does external fixator improve cheilectomy results?

I found you on the internet and would be most grateful if you would give a comment to help my decision. I am a 37 year old active male with moderate arthritis in the joint below my big toe after an injury playin gbasketball 3years ago. I still have some “joint space” and the cartilage has not completely deteriorated, although the ostephyte at the 1st methed has increased I nsize over a year. My podiatrist recommended a cheilectomy with an external joint fixative device during recovery. My understanding is that the fixative device and letting some bleeding occur into the joint is supposed to create scar tissue that acts like cartilage. Evidently, the use of the external device has only recently been approved but my podiatrist believes that this innovation goes a long way in delaying an eventual joint fusion.Sounded great to me except that two orthopedic surgeons said that there was no evidence that this will improve results. One said that the procedure might buy me a year or two in the degeneration of the joint but that was it. Neither recommended the surgery, they said just treat symptoms until it gets too bad and then consider a fusion.One surgeoen said that the use of these devices and this technique with knees has proven far less effective than originally thought. He said we simply have not found any way to reporduce the appropriate cartilage and everything else just breaks down.My question is about the efficacy of the procedure. Are you familiar with it? Does the use of the external fixitive device which immobilizes and slightly strethces the joint while healing make a big difference?
Is there evidence that this change in the procedure substantively changes the likelihood of returning health to the joint for any length of time? I would be most grateful if you could comment. I understand that you cannot give me a medical opinion without an exam, however if you could give me an opinion about the procedure itself that would be most helpful!

1 Comment found

    Vivian Abrams DPM

    9 10

    I understand your concern regarding the different opinions. This happens frequently with surgeons, since surgery is an art. Surgeons vary with their abilities and training and some are on the cutting edge, others are on the bleeding edge and others yet may be stuck in the past. Unfortunately, I do not have any experience using an external fixator for this procedure. If the joint is not so bad, subchondral drilling seems to work. If the joint is really bad, then the surgeon should discuss arthroplasty with or without a joint replacement or fusion. The external fixator has many uses, such as lengthening bone and fixating where internal fixation is a disadvantage. It is somewhat cumbersome to get around on crutches for a length of time.Can your doctor show you any published studies? Whether or not you fully understand the entire article, usually the conclusion would be understandable. If the studies do not have a number of subjects or the follow up is too brief, it would be difficult to claim this as evidence of success. Thjat being said, every surgery aand every surgeon for that matter owes a debt of gratitude to those who pioneered the procedures that are done now. Someone had to think of the procedure and others had to do them. Failures and successes had to be chronicled and further enhancements or variations suggested. So, in short you should decide what you want to do based on information and faith in your doctor. Good luck.


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