USE OF TITANIUM GROMMETS IN SILICONE IMPLANT ARTHROPLASTY OF THE HALLUX METATARSOPHALANGEAL JOINT

Double-stem silicone implants protected by titanium grommets were plac ed in the hallux metatarsophalangeal joints of 32 patients (47 feet). All patients had a painful destroyed joint and most were women. Three patients (six feet) were lost to follow-up. Nineteen patients had a di agnosis of rheumatoid arthritis (25 feet) and 10 had degenerative join t disease (16 feet). The average age for the group was 57 years and th e average follow-up was 51 months (range, 34-76 months). Twenty patien ts (30 feet) were completely satisfied with their result. Eight patien ts (10 feet), all with rheumatoid arthritis, had some minor postoperat ive complaints, usually involving the lateral toes. Two patients (thre e feet) in this group had no pain, but would have preferred more hallu x motion. One patient with rheumatoid arthritis (one foot) had a poor result due to implant removal for deep sepsis. Radiographic analysis o f these patients showed no evidence of implant fracture and the implan t composite appeared to be well tolerated by the surrounding bone in w hich it was placed. When compared with another, similar group of patie nts in whom grommets were not used, this implant appeared to be much m ore stable, as there was significantly less evidence of radiolucency s een around those implants protected by the grommets. It appears that t he titanium grommets may protect the silicone implant and may help pro vide a longer life for the silicone implant.