Resources For Surgeons

Resources

Tips for Surgeons

• Indicated for patients with advanced arthritis of the 1st MTP joint associated with good alignment
• Not for Hallux Valgus.
• The sesamoids must be freed up completely. The lateral (fibular) sesamoid tends to be the most adherent. If access is difficult, this can be addressed further once the bone cuts have been made.
• Clear osteophytes and just enough bone medially or dorsally (depending on approach) to allow the jig to lie in a stable position on the bone.
• Try to use bicortical fixation on the jig, with the fixation pins.
• We recommend using X-ray to confirm the jig position.
• Spending time on this part of the operation is important to ensure a reliable outcome.
• Ensure that rotation of the metatarsal component is correct otherwise the metal condyle can be prominent under the skin.
• Once the cuts have been made and the bone removed, re-visit the sesamoids to ensure they are freed up.
• Ensure the phalangeal component is as large as possible for the bone surface but it mustn’t over hang the cortex.
• If you will be using the Large or X-Large component, then the stem is large also. If the component is angled plantarward, it will impinge on the plantar cortex and the cortex may perforate or the component will not sit flush. Ensure the cut surface is perpendicular to the dorsal phalangeal surface.
• Once reaming has been undertaken, the trials should be an easy fit as the definitive implants have additional thickness from the hydroxyapatite coating.
• The meniscus size should match the phalangeal size (use the large meniscus for the  X-Large phalangeal component.
• With the trial meniscus in-situ, there should be at least 2mm of pistoning, but not too loose that the meniscus is unstable. The implants must NOT be put in tight.
• The great toe should dorsiflex to near 90 degrees with the trial prostheses in-situ.
• There are two menisci, the Standard and Anatomical. Always use the Standard unless you need to correct 3 degrees of varus or valgus, where the Anatomical meniscus is used, rotated as required to make the correction.
• When inserting the definitive implants, they should not feel tight until a few millimetres off seating, if they are, remove carefully and ream the bone further.
• Closure needs to be in layers and a secure skin closure is required so that the patient can have confidence to start toe exercises straight after surgery. Adequate pain relief, including a regional local anaesthetic block should be considered to aid the early mobilisation.