|
1
|
Anastasio AT, Wixted C, Nunley JA. Interpositional Arthroplasty for Hallux Rigidus: Surgical Technique and Outcomes Discussion. Foot Ankle Clin 2024; 29:443-454. [PMID: 39068020 DOI: 10.1016/j.fcl.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Interpositional arthroplasty for the treatment of hallux rigidus (HR) involves resection of the diseased joint surface and placement of spacer material within the joint to preserve length at the metatarsophalangeal joint while still allowing for range of motion. The majority of studies available in the literature have focused on capsular interpositional arthroplasty, revealing generally positive outcomes. Other forms of interpositional arthroplasty are less supported by long-term follow-up and large sample sizes. Moreover, there exists substantial heterogeneity in the studies evaluating interpositional arthroplasty. Despite the limitations of the current data, interpositional arthroplasty seems to be a viable treatment option for HR.
Collapse
Affiliation(s)
- Albert T Anastasio
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Duke University, 200 Trent Drive, Durham, NC 27710, USA
| | - Colleen Wixted
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Duke University, 200 Trent Drive, Durham, NC 27710, USA.
| | - James A Nunley
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Duke University, 200 Trent Drive, Durham, NC 27710, USA
| |
Collapse
|
|
2
|
Noble DM, Sumpter A, Small B, Ruland JR, Cooper MT, Park JS, Perumal V. Clinical, Radiographic, and Patient-Reported Outcomes of First Metatarsophalangeal Interposition Arthrodesis Using Porous Titanium Wedges. Foot Ankle Spec 2023:19386400231218337. [PMID: 38130108 DOI: 10.1177/19386400231218337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND First metatarsophalangeal (MTP) arthrodesis is a common surgical procedure for addressing hallux MTP pathology. In the setting of revision procedures with significant bone loss, porous titanium wedges may provide an alternative to structural bone autograft or allograft. OBJECTIVE The purpose of this study is to report the clinical and radiographic outcomes achieved in first MTP interposition arthrodesis using porous titanium wedges. METHODS A retrospective analysis of 9 patients with a mean age 65.4 years (45-82 years) who underwent first MTP interposition arthrodesis with the use of porous titanium wedges from February 2014 to September 2017 was performed. Outcomes were assessed using both plain-film radiographs and computed tomography (CT) scans, as well as patient-reported outcome measures, including Foot and Ankle Ability Measure (FAAM) (Sports and Activities of Daily Living), pain Visual Analogue Scale (VAS), and 36-Item Short Form Survey (SF-36). Average follow-up time was 34.2 months (14-72 months). RESULTS At final follow-up, the average FAAM score was 91.1 ± 14.7 (75.1 ± 5.3 FAAM Activities of Daily Living; 17.9 ± 9.9 FAAM Sports). Average pain VAS score was 1.9 ± 1.7. Postoperative computed tomography (CT) imaging was obtained for 5 patients, all of which demonstrated good bony apposition or osseous integration of the wedge. Four patients underwent subsequent surgical procedures, including 3 isolated dorsal fixation revisions, and 1 complete MTP arthrodesis revision. CONCLUSION To our knowledge, this study represents the first reported clinical and radiographic outcomes in patients undergoing first MTP interposition arthrodesis with use of porous titanium wedges. While we found this technique to be a viable alternative to bone grafting for this difficult problem, further research should focus on comparative data with other commonly performed operative techniques. LEVEL OF EVIDENCE Level IV: Case series.
Collapse
Affiliation(s)
- David M Noble
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Anna Sumpter
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Benjamin Small
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Jeffrey R Ruland
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - M Truitt Cooper
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Joseph S Park
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Venkat Perumal
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
|
3
|
Di Caprio F, Mosca M, Ceccarelli F, Caravelli S, Di Ponte M, Zaffagnini S, Ponziani L. Interposition Arthroplasty in the Treatment of End-Stage Hallux Rigidus: A Systematic Review. Foot Ankle Spec 2023; 16:547-557. [PMID: 34724832 DOI: 10.1177/19386400211053947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Patients affected by moderate to severe hallux rigidus may opt for interposition arthroplasty to avoid the movement restrictions of arthrodesis and the complications related to prosthetic replacement. The propose of this article was to review the current literature about interposition arthroplasty to examine the overall outcomes and to evaluate the advantages and disadvantages of different types of technique, compared with more consolidated procedures. METHODS A literature PubMed search was performed. Studies reporting the results of interposition arthroplasty in moderate to severe hallux rigidus were included. The data were pooled and weighted for number of patients in every study. RESULTS The overall results for interposition arthroplasties are comparable to other alternatives for end-stage hallux rigidus, providing better plantar load distribution than arthrodesis and avoiding the drawbacks of prosthetic replacement. Among the various interposition arthroplasty techniques, the Modified Oblique Keller Capsular Interposition Arthroplasty technique preserves toe length and flexor hallucis brevis function, showing the highest satisfaction rate, with lowest metatarsalgia and revision rate. CONCLUSION Although long-term randomized controlled trials are lacking for interposition arthroplasty, it represents a valid alternative for the treatment of end-stage hallux rigidus also in the young active patient who wants to avoid a definitive intervention immediately. LEVEL OF EVIDENCE III (systematic review of level III-IV-V studies).
Collapse
Affiliation(s)
| | - Massimiliano Mosca
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | | | - Silvio Caravelli
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Marco Di Ponte
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Stefano Zaffagnini
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Lorenzo Ponziani
- Operating Unit of Orthopaedics and Traumatology, ISS, Cailungo, San Marino
| |
Collapse
|
|
4
|
Georgiannos D, Lampridis V, Kazamias K, Kitridis D, Bisbinas I, Badekas A. Converting 1st metatarsophalangeal joint fusion to interposition arthroplasty. Mid-term results of a case series. Foot (Edinb) 2023; 56:102029. [PMID: 37001345 DOI: 10.1016/j.foot.2023.102029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Fusion of the first metatarsophalangeal (MTP) joint has been considered as the gold standard for treatment of advanced hallux rigidus. The main disadvantage is the restriction of movement which may not be as favorable as anticipated by several patients. The purpose of this study was to report clinical and functional outcomes on patients who were treated with interposition arthroplasty after a 1st MTP joint fusion which had not fulfilled their expectations. METHODS Between 2009 and 2014, 11 patients who were not satisfied by 1st MTP joint fusion for hallux rigidus, underwent a conversion to interposition arthroplasty. After removal of hardware, the fusion was taken down by removal of a bone block from the fused joint. A fascia lata graft was interposed. Intraoperative and postoperative complications, range of motion of the first MTP joint, length of first ray, and patients' satisfaction were recorded as the primary outcomes. RESULTS Mean age was 34 years (range, 24-42 y). The mean ± SD AOFAS/H/MTP/IP score was 61 ± 5.5 preoperatively, 90.5 ± 4.5 at one year and 92 ± 4 at five years postoperatively (p < 0.001). The mean ± SD VAS-FA score was 91 ± 3.5 preoperatively, 94.5 ± 2.5 at one year and 95 ± 2.5 at five years postoperatively (p > 0.05). Mean ROM at the final follow-up was 58° ± 5° of dorsiflexion and 27° ± 4° of plantarflexion. No inter- or postoperative complications were encountered. The length of the hallux was decreased by a mean of 1.5 mm (range, 1-2.5 mm). All patients were satisfied with the overall outcome, walking ability and shoe-wear convenience and graded their condition as excellent (9 cases) or good (2 cases). CONCLUSIONS Converting a 1st MTP joint fusion to interposition arthroplasty with a fascia lata allograft could be a safe alternative with promising results in selected cases especially in relatively young and athletic population. LEVEL OF EVIDENCE Level IV retrospective case series.
Collapse
Affiliation(s)
| | - Vasileios Lampridis
- 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Greece
| | | | - Dimitrios Kitridis
- 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Greece
| | - Ilias Bisbinas
- 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Greece
| | | |
Collapse
|
|
5
|
Colò G, Fusini F, Alessio-Mazzola M, Samaila EM, Formica M, Magnan B. Interposition arthroplasty with bovine collagenous membrane for hallux rigidus: A long-term results retrospective study. Foot Ankle Surg 2022; 28:1473-1478. [PMID: 36117005 DOI: 10.1016/j.fas.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/27/2022] [Accepted: 08/31/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux rigidus (HR) is a degenerative arthritis of the first metatarsophalangeal joint (MTP1) with progressive loss of range of movement (ROM). Interposition arthroplasty (IA) is a technique widely used for the treatment of HR;however, few studies reported long-term clinical results. This study aims to report the clinical results of IA using a bovine pericardium collagen matrix for HR with a minimum 10-years follow-up. METHODS Thirty patients (31 feet) who underwent IA using a bovine pericardium collagen matrix from 2001 to 2009 were retrospectively evaluated with a mean follow up of 154.1 ± 28.6 (range 124-218) months. All HR ranged from grade II to grade III, according to Regnauld classification. All patients were clinically assessed with the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal- Interphalangeal Scale, a pain Visual Analog Scale, and the Foot and Ankle Disability Index. Scores before and after treatment, respectively achieved from clinical records and clinical evaluation at final follow-up were compared. RESULTS At final follow-up, an improvement of all the considered scores (p < 0.01) was recorded. The overall rate of unsatisfying results was 16.1 %. Two (6.4 %) patients complained discomfort due to first ray shortening and 3 (9.7 %) cases of persistent metatarsal pain. There was one (3.2 %) case of Complex Regional Pain Syndrome (CPRS). No revision surgeries, infection, or other adverse events were reported. CONCLUSION Interposition arthroplasty using bovine collagenous membrane is a reliable solution for high-grade HR with durable results over 10 years in more than 80 % of patients.
Collapse
Affiliation(s)
- Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy.
| | - Federico Fusini
- Department of Orthopaedics and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Via S. Rocchetto, 99, 12084 Mondovì, CN, Italy.
| | - Mattia Alessio-Mazzola
- IRCCS San Raffaele Hospital Orthopaedic and Trauma Unit Via Olgettina 60, 20132, Milan, Italy..
| | - Elena Manuela Samaila
- Department of Orthopedics and Trauma Surgery, University of Verona, Surgical Center "P. Confortini", P.le A. Stefani, 1, 37126 Verona, VR, Italy.
| | - Matteo Formica
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), University of Genoa, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Bruno Magnan
- Department of Orthopedics and Trauma Surgery, University of Verona, Surgical Center "P. Confortini", P.le A. Stefani, 1, 37126 Verona, VR, Italy.
| |
Collapse
|
|
6
|
Artioli E, Mazzotti A, Zielli S, Bonelli S, Arceri A, Geraci G, Faldini C. Keller's arthroplasty for hallux rigidus: A systematic review. Foot Ankle Surg 2022; 28:526-533. [PMID: 35279396 DOI: 10.1016/j.fas.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/25/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several surgical procedures have been described to treat hallux rigidus. Keller arthroplasty is a joint-sacrificing procedure proposed in 1904. Considering the current trends to mini-invasiveness and the debate about the technique's suitability, this review intends to state Keller arthroplasty results and the conditions where it could be still adopted in the treatment of hallux rigidus. METHODS Selected articles were reviewed to extract: population data, surgical indications, different surgical techniques, clinical and radiological outcomes, and complications. RESULTS Seventeen retrospective studies were selected, counting 508 patients. Mean age at surgery was 55 years. Patients were affected by moderate-severe hallux rigidus. Three modified Keller arthroplasty were identified. Good clinical and radiological outcomes were reported. Metatarsalgia was the most frequent complication (12%). CONCLUSION Despite for many authors KA seems a viable surgical treatment for middle aged and elderly patients affected by moderate-severe hallux rigidus, the available literature provides little evidence on the real efficacy and safety of the technique. A non-negligible percentage of complications may occur, and therefore is essential to set correct indications through an accurate patients' selection.
Collapse
Affiliation(s)
- E Artioli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - A Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy.
| | - S Zielli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - S Bonelli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - A Arceri
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - G Geraci
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - C Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedic and Traumatologic Clinic, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
| |
Collapse
|
|
7
|
Butler JJ, Shimozono Y, Gianakos AL, Kennedy JG. Interpositional Arthroplasty in the Treatment of Hallux Rigidus: A Systematic Review. J Foot Ankle Surg 2022; 61:657-662. [PMID: 35033445 DOI: 10.1053/j.jfas.2021.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/15/2020] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
Hallux rigidus is the most common arthritic condition of the foot. Interpositional arthroplasty (IPA) is indicated for advanced-stage hallux rigidus and attempts to maintain joint motion through insertion of a biologic spacer into the joint. However, the data evaluating the effectiveness of IPA are limited. The purpose of this study was to systematically review the outcomes of IPA in the treatment of hallux rigidus. MEDLINE, EMBASE, and Cochrane Library databases were systematically reviewed based on the preferred reporting items for systematic reviews and meta-analyses guidelines. Outcomes collected and analyzed included: American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (HMI) score, visual analogue scale score, short-form 36 score, range of motion (ROM), radiographic parameters, and postoperative complications. The level and quality of clinical evidence were recorded and assessed. Sixteen studies with a total of 428 patients met inclusion/exclusion criteria. The mean AOFAS-HMI score improved from 51.6 ± 10.1 (range 35.0-64.2) preoperatively to 86.0 ± 7.7 (range 71.6-95.4) postoperatively (p ≤ .001) at weighted mean follow-up of 58.0 ± 34.5 (range 16.5-135.6) months. The preoperative weighted mean total ROM was 39.3° ± 9.6° (range 24.2-49.9) and the postoperative weighted mean total ROM was 61.5° ± 4.8° (range 54.0-66.5) (p ≤ .001). The complication rate was 21.5% with metatarsalgia as the most commonly reported complication. One study was level 3 and 15 studies were level 4 clinical evidence. This systematic review demonstrates improvement in functional and ROM outcomes following IPA procedure at mid-term follow-up. The procedure however has a moderate complication rate. In addition, there is a low level and quality of evidence in the current literature with inconsistent reporting of data.
Collapse
Affiliation(s)
- James J Butler
- Research Fellow, NYU Langone Health, New York, NY; Research Fellow, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | |
Collapse
|
|
8
|
Di Caprio F, Mosca M, Ceccarelli F, Caravelli S, Vocale E, Zaffagnini S, Ponziani L. Hallux rigidus: current concepts review and treatment algorithm with special focus on interposition arthroplasty. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022218. [PMID: 36300241 PMCID: PMC9686164 DOI: 10.23750/abm.v93i5.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/27/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIM OF THE WORK Hallux rigidus represents a surgical challenge, with a multitude of possible surgical options, but with no ideal procedures. The propose of this paper was to review the actual knowledge on the operative techniques, paying particular attention to the evolution of interposition arthroplasties, as an alternative to arthrodesis and prosthesis in the advanced stages of the disease. METHODS A comprehensive literature PubMed search was performed, and the actual literature regarding hallux rigidus was overviewed. The operative and nonoperative options for HR were described. Studies on interposition arthroplasty were classified by publication year, summarizing the operative technique, results and complications. RESULTS Among the various techniques for interposition arthroplasty, the Modified Oblique Keller Interposition Arthtoplasty (MOKCIA) showed the lower complication rate. It does not sacrifice the insertion of the flexor halluces brevis, maintaining the stability, length and strength of the big toe. CONCLUSIONS Although long-term randomized controlled trials are lacking for interposition arthroplasties, the reported results are comparable to the other alternatives for the treatment of end-stage hallux rigidus, making this technique a valid alternative also in the young active patient, without precluding other end-stage procedures in case of failure. Based on the current knowledge, a treatment algorithm was developed, according to the Coughlin classification.
Collapse
Affiliation(s)
| | | | | | - Silvio Caravelli
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute
| | - Emanuele Vocale
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopedic Institute
| | | | | |
Collapse
|
|
9
|
Sansone V, Maiorano E, Melato M, Martinelli N, Pascale V. Novel treatment for hallux rigidus using a temporary metal interpositional device. Foot Ankle Surg 2020; 26:630-636. [PMID: 31439504 DOI: 10.1016/j.fas.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this prospective study is to evaluate the results of a consecutive series of patients suffering from grade II-III hallux rigidus who underwent a mobility preserving surgical technique consisting of resection arthroplasty with implantation of a temporary metal spacer. METHODS Thirty consecutive patients, 18 female and 12 male with a diagnosis of a grade II-III hallux rigidus, not responding to conservative treatment, underwent a minimal resection arthroplasty followed by the implantation of a temporary metal interpositional device by the same surgeon. All spacers were removed after 6 months through a minimal incision under regional anaesthesia. Patients were clinically and radiographically evaluated at 3, 6, 12 months, and 5 years after spacer removal. RESULTS The clinical AOFAS scores improved already at first follow-up and continued to improve over time with a statistically significant change until the first year. At 3, 6, and 12 months follow-ups, the number of patients with severely limited ROM (i.e. under 30°, that means grade II-III according to Coughlin and Shaurnas classification) significantly decreased. There were only two minor complications, so defined as both of which resolved spontaneously and did not affect the procedure's effectiveness. CONCLUSIONS We observed good to excellent results with the use of this mobility preserving surgical technique for the treatment of symptomatic grades II and III hallux rigidus. The never before published procedure is easy to perform and inexpensive. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Valerio Sansone
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Emanuele Maiorano
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| | - Marco Melato
- Department of Orthopaedic, Hospital SS. Antonio and Biagio and Cesare Arrigo Alessandria, Italy
| | - Nicoló Martinelli
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy.
| | - Valerio Pascale
- University of Milan, Via Festa del Perdono, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
| |
Collapse
|
|
10
|
Stevens J, de Bot RTAL, Witlox AM, Borghans R, Smeets T, Beertema W, Hendrickx RP, Schotanus MGM. Long-term Effects of Cheilectomy, Keller's Arthroplasty, and Arthrodesis for Symptomatic Hallux Rigidus on Patient-Reported and Radiologic Outcome. Foot Ankle Int 2020; 41:775-783. [PMID: 32436737 DOI: 10.1177/1071100720919681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several operative interventions are available to alleviate pain in hallux rigidus, and the optimal operative technique is still a topic of debate among surgeons. Three of these are arthrodesis, cheilectomy, and Keller's arthroplasty. Currently, it is unclear which intervention yields the best long-term result. The aim of this study was to assess which of these interventions performed best in terms of patient-reported outcome, pain scores, and disease recurrence at long-term follow-up. METHODS These data are the follow-up to the initial study published in 2006. In the original study, 73 patients (n = 89 toes) with symptomatic hallux rigidus were recruited and underwent first metatarsophalangeal joint arthrodesis (n = 33 toes), cheilectomy (n = 28 toes), or Keller's arthroplasty (n = 28 toes). Outcome measures were AOFAS hallux metatarsophalangeal-interphalangeal (HMI) score, and pain was assessed with a visual analog scale (VAS) at a mean follow-up period of 7 years. Patients of the original study were identified and invited to participate in the current study. Data were collected in the form of AOFAS-HMI score, VAS pain score, Manchester-Oxford Foot Questionnaire (MOXFQ), and Forgotten Joint Score (FJS-12). In addition, a clinical examination was performed and radiographs were obtained. Data were available for 37 patients (45 toes), with a mean follow-up period over 22 years. RESULTS AOFAS-HMI and VAS pain score improved during follow-up only in arthrodesis patients. Furthermore, no statistically significant differences in clinical and patient-reported outcome were detected between groups based on AOFAS-HMI, VAS pain, MOXFQ, or FJS-12. However, clinically important differences in patient-reported outcomes and pain scores were detected, favoring arthrodesis. Radiographic disease progression was more evident after cheilectomy compared with Keller's arthroplasty. CONCLUSION Arthrodesis, cheilectomy, and Keller's arthroplasty are 3 sucessful operative interventions to treat symptomatic hallux rigidus. Because clinically important differences were detected and symptoms still diminish many years after surgery, a slight preference was evident for arthrodesis. LEVEL OF EVIDENCE Level III, comparative study.
Collapse
Affiliation(s)
- Jasper Stevens
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen-Heerlen, the Netherlands.,Department of Orthopaedics, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Robin T A L de Bot
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen-Heerlen, the Netherlands.,Department of Orthopaedics, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Adhiambo M Witlox
- Department of Orthopaedics, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Rob Borghans
- Department of Radiology, Zuyderland Medical Centre, Sittard-Geleen-Heerlen, the Netherlands
| | | | - Wieske Beertema
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen-Heerlen, the Netherlands
| | - Roel P Hendrickx
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen-Heerlen, the Netherlands
| | - Martijn G M Schotanus
- Department of Orthopaedics, Zuyderland Medical Centre, Sittard-Geleen-Heerlen, the Netherlands
| |
Collapse
|
|
11
|
de Cesar Netto C, Godoy-Santos AL, Cabe TN, Roberts LE, Harnroongroj T, Deland J, Drakos M. The use of polyvinyl alcohol hydrogel implants in the lesser metatarsal heads. Is it safely doable? A cadaveric study. Foot Ankle Surg 2020; 26:128-137. [PMID: 30655193 DOI: 10.1016/j.fas.2018.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/19/2018] [Accepted: 12/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The use of synthetic polyvinyl alcohol hydrogel (PVAH) implants for treatment of lesser toe metatarsophalangeal joint (MTPJ) arthritis is promising and currently limited by the size of implants available. The primary objective of this cadaveric study was to investigate the maximum drilling size and largest PVAH implant dimension that could be safely introduced while still preserving an intact bone rim of the lesser metatarsal heads. METHODS Height and width of all lesser metatarsals were measured on CT and during anatomic dissection. Sequential reaming of the second to fourth metatarsals was performed. Maximum reaming size, largest implant inserted, and failure of the metatarsal head were recorded. Metatarsal head sizes were compared and a multiple regression analysis evaluated measurements that influenced maximum drilling and implant size. RESULTS CT and anatomical measurements demonstrated significant correlation (ICC range, 0.-0.85). Mean values for height and width of the metatarsal heads were respectively: second (14.9 mm and 9.9 mm), third (14.8 mm and 8.8 mm), fourth (14.0 mm and 8.7 mm) and fifth (12.3 mm and 9.3 mm). All the second, third and fourth metatarsal heads could be safely drilled up to 7.5 mm, preserving an intact bone rim. At 80% of the time, the heads could be safely drilled up to 8.0 mm. Height of the metatarsal heads was the only factor to significantly influence the size of maximum reaming and implant introduced. In respectively 20%, 40% and 50% of the second, third, and fourth metatarsal heads, neither 8 mm nor 10 mm PVAH implants could be used. CONCLUSIONS Our cadaveric study found that the even though the majority of the lesser metatarsal heads could be safely drilled up to 8 mm, the smallest PVAH implant size currently available in most countries (8 mm) could be inserted in most of the second, but only in about half of the third and fourth metatarsal heads. The remaining bone rim around inserted implants was considerably thin, usually measuring less than 1 mm. In order to optimize the use PVAH in lesser metatarsal heads, smaller implant options are needed.
Collapse
Affiliation(s)
- Cesar de Cesar Netto
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Alexandre Leme Godoy-Santos
- Department of Orthopaedics, Foot and Ankle Surgery, University of Sao Paulo (USP), St. Ovidio Pires de Campos 333, Sao Paulo, SP, Brazil.
| | - Taylor N Cabe
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Lauren E Roberts
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Thos Harnroongroj
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Jonathan Deland
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| | - Mark Drakos
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72nd Street, New York, NY 10023, USA.
| |
Collapse
|
|
12
|
Partio N, Ponkilainen VT, Rinkinen V, Honkanen P, Haapasalo H, Laine HJ, Mäenpää HM. Interpositional Arthroplasty of the First Metatarsophalangeal Joint with Bioresorbable Pldla Implant in the Treatment of Hallux Rigidus and Arthritic Hallux Valgus: A 9-Year Case Series Follow-Up. Scand J Surg 2019; 110:93-98. [PMID: 31885327 DOI: 10.1177/1457496919893597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS The interpositional arthroplasty was developed to retain foot function and to relieve pain due to the arthritis of the first metatarsophalangeal joint. The bioabsorbable poly-L-D-lactic acid RegJoint® interpositional implant provides temporary support to the joint, and the implant is subsequently replaced by the patient's own tissue. In this study, we retrospectively examined the results of the poly-L-D-lactic acid interpositional arthroplasty in a 9-year follow-up study among patients with hallux valgus with end-stage arthrosis or hallux rigidus. MATERIAL AND METHODS Eighteen patients and 21 joints underwent interpositional arthroplasty using the poly-L-D-lactic acid implant between February 1997 and October 2002 at Tampere University Hospital. Of these, 15 (83.3%) (21 joints) patients were compliant with clinical examination and radiographic examination in long-term (average 9.4 years) follow-up. The mean age of the patients was 48.3 (from 28 to 67) years at the time of the operation. Six patients underwent the operation due to arthritic hallux valgus and nine patients due to hallux rigidus. RESULTS The mean Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale and visual analogue scale (VAS) for pain scores improved after the operation in all patients. The decrease of pain (visual analogue scale) after the operation was statistically significant (77.5 vs 10.0; p < 0.001). Postoperative complications were observed in 3 (14.3%) joints of two hallux rigidus patients. For these patients, surgery had only temporarily relieved the pain, and they underwent reoperation with arthrodesis. CONCLUSION In conclusion, interpositional arthroplasty using a poly-L-D-lactic acid implant yielded good results. This study indicates that the poly-L-D-lactic acid interpositional implant may be a good alternative for arthrodesis for treatment of end-stage degeneration of the first metatarsophalangeal joint.
Collapse
Affiliation(s)
- N Partio
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - V T Ponkilainen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | | | - P Honkanen
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - H Haapasalo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | | | - H M Mäenpää
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
|
13
|
Is interposition arthroplasty a viable option for treatment of moderate to severe hallux rigidus? - A systematic review and meta-analysis. Foot Ankle Surg 2019; 25:571-579. [PMID: 30321931 DOI: 10.1016/j.fas.2018.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/25/2018] [Accepted: 07/13/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION When conservative therapy for hallux rigidus fails, surgical options such as arthrodesis and interposition arthroplasty can be considered. Although arthrodesis of MTP joint is the gold standard treatment. However patients desiring MTP joint movement may opt for either interposition arthroplasty or implant arthroplasty to avoid the movement restrictions of arthrodesis. The purpose of this systematic review was to investigate clinical outcomes and complications following interposition arthroplasty for moderate to severe hallux rigidus, for patietns who would prefer to maintain range of motion in the MTP joint. METHODS A systematic search on MEDLINE, EMBASE and Cochrane library database was performed during February 2018. Demographics, surgical techniques, clinical outcomes, radiological outcomes and complications were recorded from each included study. Pooled statistics performed for variables with homogenous data across the studies. A linear regression model used to compare the clinical outcomes between autogenous vs allogenous material interposition arthroplasty. RESULTS Fifteen articles were included in the systematic review. Mean AOFAS scores improved from preoperative 41.35 to postoperative 83.17. Mean pain, function, and alignment score improved from preoperative values of 14.9, 24.9, and 10 to postoperative values of 33.3, 35.8, and 14.5. Mean dorsiflexion increased from 21.27° (5-30) to 42.03° (25-71). Mean ROM improved from 21.06° to 46.43°. Joint space increased from 0.8mm to 2.5mm. The most common postoperative complications included metatarsalgia (13.9%), loss of ground contact (9.7%), osteonecrosis (5.4%), great toe weakness (4.8%), hypoesthesia (4.2%), decreased push off power (4.2%), and callous formation (4.2%). CONCLUSION Interposition arthroplasty is an effective treatment option with acceptable clinical outcomes in patients with moderate-severe hallux rigidus who prefer to maintain range of motion and accept the risk of future complications. LEVEL OF EVIDENCE IV.
Collapse
|
|
14
|
Emmons BR, Carreira DS. Outcomes Following Interposition Arthroplasty of the First Metatarsophalangeal Joint for the Treatment of Hallux Rigidus: A Systematic Review. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011418814427. [PMID: 35097316 PMCID: PMC8696831 DOI: 10.1177/2473011418814427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Interposition arthroplasty of the first MTP joint has recently experienced renewed interest as a treatment for hallux rigidus. The purpose of this study was to systematically review the rapidly expanding literature on PRO following interposition arthroplasty of the first MTP joint. Methods: PubMed Central, Embase, and the Cochrane Central Register for Controlled Trials (CENTRAL) were searched. Inclusion criteria included length of time to follow-up, number of patients, outcome measure, and use of allogeneic or autogenous soft tissue or a synthetic matrix as interposition. Results: 20 studies were included in the review, comprising 498 patients and 539 feet with mean time to follow-up of 4.5 years. The most common substance used for interposition in the included studies was autogenous first MTPJ capsular tissue, a technique reported on in 12 (60.0%) of the included articles. In studies reporting preoperative and postoperative outcomes by way of a standardized outcome scoring system, mean group improvements exceed minimal clinically important differences in the majority of studies. Eighty-five percent of the studies included in this review were of Level IV quality evidence, and of this subset of studies, 70.6% were of a retrospective nature. Progression to further surgery was observed in 3.8% of toes. The most common complication reported was transfer metatarsalgia of 1 or more lesser toes, observed in up to 57.9% of patients in one study. Conclusion: Interposition arthroplasty appears to be a viable option for the treatment of moderate to severe hallux rigidus in patients looking to salvage motion through the first metatarsophalangeal joint. A wide array of autogenous, allogeneic, and synthetic implant materials have surfaced in recent years, but long-term follow-up and prospective, comparative study designs with low risk of bias are limited. Level of Evidence: Level IV, systematic review of Level III-IV studies
Collapse
|
|
15
|
Watson TS, Panicco J, Parekh A. Allograft Tendon Interposition Arthroplasty of the Hallux Metatarsophalangeal Joint: A Technique Guide and Literature Review. Foot Ankle Int 2019; 40:113-119. [PMID: 30379090 DOI: 10.1177/1071100718807738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The "anchovy" interpositional arthroplasty technique can be used as a salvage option for failed hallux rigidus procedures. The operative technique utilized by the senior author is described. Careful soft-tissue handling, meticulous joint space and graft preparation, and interposition graft stabilization using a bone tunnel and suture anchors are unique aspects of this technique, which in the authors' experience have contributed to improved outcomes. Current literature regarding indications and outcomes is limited and controversial. The proposed benefits of soft-tissue interposition arthroplasty of the hallux metatarsophalangeal joint for patients with prior failed implant arthroplasty are improved pain scores and preservation of range of motion. Level of Evidence: Level V, technique guide.
Collapse
Affiliation(s)
- Troy S Watson
- 1 Foot and Ankle Institute, Desert Orthopaedic Center, Las Vegas, NV, USA
| | - Jordan Panicco
- 1 Foot and Ankle Institute, Desert Orthopaedic Center, Las Vegas, NV, USA
| | - Amit Parekh
- 2 Valley Hospital Medical Center, Las Vegas, NV, USA
| |
Collapse
|
|
16
|
Nurmukhametov MR. PRINCIPLES OF SURGICAL TREATMENT IN PATIENTS WITH OSTEOARTHRITIS OF THE FIRST METATARSOPHALANGEAL JOINT. RHEUMATOLOGY SCIENCE AND PRACTICE 2018. [DOI: 10.14412/1995-4484-2018-363-372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
At present, there is no general approach to choosing surgical tactics for hallux rigidus. Many surgical procedures are used to treat osteoarthritis (OA) of the first metatarsophalangeal joint (FMPJ), which are relevant at different stages of the disease. Nevertheless, this fact also suggests that all proposed methods have one or other disadvantages. At the same time, FMPJ arthrodesis that relieves pain and is functionally inferior to joint-sparing surgery remains the gold standard. However, due to the fact that not only persons over the age of 50 years, but also younger patients often suffer from FMPJ OA, the most non-damaging option of joint-sparing surgery is cheilectomy with chondroplasty of the FMPJ, which allows restoration of painless joint motions, thus sparing the anatomy of the foot. Chondroplasty using the authologous matrix-induced chondrogenesis (AMIC®) technique for knee, hip, and ankle cartilage defects is described. There are no reports on FMPJ chondroplasty with the AMIC method in either Russian or foreign literature.
Collapse
|
|
17
|
Vulcano E, Chang AL, Solomon D, Myerson M. Long-Term Follow-up of Capsular Interposition Arthroplasty for Hallux Rigidus. Foot Ankle Int 2018; 39:1-5. [PMID: 28975843 DOI: 10.1177/1071100717732124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Capsular interposition arthroplasty is a joint- and motion-sparing procedure that has been shown as an effective alternative to fusion. This study aimed to evaluate patient function and satisfaction after long-term follow-up. METHODS Sixty-four patients were treated with capsular interposition arthroplasty for hallux rigidus by the senior author performed between February 1998 and July 2011. Twenty-two patients could not be reached for follow-up and were thus excluded from the analysis. Therefore, 42 remaining patients were evaluated using the visual analog scale (VAS), Foot Function Index (FFI), Short Form 12 (SF-12), and patient satisfaction scores. The mean follow-up was 11.3 (range, 4-16) years. RESULTS The mean VAS for pain was 7.9 preoperatively and 1.8 postoperatively ( P = .003). The mean preoperative SF-12 physical score was 42.0 vs 64.2 postoperatively ( P = .02). The mean preoperative SF-12 mental score was 50.7, while the postoperative SF-12 mental score was 54.6 ( P = .01). The total FFI score also significantly improved, with a preoperative value of 98.3 and a postoperative mean score of 49.6 ( P = .001). The mean patient satisfaction score was 7.4 of 10. Overall, 39 of 42 patients (92.9%) stated they would have the surgery again. Four of the 42 patients (9.5%) required conversion to hallux metatarsophalangeal fusion at a mean of 6.1 years after the index procedure secondary to pain, but no other complications were reported. CONCLUSION Capsular interposition arthroplasty was a safe and effective treatment for severe hallux rigidus. These longer term results demonstrate a high level of patient satisfaction. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
| | | | | | - Mark Myerson
- 2 The Foot and Ankle Association, Inc, Baltimore, MD, USA
| |
Collapse
|
|
18
|
Lam A, Chan JJ, Surace MF, Vulcano E. Hallux rigidus: How do I approach it? World J Orthop 2017; 8:364-371. [PMID: 28567339 PMCID: PMC5434342 DOI: 10.5312/wjo.v8.i5.364] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/20/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
Hallux rigidus is a degenerative disease of the first metatarsalphalangeal (MTP) joint and affects 2.5% of people over age 50. Dorsal osteophytes and narrowed joint space leads to debilitating pain and limited range of motion. Altered gait mechanics often ensued as 119% of the body force transmit through the 1st MTP joint during gait cycle. Precise etiology remains under debate with trauma being often cited in the literature. Hallux valgus interphalangeus, female gender, inflammatory and metabolic conditions have all been identified as associative factors. Clinical symptoms, physical exam and radiographic evidence are important in assessing and grading the disease. Non-operative managements including nonsteroidal antiinflammatory drugs, intra-articular injections, shoe modification, activity modification and physical therapy, should always be attempted for all hallux rigidus patients. The goal of surgery is to relieve pain, maintain stability of the first MTP joint, and improve function and quality of life. Operative treatments can be divided into joint-sparing vs joint-sacrificing. Cheilectomy and moberg osteotomy are examples of joint-sparing techniques that have demonstrated great success in early stages of hallux rigidus. Arthrodesis is a joint-sacrificing procedure that has been the gold standard for advanced hallux rigidus. Other newer procedures such as implant arthroplasty, interpositional arthroplasty and arthroscopy, have demonstrated promising early patient outcomes. However, future studies are still needed to validate its long-term efficacy and safety. The choice of procedure should be based on the condition of the joint, patient’s goal and expectations, and surgeon’s experience with the technique.
Collapse
|
|
19
|
Aynardi MC, Atwater L, Dein EJ, Zahoor T, Schon LC, Miller SD. Outcomes After Interpositional Arthroplasty of the First Metatarsophalangeal Joint. Foot Ankle Int 2017; 38:514-518. [PMID: 28068843 DOI: 10.1177/1071100716687366] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND For patients with hallux rigidus seeking a motion-sparing procedure, interposition arthroplasty is an alternative to fusion. The purpose of this study was to report patient outcomes after interpositional arthroplasty for hallux rigidus. METHODS All patients undergoing interpositional arthroplasty at our institution from 2001 to 2014 were identified and a retrospective chart review was performed. Follow-up was conducted through a telephone survey to obtain survivorship, satisfaction, and functional scores. Survivorship of the interpositional arthroplasty procedure was defined as no subsequent surgery on the hallux after the index procedure. Patients were excluded for incomplete records. Complications were recorded. From 2001 to 2014, 183 patients were identified. Of these, 14 were excluded for incomplete data, leaving 169 patients. Of these, 133 had an average follow-up of 62.2 months (range, 24.3 months to 151.2 months). RESULTS The overall failure rate was 3.8% (5/133). Patient-reported outcome was rated as excellent in 65.4% (87/133) or good in 24.1% (32/133) of patients and fair or poor in 10.5% (14/133) of patients. Of 133 patients, 101 (76%) were able to return to fashionable or regular footwear. The infection rate was 1.5% (2/133). Patient-reported cock-up deformity of the first metatarsophalangeal joint (MTPJ) occurred in 4.5% (6/133) of patients. In addition, 17.3% (23/133) of patients reported metatarsalgia of the second or third MTPJ at the time of final follow-up, and there was no significant difference between interposition types ( P = .441). CONCLUSION Interpositional arthroplasty for hallux rigidus was found to have excellent or good results in most patients at a mean follow-up of 62.2 months. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Michael C Aynardi
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Lara Atwater
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Eric J Dein
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Talal Zahoor
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Lew C Schon
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Stuart D Miller
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| |
Collapse
|
|
20
|
Vulcano E, Tracey JA, Myerson MS. Accurate Measurement of First Metatarsophalangeal Range of Motion in Patients With Hallux Rigidus. Foot Ankle Int 2016; 37:537-41. [PMID: 26660863 DOI: 10.1177/1071100715621508] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The reliability of range of motion (ROM) measurements has not been established for the hallux metatarsophalangeal (MTP) joint in patients with hallux rigidus. The aim of the present study was to prospectively assess the clinical versus radiographic difference in ROM of the arthritic hallux MTP joint. METHOD One hundred consecutive patients who presented with any grade of hallux rigidus were included in this prospective study to determine the hallux MTP range of motion. Clinical range of motion using a goniometer and radiographic range of motion on dynamic x-rays was recorded. RESULTS The mean difference between clinical and radiographic dorsiflexion was 13 degrees (P < .001). For all measurements, clinical dorsiflexion was equal to or less than radiographically measured dorsiflexion. The difference was significantly greater in patients with a clinical dorsiflexion of less than 30 degrees than in patients with 30 degrees or more. Radiographic measurement of hallux dorsiflexion had an excellent intra- and interobserver reliability. CONCLUSION We describe a reliable, reproducible, and straightforward method of measuring hallux MTP ROM that improved upon measuring clinical ROM. LEVEL OF EVIDENCE Level II, prospective comparative study.
Collapse
Affiliation(s)
- Ettore Vulcano
- Limb Lengthening and Complex Reconstruction at the Hospital for Special Surgery, NY, USA
| | - Joseph A Tracey
- Institute for Foot and Ankle Reconstruction at Mercy, Baltimore, MD, USA
| | - Mark S Myerson
- Institute for Foot and Ankle Reconstruction at Mercy, Baltimore, MD, USA
| |
Collapse
|
|
21
|
Abstract
Hallux rigidus is the most common arthritic malady to afflict the foot. A host of nonoperative measures can alleviate pain, and with failure of conservative treatment, joint preserving and joint sacrificing procedures can be used to treat persistent symptoms. Although arthrodesis is an effective pain-relieving operation, loss of motion at the hallux metatarsophalangeal joint may limit the patient's function and can be an unacceptable solution. Various types of interposition arthroplasty can offer a motion-preserving alternative to arthrodesis.
Collapse
|
|
22
|
Abstract
Hallux rigidus is the most commonly occurring arthritic condition of the foot and is marked by pain, limited motion in the sagittal plane of the first metatarsophalangeal joint and varying degrees of functional impairment. In conjunction with clinical findings, radiographic grading helps guide therapeutic choices. Nonsurgical management with anti-inflammatory medications, corticosteroid injections, or shoewear and activity modifications can be successful in appropriately selected patients. Patients with more severe disease or refractory to conservative management may benefit from surgical intervention. Operative options range from joint-preserving procedures (eg, cheilectomy with or without associated osteotomies) to joint-altering procedures (eg, arthroplasty or arthrodesis).
Collapse
Affiliation(s)
- Kamran S Hamid
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Selene G Parekh
- Department of Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Duke University School of Medicine, 3609 Southwest Durham Drive, Durham, NC 27707, USA.
| |
Collapse
|
|
23
|
Proposed global treatment algorithm for Hallux rigidus according to evidence-based medicine. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014. [DOI: 10.1016/j.recote.2014.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
|
24
|
Clews CNL, Kingsford AC, Samaras DJ. Autogenous capsular interpositional arthroplasty surgery for painful hallux rigidus: assessing changes in range of motion and postoperative foot health. J Foot Ankle Surg 2014; 54:29-36. [PMID: 25441283 DOI: 10.1053/j.jfas.2014.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Indexed: 02/03/2023]
Abstract
The autogenous capsular interpositional arthroplasty procedure can be a motion-sparing alternative to arthrodesis for the treatment of recalcitrant hallux rigidus deformity. Previous studies have reported positive results; however, many had small samples or lacked comparable preoperative measures. The present study used a prospective cohort study to assess the benefit of this technique for increasing range of motion, and comparative data to assess the reduction of pain and improvements in perceived foot health status for a consecutively drawn sample of patients. Thirty-four patients (44 feet) reviewed using a long-arm goniometer at a mean of 3.75 years after surgery experienced a significant increase in dorsiflexion (preoperative mean 11.09° ± 10.13°; postoperative mean 26.64° ± 10.07°; p < .001); plantar flexion remained unchanged. Additionally, 15 of 17 patients for whom the hallux abductus angle was initially greater than the normal range was within the normal range postoperatively. The postoperative patient perceptions of foot pain were significantly better than those from a comparable sample of patients presenting for a surgical opinion (t[69] = 6.80), just as were the perceptions of foot function, foot health, and footwear comfort (p < .001 for all). The postoperative perceptions of foot pain were comparable with the postoperative results from a range of previously published studies. These results have shown, with improvements in range of motion and reduction in pain, that autogenous capsular interpositional arthroplasty is a useful, motion-sparing technique in the treatment of painful hallux rigidus and should be considered for classification as a clinical practice guideline.
Collapse
Affiliation(s)
- Clayton N L Clews
- Surgeon, ACT Podiatry, Australasian College of Podiatric Surgeons, Victoria, Australia.
| | - Andrew C Kingsford
- Surgeon, Kingsford Podiatry Group, Australasian College of Podiatric Surgeons Victoria, Australia
| | - Dean J Samaras
- Registrar, Kingsford Podiatry Group, Australasian College of Podiatric Surgeons, Victoria, Australia
| |
Collapse
|
|
25
|
Herrera-Pérez M, Andarcia-Bañuelos C, de Bergua-Domingo J, Paul J, Barg A, Valderrabano V. [Proposed global treatment algorithm for hallux rigidus according to evidence-based medicine]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:377-86. [PMID: 25088241 DOI: 10.1016/j.recot.2014.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/30/2014] [Accepted: 05/05/2014] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Hallux rigidus is the most common arthritis of the foot and ankle. There are numerous reviews on the surgical treatment, but few publications that address the effectiveness of conservative treatment. OBJECTIVE To present a comprehensive algorithm for treatment of all grades of this disease. METHODS Literature search in the following sources: Pubmed and PEDro database (physiotherapy evidence database) until October 2013 for articles on treatment hallux rigidus to record levels of evidence. RESULTS A total of 112 articles were obtained on conservative treatment and 609 on surgical treatment. Finally, only 4 met the inclusion criteria. CONCLUSIONS The use of orthoses or footwear modifications, infiltration with hyaluronate, cheilectomy in moderate degrees and the metatarsophalangeal arthrodesis for advanced degrees, are the only procedures contrasted with grade B or moderate evidence in the treatment of hallux rigidus.
Collapse
Affiliation(s)
- M Herrera-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España; Facultad de Medicina, Universidad de La Laguna, Tenerife, España; Unidad de Tobillo y Pie, Hospital Universitario de Canarias, Tenerife, España.
| | - C Andarcia-Bañuelos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España
| | - J de Bergua-Domingo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Tenerife, España
| | - J Paul
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Basilea, Basilea, Suiza
| | - A Barg
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Basilea, Basilea, Suiza
| | - V Valderrabano
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Basilea, Basilea, Suiza
| |
Collapse
|
|
26
|
Polzer H, Polzer S, Brumann M, Mutschler W, Regauer M. Hallux rigidus: Joint preserving alternatives to arthrodesis - a review of the literature. World J Orthop 2014; 5:6-13. [PMID: 24649409 PMCID: PMC3952696 DOI: 10.5312/wjo.v5.i1.6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 10/29/2013] [Accepted: 11/16/2013] [Indexed: 02/06/2023] Open
Abstract
Hallux rigidus describes the osteoarthritis of the first metatarsophalangeal joint. It was first mentioned in 1887. Since then a multitude of terms have been introduced referring to the same disease. The main complaints are pain especially during movement and a limited range of motion. Radiographically the typical signs of osteoarthritis can be observed starting at the dorsal portion of the joint. Numerous classifications make the comparison of the different studies difficult. If non-operative treatment fails to resolve the symptoms operative treatment is indicated. The most studied procedure with reproducible results is the arthrodesis. Nevertheless, many patients refuse this treatment option, favouring a procedure preserving motion. Different motion preserving and joint sacrificing operations such as arthroplasty are available. In this review we focus on motion and joint preserving procedures. Numerous joint preserving osteotomies have been described. Most of them try to relocate the viable plantar cartilage more dorsally, to decompress the joint and to increase dorsiflexion of the first metatarsal bone. Multiple studies are available investigating these procedures. Most of them suffer from low quality, short follow up and small patient numbers. Consequently the grade of recommendation is low. Nonetheless, joint preserving procedures are appealing because if they fail to relief the symptoms an arthrodesis or arthroplasty can still be performed thereafter.
Collapse
|
|
27
|
Perler AD, Nwosu V, Christie D, Higgins K. End-stage osteoarthritis of the great toe/hallux rigidus: a review of the alternatives to arthrodesis: implant versus osteotomies and arthroplasty techniques. Clin Podiatr Med Surg 2013; 30:351-95. [PMID: 23827492 DOI: 10.1016/j.cpm.2013.04.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hallux rigidus is defined as end-staged arthrosis of the first metatarsophalangeal joint. Although the literature supports arthrodesis as being the gold standard for the treatment of end-staged hallux rigidus, there are several other treatments available that can either prolong the life of the remaining joint or artificially mimic the original biomechanics by replacing a portion of or the entire joint with the added advantage of preserving joint mobility. There are several new and emerging joint preservative techniques that may delay or prevent the need for a joint-destructive procedure, such as arthrodesis or arthroplasty.
Collapse
Affiliation(s)
- Adam D Perler
- Saint Vincent's Hospital System, Indianapolis, IN, USA.
| | | | | | | |
Collapse
|
|
28
|
McNeil DS, Baumhauer JF, Glazebrook MA. Evidence-based analysis of the efficacy for operative treatment of hallux rigidus. Foot Ankle Int 2013; 34:15-32. [PMID: 23386758 DOI: 10.1177/1071100712460220] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this article is to provide an evidence-based literature review and assessment of the quality of literature regarding operative interventions for hallux rigidus. METHODS A comprehensive evidence-based literature review of the PubMed database was conducted on June 24, 2011, identifying 586 articles, of which 135 were relevant in assessing the efficacy of common operative interventions for hallux rigidus. The 135 studies were then assigned a level of evidence (I-V) to denote quality. They were then reviewed to provide a grade of recommendation (A-C, I) in support of or against the operative intervention in treatment of hallux rigidus. RESULTS Based on the results of this evidence-based review, there is fair evidence (grade B) in support of arthrodesis for treatment of hallux rigidus. There is poor evidence (grade C) in support of cheilectomy, osteotomy, implant arthroplasty, resection arthroplasty, and interpositional arthroplasty for treatment of hallux rigidus. There is insufficient evidence (grade I) for cheilectomy with osteotomy for treatment of hallux rigidus. CONCLUSION There are no consistent findings in comparative studies that are properly powered with validated and appropriate outcome measures to allow any definitive conclusions on which procedure is best. However, the grade B recommendation assigned to arthrodesis may make it the logical leading candidate for future high-quality randomized controlled trials. Clearly, further studies-ideally, high-quality Level I randomized controlled trials with validated outcome measures-are needed to allow stronger recommendations to be made. LEVEL OF EVIDENCE Level III, systematic review.
Collapse
Affiliation(s)
- Daniel S McNeil
- Faculty of Medicine, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Nova Scotia, Canada.
| | | | | |
Collapse
|
|
29
|
The long-term patient focused outcomes of the Keller's arthroplasty for the treatment of hallux rigidus. Foot (Edinb) 2012; 22:167-71. [PMID: 22560255 DOI: 10.1016/j.foot.2012.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 02/19/2012] [Accepted: 02/20/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Keller arthroplasty has been used to treat painful conditions of the first MTP joint for over 100 years. More recently the procedure has fallen out of favour, due to a high incidence of transfer metatarsalgia and poor function of the first MTP joint post-operatively. OBJECTIVE This study sought to review the place for Keller arthroplasty in the management of hallux rigidus by considering outcomes from the patient's perspective. METHODS From 1997 to 2005, 104 patients (131 feet) underwent a Keller excisional arthroplasty for the treatment of hallux rigidus. All subjects were classed as grade III on the Hattrup and Johnson scale of joint classification and had a primary complaint of painful hallux rigidus. The American orthopaedic foot and ankle scale was applied pre-operatively and post-operatively. Thirty-two participants (42 feet) were available for a final review (6 male feet and 34 female feet). The range of follow up was 36-154 months with a mean average follow up of 92 months (7.6 years). The age range at the time of surgery was 42-78 years with a mean average age of 62 years at surgery and 69 years and eight months at review. RESULTS Seventy-six percent of participants were completely satisfied, 21.5% satisfied with reservations and 2.5% were dissatisfied. High levels of satisfaction were recorded for pain relief, activity levels and overall patient satisfaction. Ninety-five percent of participants reported their symptoms were improved at long-term follow up compared to pre operatively; however 9.5% of the group complained of transfer metatarsalgia. Nineteen percent of participants, all female, were not happy with the cosmetic appearance of their foot. The mean pre-operative AOFAS clinical rating scale scores was 38. At final follow up the mean score was 89. CONCLUSION The Keller excisional arthroplasty is a simple reliable procedure for the treatment of severe hallux rigidus. Furthermore, it is effective in achieving pain-free movement of the first MTP joint, but carries a risk of creating transfer metatarsalgia. For nearly 20% of participants post-operative cosmetic appearance was disappointing.
Collapse
|
|
30
|
Abstract
Hallux rigidus is the most common degenerative joint pathology of the foot. Untreated, it may result in notable limitations in gait, activity level, and daily function. Positive outcomes can be achieved with nonsurgical management; surgery is recommended for the sufficiently symptomatic patient for whom nonsurgical measures are unsuccessful. Surgery is selected based on grade of involvement. Early to mid-stage hallux rigidus is best managed with cheilectomy or cheilectomy and proximal phalanx osteotomy. Arthrodesis and arthroplasty are reserved for late-stage hallux rigidus.
Collapse
|
|
31
|
Kim PJ, Hatch D, Didomenico LA, Lee MS, Kaczander B, Count G, Kravette M. A multicenter retrospective review of outcomes for arthrodesis, hemi-metallic joint implant, and resectional arthroplasty in the surgical treatment of end-stage hallux rigidus. J Foot Ankle Surg 2011; 51:50-6. [PMID: 21962382 DOI: 10.1053/j.jfas.2011.08.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Indexed: 02/03/2023]
Abstract
This is a retrospective, multicenter study examining the long-term results for the treatment of end-stage hallux rigidus using 3 different surgical procedures. A total of 158 subjects (105 females and 53 males) were included in the present study. They had undergone 1 of the following surgical procedures: arthrodesis, hemi-implant, or resectional arthroplasty. The long-term results for the subjective assessment of pain, function, and alignment, as well as objective radiographic and physical findings, were examined. The median interval to postoperative follow-up for the 3 procedure groups was 159 weeks. No statistically significant difference was found in age or the number of subjects included in the 3 treatment groups (p = .11 and p = .16, respectively). The body mass index was significantly different statistically among the 3 treatment groups, with the hemi-implant group representing a smaller body mass index compared with the other procedures (p = .007). No statistically significant difference was found in the subjective outcomes among the 3 treatment groups using the American College of Foot and Ankle Surgeons' First Metatarsophalangeal Joint and First Ray Scoring Scale (patient questionnaire) or the modified Hallux Metatarsophalangeal-Interphalangeal Scale of the American Orthopedic Foot and Ankle Society (p = .64 and p = .14, respectively). Furthermore, the correlation coefficient between the 2 subjective scoring scales was 0.78, statistically significant and reflecting a moderate to high correlation (p < .001). The results of the radiographic and clinical evaluation revealed that metatarsalgia was the most common finding for the arthrodesis group (9.8%), bony overgrowth into the joint for the hemi-implant group (28.3%), and floating hallux for the resectional arthroplasty group (30.9%). The results of our study suggest that all 3 surgical procedures are viable options for the treatment of end-stage hallux rigidus.
Collapse
Affiliation(s)
- Paul J Kim
- Associate Professor, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007-0469, USA.
| | | | | | | | | | | | | |
Collapse
|
|
32
|
Galli MM, Hyer CF. Hallux rigidus: what lies beyond fusion, resectional arthroplasty, and implants. Clin Podiatr Med Surg 2011; 28:385-403, ix. [PMID: 21669345 DOI: 10.1016/j.cpm.2011.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hallux rigidus (HR) is the limitation of motion at the first metatarsophalangeal (MTP) joint, most commonly secondary to degenerative arthritis. Surgical options for treating HR include 2 general categories: joint salvage and joint destruction. A hybrid of techniques from the 2 categories has emerged: cartilage resurfacing, interpositional arthroplasty, and arthrodiastasis. These procedures address the pathologic condition of the first MTP joint more directly than joint salvage and avoid many of the negative complications, consequences, and connotations of joint destruction procedures. Alternative surgical options for the treatment of recalcitrant pain associated with HR are evolving and are discussed in this review.
Collapse
Affiliation(s)
- Melissa M Galli
- Department of Orthopaedics, The Ohio State University Medical Center, 410 West 10th Avenue, N-1050, Columbus, OH 43210, USA
| | | |
Collapse
|
|
33
|
Freeman BL, Hardy MA. Multiplanar phalangeal and metatarsal osteotomies for hallux rigidus. Clin Podiatr Med Surg 2011; 28:329-44, viii. [PMID: 21669342 DOI: 10.1016/j.cpm.2011.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Many articles have been published on the various treatments of hallux rigidus/limitus but few, if any, have focused solely on the osteotomies performed in the treatment of this disorder and provided a thorough review of the literature and critique of the procedures. Here, we describe the most commonly used, most widely accepted, and most effective osteotomies in the treatment of hallux limitus/rigidus. Along with this discussion are figures and tables to make the information accessible and user friendly. Among the procedures discussed are Keller arthroplasty, Keller interpositional arthroplasty, Bonney-Kessel, Mayo-Stone, Regnauld, Youngswick, Watermann, Watermann-Green, tricorrectional metatarsal osteotomy, sagittal V, LADO (long-arm decompression osteotomy), Drago, Lambrinudi (plantarflexory closing base wedge osteotomy), sagittal Scarf/sagittal Z, and Weil/Mau/distal oblique osteotomy.
Collapse
Affiliation(s)
- Brian L Freeman
- Foot and Ankle Residency Program, Cleveland Clinic/Kaiser Permanente, 9500 Euclid Avenue, Cleveland, OH 44195-0002, USA
| | | |
Collapse
|
|
34
|
Maffulli N, Papalia R, Palumbo A, Del Buono A, Denaro V. Quantitative review of operative management of hallux rigidus. Br Med Bull 2011; 98:75-98. [PMID: 21239418 DOI: 10.1093/bmb/ldq041] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Surgical techniques for the management of hallux rigidus include cheilectomy, Keller resection arthroplasty, arthrodesis, Silastic implantation, phalangeal or metatarsal osteotomy, capsular arthroplasty, partial or total joint replacement, interposition arthroplasty. However, the optimal management is controversial. SOURCES OF DATA We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 2 November 2010. Sixty-nine articles published in peer reviewed journals were included in this comprehensive review. AREAS OF AGREEMENT Cheilectomy and first metatarsal or phalangeal corrective osteotomy may provide better outcome for patients with early and intermediate hallux rigidus (Stages I-II), while arthrodesis or arthroplasty are indicated to manage more severe conditions. The Coleman Methodology Score showed great heterogeneity in terms of study design, patient characteristics, management methods and outcome assessment and generally low methodological quality. AREAS OF CONTROVERSY Definitive conclusions on the use of these techniques for routine management of patients with hallux rigidus are not possible. Given the limitations of the published literature, especially the extensive clinical heterogeneity, it is not possible to compare outcomes of patients undergoing different surgical procedures and determine clear guidelines. GROWING POINTS To assess whether benefits from surgery, validated and standardized measures should be used to compare the outcomes of patients undergoing standard surgical procedures. RESEARCH There is a need to perform appropriately powered randomized clinical trials of using standard diagnostic assessment, common and validated scoring system comparing reported outcomes and duration of follow-up >2 years.
Collapse
Affiliation(s)
- Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, UK.
| | | | | | | | | |
Collapse
|
|
35
|
First metatarsophalangeal hemiarthroplasty for hallux rigidus. INTERNATIONAL ORTHOPAEDICS 2010; 34:1193-8. [PMID: 20495803 PMCID: PMC2989092 DOI: 10.1007/s00264-010-1012-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 03/19/2010] [Accepted: 03/23/2010] [Indexed: 11/12/2022]
Abstract
There is a paucity of objective information in the literature about first metatarsophalangeal (MTP) hemiarthroplasty. The authors postulate that it is a reasonable treatment option for severe hallux rigidus in selected patients. Twenty-two elective first MTP hemiarthroplasties were performed on 20 patients that met the inclusion criteria. Pre- and postoperative evaluations were done using the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, visual analogue scale (VAS) pain score, range of motion (ROM) measurements, and radiographs. Average ROM and dorsiflexion improved by 15° and 8°, respectively. VAS pain scores improved from 5 to 2.5 after six weeks. Painless ambulation occurred after six weeks, with maximum improvement by six months. After 24 months, two patients had pain at the surgical site interfering with function, leading to an unsatisfactory result that required conversion to arthrodesis. First MTP hemiarthroplasty for severe hallux rigidus can be considered an alternative to fusion in properly selected patients who wish to maintain a functional range of motion.
Collapse
|
|
36
|
Roukis TS. Outcome following autogenous soft tissue interpositional arthroplasty for end-stage hallux rigidus: a systematic review. J Foot Ankle Surg 2010; 49:475-8. [PMID: 20350819 DOI: 10.1053/j.jfas.2010.02.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Indexed: 02/03/2023]
Abstract
Autogenous soft tissue interpositional arthroplasty has been proposed as an alternative to arthrodesis and other forms of arthroplasty for treatment of end-stage hallux rigidus because of the perceived safety and efficacy. The author undertook a systematic review of electronic databases and other relevant sources to identify material relating to the outcomes following autogenous soft tissue interpositional arthroplasty for end-stage hallux rigidus. Information from peer-reviewed journals, as well as from non-peer-reviewed publications, abstracts and posters, textbooks, and unpublished works, were also considered. In an effort to procure the highest quality studies available, studies were eligible for inclusion only if they involved consecutively enrolled patients undergoing isolated autogenous soft tissue interpositional arthroplasty for the treatment of end-stage hallux rigidus, evaluated patients at mean follow-up of 12-months' duration or longer, included pre- and postoperative range of motion of the first metatarsal-phalangeal joint, determined pre- and postoperative outcomes using a scoring system, and documented any complications. Two studies involving a total of 28 autogenous soft tissue interpositional arthroplasties for end-stage hallux rigidus were identified that met the inclusion criteria. There were 12 men (52%) and 11 women (48%) with a mean age of 58.2 years followed for a mean of 21.6 months. Both studies used the AOFAS First Metatarsal-Phalangeal-Hallux Scoring System, which had a mean of 26.0 preoperatively rising to 89.4 postoperatively. First metatarsal-phalangeal joint dorsiflexion had a mean of 16.7 degrees preoperatively rising to 51.1 degrees postoperatively. Complications occurred in 4 (14.3%) feet and no feet required surgical revision. The results of this systematic review demonstrate improvement in patient outcomes and first metatarsal-phalangeal joint dorsiflexion, as well as few complications following autogenous soft tissue interpositional arthroplasty for end-stage hallux rigidus. However, there is still a need for methodologically sound prospective cohort studies that compare autogenous soft tissue interpositional arthroplasty with other forms of arthroplasty and arthrodesis for end-stage hallux rigidus.
Collapse
Affiliation(s)
- Thomas S Roukis
- Department of Orthopaedics, Podiatry, and Sports Medicine, Gundersen Lutheran Medical Center, La Crosse, WI 54601, USA.
| |
Collapse
|