von-Borries Str. 1–7, 30625, Hannover, Deutschland

    Matthias Lerch, Christian Plaass, Leif Claassen & Sarah Ettinger

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  1. Matthias Lerch
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  2. Christian Plaass
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  3. Leif Claassen
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  4. Sarah Ettinger
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Correspondence to Matthias Lerch.

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Interessenkonflikt

M. Lerch, C. Plaass, L. Claassen und S. Etting geben an: Die Klinik der Autoren erhielt Drittmittel von der Arthrex GmbH. M. Lerch ist als Referent für die Arthrex GmbH tätig und erhielt Reisekostenübernahmen.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Lerch, M., Plaass, C., Claassen, L. et al. Mini-Implantate am Fuß- und Sprunggelenk: Eine Alternative zur Vollprothese oder Versteifung. Orthopäde 50, 96–103 (2021). https://doi.org/10.1007/s00132-020-04052-x

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