kim wrote:
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i had bunion surgery on both feet in 1982 and the right foot is as painful now as it was before surgery. My surgeon now wants to fuse my toe joint leaving me pain free but causing restrictions as to shoes i will be able to wear (e.g. no heel higher than 1 inch )and the difficulties of living/walking with a permanently stiff toe joint.
I have lost the article but I did read of an operation involving a ceramic toe joint for arthritic toes that sounds less disabling afterwards. I will see if that is more suitable for me.
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It would be interesting in knowing the specific features of the bunion deformity (in medical terms) which had been present some 23 years ago, how they were addressed surgically and what procedure was elected.
Quite obviously, you are now troubled by limited and probably painful dorsi-flexion of the great toe. This is generally occasioned by the development of osteoarthritis, which everyone developes to one degree or another as life and the joint wears on. It, in essence, is a wear and tear condition, and if one uses a joint, there will always be wear and tear of the cartilagenous articular surfaces over a lifetime. Those, such as yourself, who sustain wear and tear of the cartilage to the extent that there is either partial or complete bone to bone contact within the joint, then have clinical complaints as do you.
It would be important to know if there were clinical and radiologic indications of osteoarthritis prior to your first procedure, as subsequent development of such arthritis does not necessarily indicate a failure or recurrence of the bunionectomy, but may simply be the result of excessive wear and tear over time. On the other hand, certain bunion correction are notable for jamming the joint, and if such a procedure were initially done, and this issue were not addressed, it could have either caused or speeded-up the development of clinical symptoms of osteoarthritis.
Joint replacement for bunions, though available earlier, became popular in the 70's with the advent of a silastic (a silicon polymer) made by, as I recall, DOW, and formed into a hemi-joint prosthesis developed by a Dr. Swanson. It was know, curiously enough, as the Swanson Great Toe Hemi-Implant. After appropriate consideration and correction of any excessive metatarsus primus varus, if required, an essentially Keller-like first MPJ arthroplasty was performed (resection of the base proximal phalanx of the great toe). Then the stump of the proximal phalanx was reamed for subsequent insertion of a stemmed implant to replace the the portion of the great toe just removed. Generally, there was no real attempt to secure the implant, as normal joint pressure and subsequent scarring would maintain its position. Some of these type joints replacements, though they look good post-surgically and they held up for a fair amount of time, tended to not uncommonly break down, some showing resorption or fragmentation of the prosthesis and/or bony overgrowth, and they fell out of disfavor after having been used for a number of years. There were also the hinged silastic joints, which required that both the base of the great toe and the head of the first metataral be resected and stems placed in both bones . . . with flexible joint between them for dorsiflexion of the great toe. Further development of joint prostheses for bunions included the two-part prosthesis, where instead of a hinge, there were two separate and distinct parts . . a portion to replace the head of the metatarsal and a portion to replace the base of the great toe. Materials, in addition to silicon polymers include cobalt-chrome and titanium alloys, and more recently, ceramics.
I have not used the ceramic implants to which you refer, and after a less than glorious experience years ago with other joint implants, I have generally felt that, for the majority of the patients whom I have seen and who might require such a procedure, more often than not, the old Keller procedure is far simpler and generally just as or more satisfactory for its purpose. I realize that there will be those surgeons who may disagree with this, but those have been MY conclusions.
I really don't know if it makes any difference whether the material is ceramic or something else as far as the degree of post-operative disability is concerned.
kim wrote:
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i had bunion surgery on both feet in 1982 and the right foot is as painful now as it was before surgery. My surgeon now wants to fuse my toe joint leaving me pain free but causing restrictions as to shoes i will be able to wear (e.g. no heel higher than 1 inch )and the difficulties of living/walking with a permanently stiff toe joint.
I have lost the article but I did read of an operation involving a ceramic toe joint for arthritic toes that sounds less disabling afterwards. I will see if that is more suitable for me. |
