Zusammenfassung
Studienziel: Ziel der prospektiven Studie war die mittelfristige Darstellung der Ergebnisse nach endoprothetischer Versorgung des Großzehengrundgelenks. Material und Methode: Die prospektive Studie wurde klinisch und röntgenologisch bei 78 Patienten (56 Frauen, 22 Männer) im Zeitraum von Januar 2000 bis April 2007 durchgeführt. Der durchschnittliche Follow-up lag bei 56 Monaten (6 – 87). Der Altersdurchschnitt betrug 58 Jahre (34 – 80). Die Indikationen umfassten den schweren Hallux rigidus (Grad IV) (85,5 %), Z. n. Keller-Brandes (3,6 %), Metatarsalköpfchennekrose (8,5 %) sowie 2 Revisionen von einer Silastik-Prothese sowie einer Pseudarthrose nach Arthrodese des Großzehengrundgelenks (2,4 %). Die klinische Beurteilung erfolgte mit dem Score nach Kitaoka et al. Ergebnisse: Die mittlere Zeit zur Erreichung normaler Aktivitäten lag bei 35,2 Tagen (21 – 76). Nach 3 Monaten postoperativ wurde eine signifikante Verbesserung des Kitaoka-Scores auf 75 Punkte (p < 0,05) und nach 6 Monaten postoperativ auf 85 Punkte (p < 0,05) festgestellt. Das durchschnittliche Bewegungsausmaß betrug nach 6 Monaten 38,6° (Ex 21,5°/Flex 17,1°). Schlussfolgerung: Die ToeFit-Großzehengrundgelenksendoprothese zeigte gute mittelfristige klinische Ergebnisse. Die Vorteile bestanden in der erhaltenen postoperativen Bewegungsfähigkeit, der sofortigen Mobilisation und der guten Patientenakzeptanz.
Abstract
Aim: This prospective report evaluates the clinical outcome of titanium arthroplasty in the management of hallux metatarsophalangeal joints. Patients and Methods: Eigthy joints in 78 patients were treated surgically with the titanium implant for hallux metatarsophalangeal joints between January 2000 and April 2007. There were 56 women and 22 men. The mean age was 58 (range: 34 – 80) years, and the mean follow-up was 56 (range: 6 – 87) months. The pathological indications were hallux rigidus (85.5 %), metatarsalhead necrosis (8.5 %), revision of Keller-Brandes (3.6 %) and 2 cases were done as a revision of silastic to titanium prosthesis and a revision of pseudarthrosis after arthrodesis (2.4 %). The patients were subsequently examined by means of clinical and radiological assessments. The clinical function was classified using the score of Kitaoka et al. Results: The mean time taken to get back to normal activities is 35.2 (range: 21 – 76) days. The average Kitaoka score improved to 75 points (p < 0.05) at 3 months postoperatively and to 85 points (p < 0.05) at 6 months postoperatively. The mean range of motion achieved was 38.6° (range ex 21.5°/flex 17.1°). Conclusion: The clinical results of titanium arthroplasty were good. The advantages of this procedure are preservation of joint movement and good pain relief with an early mobilisation.
Schlüsselwörter
Hallux rigidus - Großzehengrundgelenk - Endoprothese
Key words
first metatarsophalangeal joint - arthroplasty - titanium prosthesis
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Dr. Jörn Lange
Klinik für Orthopädie und Orthopädische Chirurgie
Universität Greifswald
Sauerbruchstraße
17475 Greifswald
Telefon: 0 38 34/86 70 51
Fax: 0 38 34/86 70 52
eMail: joern.lange@uni-greifswald.de
