Comparison between dorsiflexion osteotomy and implant arthroplasty for advanced Freiberg disease_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Shizhou ^1,2 , QING Boquan ^1,2 , TANG Xia ^2,3 , XIE Huiqi ⁴ , HUANG Fuguo ³ ,  ZHANG Hui ^2,3

1. West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Disaster Medical Center, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
3. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
4. Laboratory of Stem Cell and Tissue Engineering, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

ZHANG Hui, Email: caesarzh@163.com

Keywords：

Freiberg disease; implant arthroplasty; dorsiflexion osteotomy; metatarsophalangeal joint

DOI：

10.7507/1002-1892.201812059

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Objective To compare the dorsiflexion osteotomy (DO) and implant arthroplasty (IA) in terms of clinical and radiographic outcomes for patients with advaced Freiberg disease.Methods A clinical data of 25 cases of Freiberg disease, who were admitted between July 2012 and July 2016 and met selection criteria, was retrospectively reviewed. According to the Smillie classification, all patients were classified as stage Ⅳ-Ⅴ. Among them, 13 cases were treated with DO (DO group) and 12 cases were treated with IA (IA group). No significant difference was found between the two groups in gender, age, side of the affected metatarsophalangeal (MTP) joint, location, Smillie classification, disease duration, and preoperative visual analogue scale (VAS) score, range of motion of the affected MTP joints, and the American Orthopedic Foot and Ankle Society (AOFAS) score (P>0.05). Total costs for index admissions were compared between the two groups. Clinical outcomes were evaluated in accordance with the VAS score, AOFAS score, and the range of motion of the affected MTP joints.Results All incisions of the two groups healed by first intention. The follow-up time was 12-30 months (mean, 17 months) in DO group and 12-24 months (mean, 16 months) in IA group. The total cost of index admission was significantly higher in IA group than that n DO group (t=2.742, P=0.011). The AOFAS scores, VAS scores, and range of dorsiflexion and plantar flexion at last follow-up were significantly improved when compared with preoperative value in the two groups (P<0.05). There was no significant difference in all indexes between the two groups (P>0.05). X-ray film examination showed that the osteotomy healed within 8-12 weeks (mean, 9.5 weeks) after operation in DO group. None of the patients experienced internal fixator and implant related complications postoperatively.Conclusion DO and IA can provide significant improvement in pain and motion of the MTP joints for advanced Freiberg disease. But the DO may be the more economical method.

Citation： WU Shizhou, QING Boquan, TANG Xia, XIE Huiqi, HUANG Fuguo, ZHANG Hui. Comparison between dorsiflexion osteotomy and implant arthroplasty for advanced Freiberg disease. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(5): 563-567. doi: 10.7507/1002-1892.201812059 Copy

1.	Smillie IS. Treatment of Freiberg’s infraction. Proc R Soc Med, 1967, 60(1): 29-31.
2.	Carmont MR, Rees RJ, Blundell CM. Current concepts review: Freiberg’s disease. Foot Ankle Int, 2009, 30(2): 167-176.
3.	Schade VL. Surgical management of Freiberg’s infraction: A systematic review. Foot Ankle Spec, 2015, 8(6): 498-519.
4.	Biz C, Zornetta A, Fantoni I, et al. Freiberg’s infraction: A modified closing wedge osteotomy for an undiagnosed case. Int J Surg Case Rep, 2017, 38: 8-12.
5.	Talusan PG, Diaz-Collado PJ, Reach JS Jr. Freiberg’s infraction: diagnosis and treatment. Foot Ankle Spec, 2014, 7(1): 52-56.
6.	Swanson AB, Biddulph SL, Hagert CG. A silicone rubber implant to supplement the Keller toe arthroplasty. NY Univ Inter Clin Inform Bull, 1971, 10: 7-14.
7.	Huskisson EC. Measurement of pain. Lancet, 1974, 2(7889): 1127-1131.
8.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
9.	Cerrato RA. Freiberg’s disease. Foot Ankle Clin, 2011, 16(4): 647-658.
10.	Ihedioha U, Sinha S, Campbell AC. Surgery for symptomatic Freiberg’s disease: excision arthroplasty in eight patients. Foot, 2003, 13(3): 143-145.
11.	Lee HS, Kim YC, Choi JH, et al. Weil and dorsal closing wedge osteotomy for Freiberg’s disease. J Am Podiatr Med Assoc, 2016, 106(2): 100-108.
12.	Özkul E, Gem M, Alemdar C, et al. Results of two different surgical techniques in the treatment of advanced-stage Freiberg’s disease. Indian J Orthop, 2016, 50(1): 70-73.
13.	Pereira BS, Frada T, Freitas D, et al. Long-term follow-up of dorsal wedge osteotomy for pediatric Freiberg disease. Foot Ankle Int, 2016, 37(1): 90-95.
14.	Chao KH, Lee CH, Lin LC. Surgery for symptomatic Freiberg’s disease: extra articular dorsal closing-wedge osteotomy in 13 patients followed for 2-4 years. Acta Orthop Scand, 1999, 70(5): 483-486.
15.	Petersen WJ, Lankes JM, Paulsen F, et al. The arterial supply of the lesser metatarsal heads: a vascular injection study in human cadavers. Foot Ankle Int, 2002, 23(6): 491-495.
16.	Silva LF, Sousa CV, Rodrigues Pinto R, et al. Preliminary results from the metis-newdeal(®) total metatarsophalangeal prosthesis. Rev Bras Ortop, 2015, 46(2): 200-204.
17.	温建民, 孙卫东, 桑志成, 等. Swanson 人工跖趾关节置换治疗 Freiberg 病近期疗效观察. 中国骨伤, 2009, 11(6): 423-425.
18.	Shih AT, Quint RE, Armstrong DG, et al. Treatment of Freiberg's infraction with the titanium hemi-implant. J Am Podiatr Med Assoc, 2004, 94(6): 590-593.
19.	Squitieri L, Chung KC. A systematic review of outcomes and complications of vascularized toe joint transfer, silicone arthroplasty, and PyroCarbon arthroplasty for posttraumatic joint reconstruction of the finger. Plast Reconstr Surg, 2008, 121(5): 1697-1707.
20.	Shankar NS. Silastic single-stem implants in the treatment of hallux rigidus. Foot Ankle Int, 1995, 16(8): 487-491.
21.	Moeckel BH, Sculco TP, Alexiades MM, et al. The double-stemmed silicone-rubber implant for rheumatoid arthritis of the first metatarsophalangeal joint. Long-term results. J Bone Joint Surg (Am), 1992, 74(4): 564-570.
22.	Bales JG, Wall LB, Stern PJ. Long-term results of Swanson silicone arthroplasty for proximal interphalangeal joint osteoarthritis. J Hand Surg (Am), 2014, 39(3): 455-461.
23.	Sethu A, D’Netto DC, Ramakrishna B. Swanson’s silastic implants in great toes. J Bone Joint Surg (Br), 1980, 62-B(1): 83-85.
24.	朱敏, 冯凡哲. 足踝外科新进展. 中国修复重建外科杂志, 2018, 32(7): 860-865.

1. Smillie IS. Treatment of Freiberg’s infraction. Proc R Soc Med, 1967, 60(1): 29-31.
2. Carmont MR, Rees RJ, Blundell CM. Current concepts review: Freiberg’s disease. Foot Ankle Int, 2009, 30(2): 167-176.
3. Schade VL. Surgical management of Freiberg’s infraction: A systematic review. Foot Ankle Spec, 2015, 8(6): 498-519.
4. Biz C, Zornetta A, Fantoni I, et al. Freiberg’s infraction: A modified closing wedge osteotomy for an undiagnosed case. Int J Surg Case Rep, 2017, 38: 8-12.
5. Talusan PG, Diaz-Collado PJ, Reach JS Jr. Freiberg’s infraction: diagnosis and treatment. Foot Ankle Spec, 2014, 7(1): 52-56.
6. Swanson AB, Biddulph SL, Hagert CG. A silicone rubber implant to supplement the Keller toe arthroplasty. NY Univ Inter Clin Inform Bull, 1971, 10: 7-14.
7. Huskisson EC. Measurement of pain. Lancet, 1974, 2(7889): 1127-1131.
8. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
9. Cerrato RA. Freiberg’s disease. Foot Ankle Clin, 2011, 16(4): 647-658.
10. Ihedioha U, Sinha S, Campbell AC. Surgery for symptomatic Freiberg’s disease: excision arthroplasty in eight patients. Foot, 2003, 13(3): 143-145.
11. Lee HS, Kim YC, Choi JH, et al. Weil and dorsal closing wedge osteotomy for Freiberg’s disease. J Am Podiatr Med Assoc, 2016, 106(2): 100-108.
12. Özkul E, Gem M, Alemdar C, et al. Results of two different surgical techniques in the treatment of advanced-stage Freiberg’s disease. Indian J Orthop, 2016, 50(1): 70-73.
13. Pereira BS, Frada T, Freitas D, et al. Long-term follow-up of dorsal wedge osteotomy for pediatric Freiberg disease. Foot Ankle Int, 2016, 37(1): 90-95.
14. Chao KH, Lee CH, Lin LC. Surgery for symptomatic Freiberg’s disease: extra articular dorsal closing-wedge osteotomy in 13 patients followed for 2-4 years. Acta Orthop Scand, 1999, 70(5): 483-486.
15. Petersen WJ, Lankes JM, Paulsen F, et al. The arterial supply of the lesser metatarsal heads: a vascular injection study in human cadavers. Foot Ankle Int, 2002, 23(6): 491-495.
16. Silva LF, Sousa CV, Rodrigues Pinto R, et al. Preliminary results from the metis-newdeal(®) total metatarsophalangeal prosthesis. Rev Bras Ortop, 2015, 46(2): 200-204.
17. 温建民, 孙卫东, 桑志成, 等. Swanson 人工跖趾关节置换治疗 Freiberg 病近期疗效观察. 中国骨伤, 2009, 11(6): 423-425.
18. Shih AT, Quint RE, Armstrong DG, et al. Treatment of Freiberg's infraction with the titanium hemi-implant. J Am Podiatr Med Assoc, 2004, 94(6): 590-593.
19. Squitieri L, Chung KC. A systematic review of outcomes and complications of vascularized toe joint transfer, silicone arthroplasty, and PyroCarbon arthroplasty for posttraumatic joint reconstruction of the finger. Plast Reconstr Surg, 2008, 121(5): 1697-1707.
20. Shankar NS. Silastic single-stem implants in the treatment of hallux rigidus. Foot Ankle Int, 1995, 16(8): 487-491.
21. Moeckel BH, Sculco TP, Alexiades MM, et al. The double-stemmed silicone-rubber implant for rheumatoid arthritis of the first metatarsophalangeal joint. Long-term results. J Bone Joint Surg (Am), 1992, 74(4): 564-570.
22. Bales JG, Wall LB, Stern PJ. Long-term results of Swanson silicone arthroplasty for proximal interphalangeal joint osteoarthritis. J Hand Surg (Am), 2014, 39(3): 455-461.
23. Sethu A, D’Netto DC, Ramakrishna B. Swanson’s silastic implants in great toes. J Bone Joint Surg (Br), 1980, 62-B(1): 83-85.
24. 朱敏, 冯凡哲. 足踝外科新进展. 中国修复重建外科杂志, 2018, 32(7): 860-865.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison between dorsiflexion osteotomy and implant arthroplasty for advanced Freiberg disease

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