Lesser metatarsophalangeal joint replacement arthroplasty for degenerative joint disease: development in vitro of a new design
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Date
2019
Authors
Saragas, Nikiforos Pandelis
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Abstract
Background
Isolated lesser metatarsophalangeal joint arthritis is often post traumatic or due to Freiberg’s
infraction. The condition is initially treated conservatively with modification of life style, nonsteroidal
anti-inflammatory agents, orthotics and even intra-articular hydrocortisone injections.
When conservative treatment is no longer effective, surgery is considered as the condition can
become very debilitating. This is an in vitro study of a new design replacement arthroplasty.
Methods
A three component joint replacement implant was developed following accurate skeleton
measurements. Fifteen fresh frozen cadaver feet were utilized over a period of four years. The
implant evolved in its design until finally the last four implanted devices were tested for
mobility and stability using custom made equipment. Once the surgical technique was
perfected, a further two devices were implanted by an independent surgeon to establish the
surgical reproducibility. Furthermore, the implant was subjected to dynamic wear and fatigue
testing in the laboratory under various compressive forces.
Results
Cyclical loading for wear and tear under physiological forces showed almost no sign of wear
or surface deformation after 5 million cycles. Range of motion was well within the functional
range and the implant was stable with forces in both dorsiflexion and dorsal displacement
beyond the described forces for disrupting the joint. The surgical technique was found to be
reproducible.
Conclusion
This novel lesser metatarsophalangeal joint replacement arthroplasty has been developed to fill
the void of surgical options in the isolated arthritic lesser metatarsophalangeal joint. This
implant is the basis for clinical trials.
Description
A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, in
fulfilment of the requirements for the degree of Doctor of Philosophy
Johannesburg, 2019
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Citation
Saragas, Nikiforos Pandelis, Lesser metatarsophalangeal joint replacement arthroplasty for degenerative joint disease,University of the Witwatersrand, Johannesburg, <http://hdl.handle.net/10539/29728>