Management of failed and infected first metatarsophalangeal joint implant arthroplasty by reconstruction with an acellular dermal matrix: a case report.

Management of failed first metatarsophalangeal joint implant arthroplasty, especially in the face of infection, is an area of debate without a clear consensus. The purpose of the present report was to explore a new option of reconstructing the joint with an acellular dermal matrix substance in a single case study during a 12-month follow-up period. A staged approach that began with removal of the failed 2-component great toe implant, Koenig(®), excisional debridement of the wound with resection of the necrotic bone (proximal phalanx and distal portion of the first metatarsal bones), and culture-specific antibiosis therapy. The final stage included incorporating the acellular dermal matrix, Graftjacket(®) into the joint in an accordion-type fashion, and reconstruction of the joint capsule. Postoperative radiographs revealed a more rectus joint with some improvement in length. At 6 months postoperatively, magnetic resonance imaging revealed incorporation of the graft material into the joint. Finally, at the 1-year mark, the patient was pain free with satisfactory function at the first metatarsophalangeal joint during gait. This is the first reported case of salvaging failed and infected first metatarsophalangeal joint implant arthroplasty with incorporation of the acellular dermal matrix and provides a new option to consider in the future.

[1]  S. D. Middleton,et al.  Hemiarthroplasty augmented with bone graft for the failed hallux metatarsophalangeal Silastic® implant. , 2011, Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons.

[2]  Christopher F. Hyer,et al.  Hallux rigidus: what lies beyond fusion, resectional arthroplasty, and implants. , 2011, Clinics in podiatric medicine and surgery.

[3]  P. Stone,et al.  Late hematogenous infection of first metatarsophalangeal joint replacement: a case presentation. , 2010, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[4]  Stephen A. Brigido,et al.  Biologic resurfacing of the ankle and first metatarsophalangeal joint: case studies with a 2-year follow-up. , 2009, Clinics in podiatric medicine and surgery.

[5]  A. Landsman,et al.  Extracellular matrix biomaterials for soft tissue repair. , 2009, Clinics in podiatric medicine and surgery.

[6]  P. Stone,et al.  First metatarsal head osteoarticular transfer system for salvage of a failed hemicap-implant: a case report. , 2009, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[7]  J. Pournaras,et al.  Interposition arthroplasty of the first metatarsophalangeal joint with a fascia lata allograft. , 2008, Journal of the American Podiatric Medical Association.

[8]  M. O'Malley,et al.  Failed first metatarsophalangeal arthroplasty salvaged by hamstring interposition arthroplasty: metallic debris from grommets. , 2008, American journal of orthopedics.

[9]  Christopher F. Hyer,et al.  Interpositional Arthroplasty of the First MTP Joint Using a Regenerative Tissue Matrix for the Treatment of Advanced Hallux Rigidus , 2008, Foot & ankle international.

[10]  G. Dereymaeker,et al.  Revision of Failed Keller Arthroplasty With Intercalary Bone Graft , 2007 .

[11]  Christopher F. Hyer,et al.  A Soft-Tissue Interpositional Arthroplasty Technique of the First Metatarsophalangeal Joint for the Treatment of Advanced Hallux Rigidus Using a Human Acellular Dermal Regenerative Tissue Matrix , 2006 .

[12]  George P McCabe,et al.  Extracellular matrix bioscaffolds for orthopaedic applications. A comparative histologic study. , 2006, The Journal of bone and joint surgery. American volume.

[13]  A. Landsman,et al.  Distally based capsule-periosteum interpositional arthroplasty for hallux rigidus. Indications, operative technique, and short-term follow-up. , 2003, Journal of the American Podiatric Medical Association.

[14]  S. Kravitz,et al.  Diagnosis and treatment of First Metatarsophalangeal Joint Disorders. Section 6: Other disorders ☆ ☆☆ , 2003 .

[15]  S. Kravitz,et al.  Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 1: Hallux valgus. , 2003, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[16]  J. Grady,et al.  A retrospective analysis of 772 patients with hallux limitus. , 2002, Journal of the American Podiatric Medical Association.

[17]  J. Brodsky,et al.  Salvage First MTP Arthrodesis Utilizing ICBG: Clinical Evaluation and Outcome , 2000, Foot & ankle international.

[18]  P. Hecht,et al.  Arthrodesis of the First Metatarsophalangeal Joint to Salvage Failed Silicone Implant Arthroplasty , 1997, Foot & ankle international.

[19]  L. Horwitz,et al.  The Biomet Total Toe System utilizing the Koenig score: a five-year review. , 1996, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[20]  E. Chao,et al.  Salvage of Failed First Metatarsophalangeal Joint Implant Arthroplasty by Implant Removal and Synovectomy: Clinical and Biomechanical Evaluation* , 1992, Foot & ankle.

[21]  Koenig Rd.  Koenig total great toe implant. Preliminary report , 1990 .