Hammer Toe Correction Comparative Study


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Hammer Toe Correction Comparative Study

  1. 1. Hammertoe Deformity Treatments:  A Retrospective Comparative Study<br /><ul><li>Authors: Wenjay Sung, DPM,Lowell Weil, Jr., DPM, and Lowell Scott Weil, Sr., DPM.</li></li></ul><li>Disclosures<br />My disclosure is in the Final AOFAS Program Book.<br />I have no potential conflicts with this presentation.<br />LSW is a consultant for Wright Medical Technologies and receives royalties from the Weil Hammertoe Implant.<br />LWJ is a consultant for Wright Medical Technologies <br />
  2. 2. Purpose<br />To compare the long-term outcomes of second hammertoe deformities that underwent proximal interphalangeal (PIP) joint correction using arthroplasty, arthrodesis or interpositional implant arthroplasty. <br />Retrospective Comparative Study<br />EBM Level of evidence: III (Therapeutic)<br />
  3. 3. Purpose<br />Background<br />Indications for surgical correction of hammertoe8<br />Pain <br />Pressure over the dorsal aspect of the PIP joint <br />Deformity<br />There are many reports regarding the outcomes of PIP joint implant arthroplasty1-3, PIP arthrodesis4-6, and PIP arthroplasty7.<br />However there are no studies that compare the outcomes of all three with significant follow-up. <br />
  4. 4. Methods<br />We retrospectively reviewed medical records of patients who underwent second PIP joint deformity correction between January 1998 to December 2008. <br />A total of 114 patients (136 cases) were included in the study with at least 12 months of follow-up.<br />Assessment<br />Visual analog pain scale (VAS)<br />Anterior-posterior (AP) and lateral (LAT) radiographic views were evaluated<br />Second PIP joint angles was measured onsagittal and transverse planes<br />
  5. 5. Methods<br />Separated into three treatment groups<br />Arthroplasty<br />Arthrodesis<br />Implant<br />
  6. 6. Methods<br />Transverse<br />Pre-operative<br />Post-operative<br />Sagittal<br />Pre-operative<br />Post-operative<br />
  7. 7. Statistical Analysis<br />All statistical analysis were performed with SPSS version 14.0 (SPSS Science Inc, Chicago, Ill). <br />We used a two-way repeated measures analysis of variance (ANOVA). Inferential statistics included paired two-tailed t tests for continuous variables. <br />The a priori α level was .05 for all statistical tests.<br />
  8. 8. Results<br />Demographics & Revisions<br />Arthroplasty<br />Average follow-up of 45.3 months<br />39 patients/ 45 cases with an average age of 62.7<br />Seventeen (37.8%) cases elected revision surgery.<br />Implant<br />Average follow-up of 67.4 months<br />41 patients/ 48 cases with an average age of 67.4<br />Four (10.4%) cases elected revision surgery.<br />Arthrodesis<br />Average follow-up of 47.8 months<br />34 patients/ 43 cases with an average age of 55.5 <br />Six (14.6%) cases elected revision surgery.<br />
  9. 9.
  10. 10. Discussion<br />Our study demonstrates that all three techniques <br />Significantly improves pain<br />Significantly corrects in the sagittal plane (LAT).<br />However, only the implant group significantly corrected the deformity in the transverse plane (AP).<br />Moreover, surgical revisions were lowest in this group. <br />There are many studies that demonstrate good results of different techniques1-7, however, this study is the first to compare the results of three popular hammertoe treatments with long-term follow-up. <br />
  11. 11. Discussion<br />Strength<br />Comparative study<br />Statistical analysis<br />Follow-up<br />Weakness<br />Observer bias <br />Variability in patient selection. <br />Underpowered to determine variance <br />
  12. 12. Conclusions<br />In conclusion, our study confirms that all three techniques provide adequate pain relief and sagittal plane correction. <br />However, interpositional implant arthroplasty provides significant correction in the transverse plane with less chance for revision surgery.<br />
  13. 13. References<br />Sollitto RJ et al. A preliminary report on the status of implants for the lesser toes. J Foot Surg. 1985 Nov-Dec: 24 (6): 435-6<br />Sgarlato TE. Digital implant arthroplasty. ClinPodiatr Med Surg 1996 Apr;13(2):255-62.<br />Mednick DL et al. Comparison of total hinged and total nonhinged implants for the lesser digits. J Foot Surg. 1985 May-Jun;24(3):215-8.<br />Edwards WH et al. Interphalangeal joint arthrodesis of the lesser toes. Foot Ankle Clin. 2002 Mar;7(1):43-8.<br />Ohm OW et al. Digital arthrodesis: an alternate method for correction of hammer toe deformity. J Foot Surg 1990 May-Jun;29(3):207-11.<br />Co AY et al. Radiographic analysis of transverse plane digital alignment after surgical repair of the second metatarsophalangeal joint. J Foot Ankle Surg. 2006 Nov-Dec;45(6):380-99.<br />Rice JR. Digital arthroplasty by power surgery with minimal incision. J Am Podiatry Assoc. 1977 Nov;67(11):811-4.<br />Coughlin MJ. Lesser toe abnormalities. Instr Course Lect. 2003;52:421-44.<br />