野尻 翔

INTRODUCTION: Hallux hyperdorsiflexion and stiffness are typically associated with hallux rigidus. Although the underlying cause remains unclear, this case appears to have arisen in a patient undergoing treatment for schizophrenia, highlighting the importance of individualized and carefully tailored treatment approaches to achieve optimal patient outcomes and maintain high-quality care. CASE REPORT: A 71-year-old Asian woman undergoing treatment for schizophrenia presented with severe hyperdorsiflexion and stiffness of the right hallux, causing intense pain, which was particularly noticeable during gait and daily activities. Initially, the patient underwent rehabilitation to restore normal active motion of the right extensor hallucis longus (EHL). However, despite continuous rehabilitation, the stiffness persisted. Consequently, the patient underwent surgery involving dissection, lengthening of the distal EHL, and partial transposition of the proximal EHL. Postoperatively, the patient regained active hallux movement and showed significantly improved gait. CONCLUSION: Surgical treatment should be considered as an alternative option if symptoms persist for long in patients with hallux hyperdorsiflexion and stiffness. However, this approach is technically demanding and requires careful consideration of the strategy for successful recovery and optimal patient outcomes.

BACKGROUND: In total knee arthroplasty (TKA), cementless fixation is initially weaker than cement fixation. This study aimed to examine whether filling the tibial peg holes with bone improves initial fixation strength in cementless TKA. METHODS: This prospective, comparative study examined 88 joints in 66 patients randomized to the bone filling (48 joints) or conventional group (no bone filling; 40 joints). All patients underwent TKA with the NexGen® trabecular metal modular tibial component. In the bone filling group, resected cancellous bone was filled into the peg holes before insertion of the tibial component. We performed clinical and plain radiographic evaluations after the operation and measured bone mineral density (BMD) at five sites below the component at 1, 3, 6, and 12 months postoperatively. RESULTS: Operative time and clinical evaluations were not significantly different. Plain radiography showed significant longitudinal thickening of the trabecula below the peg (P<0.05) and decreased occurrence of reactive lines (P=0.07) in the bone filling group compared with the conventional group. BMD was significantly higher in the bone filling group in the medial region below the peg at 1, 3, and 6 months and in the central region at 1 and 3 months (all P<0.05). CONCLUSIONS: When using the NexGen trabecular metal modular tibial component, concurrent peg hole bone filling increases the initial component fixation strength. Possible effects on long-term stabilization warrant further study.