A Novel Surgical Approach to Hallux Rigidus with Dehydrated Human Umbilical Cord Allograft

Adam Bryniczka, DPM:
I'm Adam Bryniczka, Doctor of Podiatric Medicine, Fellow of American College of Foot and Ankle Surgeons. I'm in private practice with Northwest Podiatry Centers, it's in basically the suburbs of the Chicagoland area.

William Tettlebach, MD:
Yeah, so I'm Bill Tettlebach. I am currently the Executive Medical Director for HCA Healthcare in the Mountain Division.

Adam Bryniczka, DPM:
It's an interesting topic for podiatry in regards to an arthritic first metatarsal-phalangeal joint, or what we like to call, "hallux limitus/rigidis." And basically, through my years of seeing this pathology and trying to maneuver what I believe is best for my patients, and doing numerous conservative treatments, and then also getting into the surgical world of how to address persistent pain when the conservative measures don't fit the patient's needs, I wanted to try to do something that would help decompress the joint, and allow better motion, function, and then hopefully reduce the pain.

So what I started doing was, for certain patients that have that metatarsus elevatus, or the hypermobile first ray, and patients that failed conservative treatment, I decided to do something what's called a, "Lapidus fusion," which is a fusion of the first metatarsal cuneiform joint. And basically, the idea with that is to plantar flex the first ray and shorten the first ray. And I believe by doing that, as well as with a cheilectomy to remove the dorsal exostosises, it helps improve the lever arm of the first metatarsal-phalangeal joint of the flexor tendons, as well as the plantar fascia, and help result with some good range of motion.

So I was doing those types of procedures, seeing some success with it. However though, it always bothered me that there was not something else that I could do to improve the capsule of the first metatarsal-phalangeal joint, and got me thinking is, besides just fenestrating and promoting fiber cartilage within the first metatarsal head, I decided that there's got to be something else that I can do.
So I chose to use AmnioCord, and the reason why is I like the properties that it persists, as well is the integrity of the product itself. And basically, what I started doing was using this AmnioCord and parachuting it around the whole first metatarsal, as well as in between the sesamoid apparatus and the plantar aspect of the first metatarsal head, to help with the healing cascade.

William Tettlebach, MD:
What was interesting that Adam had decided to use the AmnioCord, which is a placental-derived allograft. It has over 250 regulatory proteins, both stimulatory in nature and anti-inflammatory. The results he was seeing in the sense that better outcomes, so some of his metrics were improved range of motion and decreased pain, and so that was a combination of everything that he was doing. But these patients were benefiting initially from his choice to integrate this into his procedure. And so, we heard of this and decided that we should try to move this along and actually introduce this to more of his patients. And so, that has had the effect that we now have the abstract that he presented, and poster, which will lead to actually further research looking at this down the line.

Adam Bryniczka, DPM:
Basically, the patients were very happy with the overall outcomes of the procedure with no pain, as well as the range of motion they were very happy with, which helped with their biomechanics and through the gait cycle and doing the everyday activities that they wish to do. So in my follow-ups, clinically as well as on X-ray examination, showed an increase in the joint space of the first metatarsal phalangeal joint, as well as reduced subchondral sclerosis, as well as the progression of cartilage damage in my follow-ups. On average, the fusion for the first metatarsal cuneiform joint is six months, and I usually follow them out for one year since the time of the surgery.

William Tettlebach, MD:
We've been working together on that and we plan a much larger cohort, so we've, I think, already garnered over 24 patients, we will probably double that, and we will then get this published. And then, once it gets published, then we can have discussions at podiatric conferences or podiatry conferences where this technique can be further disseminated.