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The use of polyvinyl alcohol hydrogel implants in the lesser metatarsal heads. Is it safely doable? A cadaveric study.

Publication ,  Journal Article
de Cesar Netto, C; Godoy-Santos, AL; Cabe, TN; Roberts, LE; Harnroongroj, T; Deland, J; Drakos, M
Published in: Foot Ankle Surg
February 2020

BACKGROUND: The use of synthetic polyvinyl alcohol hydrogel (PVAH) implants for treatment of lesser toe metatarsophalangeal joint (MTPJ) arthritis is promising and currently limited by the size of implants available. The primary objective of this cadaveric study was to investigate the maximum drilling size and largest PVAH implant dimension that could be safely introduced while still preserving an intact bone rim of the lesser metatarsal heads. METHODS: Height and width of all lesser metatarsals were measured on CT and during anatomic dissection. Sequential reaming of the second to fourth metatarsals was performed. Maximum reaming size, largest implant inserted, and failure of the metatarsal head were recorded. Metatarsal head sizes were compared and a multiple regression analysis evaluated measurements that influenced maximum drilling and implant size. RESULTS: CT and anatomical measurements demonstrated significant correlation (ICC range, 0.-0.85). Mean values for height and width of the metatarsal heads were respectively: second (14.9 mm and 9.9 mm), third (14.8 mm and 8.8 mm), fourth (14.0 mm and 8.7 mm) and fifth (12.3 mm and 9.3 mm). All the second, third and fourth metatarsal heads could be safely drilled up to 7.5 mm, preserving an intact bone rim. At 80% of the time, the heads could be safely drilled up to 8.0 mm. Height of the metatarsal heads was the only factor to significantly influence the size of maximum reaming and implant introduced. In respectively 20%, 40% and 50% of the second, third, and fourth metatarsal heads, neither 8 mm nor 10 mm PVAH implants could be used. CONCLUSIONS: Our cadaveric study found that the even though the majority of the lesser metatarsal heads could be safely drilled up to 8 mm, the smallest PVAH implant size currently available in most countries (8 mm) could be inserted in most of the second, but only in about half of the third and fourth metatarsal heads. The remaining bone rim around inserted implants was considerably thin, usually measuring less than 1 mm. In order to optimize the use PVAH in lesser metatarsal heads, smaller implant options are needed.

Duke Scholars

Published In

Foot Ankle Surg

DOI

EISSN

1460-9584

Publication Date

February 2020

Volume

26

Issue

2

Start / End Page

128 / 137

Location

France

Related Subject Headings

  • Tomography, X-Ray Computed
  • Prostheses and Implants
  • Polyvinyl Alcohol
  • Orthopedics
  • Middle Aged
  • Metatarsophalangeal Joint
  • Male
  • Humans
  • Female
  • Cadaver
 

Citation

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de Cesar Netto, C., Godoy-Santos, A. L., Cabe, T. N., Roberts, L. E., Harnroongroj, T., Deland, J., & Drakos, M. (2020). The use of polyvinyl alcohol hydrogel implants in the lesser metatarsal heads. Is it safely doable? A cadaveric study. Foot Ankle Surg, 26(2), 128–137. https://doi.org/10.1016/j.fas.2018.12.009
Cesar Netto, Cesar de, Alexandre Leme Godoy-Santos, Taylor N. Cabe, Lauren E. Roberts, Thos Harnroongroj, Jonathan Deland, and Mark Drakos. “The use of polyvinyl alcohol hydrogel implants in the lesser metatarsal heads. Is it safely doable? A cadaveric study.Foot Ankle Surg 26, no. 2 (February 2020): 128–37. https://doi.org/10.1016/j.fas.2018.12.009.
de Cesar Netto C, Godoy-Santos AL, Cabe TN, Roberts LE, Harnroongroj T, Deland J, et al. The use of polyvinyl alcohol hydrogel implants in the lesser metatarsal heads. Is it safely doable? A cadaveric study. Foot Ankle Surg. 2020 Feb;26(2):128–37.
de Cesar Netto, Cesar, et al. “The use of polyvinyl alcohol hydrogel implants in the lesser metatarsal heads. Is it safely doable? A cadaveric study.Foot Ankle Surg, vol. 26, no. 2, Feb. 2020, pp. 128–37. Pubmed, doi:10.1016/j.fas.2018.12.009.
de Cesar Netto C, Godoy-Santos AL, Cabe TN, Roberts LE, Harnroongroj T, Deland J, Drakos M. The use of polyvinyl alcohol hydrogel implants in the lesser metatarsal heads. Is it safely doable? A cadaveric study. Foot Ankle Surg. 2020 Feb;26(2):128–137.
Journal cover image

Published In

Foot Ankle Surg

DOI

EISSN

1460-9584

Publication Date

February 2020

Volume

26

Issue

2

Start / End Page

128 / 137

Location

France

Related Subject Headings

  • Tomography, X-Ray Computed
  • Prostheses and Implants
  • Polyvinyl Alcohol
  • Orthopedics
  • Middle Aged
  • Metatarsophalangeal Joint
  • Male
  • Humans
  • Female
  • Cadaver