Surgery for hallux rigidus

NewsBot · Apr 3, 2024

Minimally Invasive vs Open Approach for First Metatarsophalangeal Joint Arthrodesis: Short Report of Early Results
Jessica L Duggan et al
Foot Ankle Int. 2024 Mar 19

Background: We aim to compare early surgical results between groups who underwent minimally invasive surgery (MIS) vs open first metatarsophalangeal (MTP) arthrodesis to treat end-stage hallux rigidus.

Methods: We conducted a retrospective cohort review of 65 patients who underwent a first MTP fusion procedure at an academic medical center between 2015 and 2023. Success of fusion was determined radiographically. Postoperative complications were identified through medical record review.

Results: Sixty-seven first MTP fusion surgeries (41 open and 26 MIS) were performed on 65 patients with a primary diagnosis of hallux rigidus. Open surgery and MIS groups had similarly high fusion rates: 95% (39/41) and 96% (25/26), respectively (P = .84). We identified no difference in overall complication rates: 20% for open surgery and 23% for MIS (P = .73).

Conclusion: This retrospective analysis of 67 first MTP arthrodesis procedures showed no significant differences in fusion success or complications in the short term when comparing MIS to open surgery. Further studies are needed to elucidate potential differences between MIS vs open surgery.
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NewsBot · Apr 19, 2024

Polyvinyl alcohol hydrogel implant for the treatment of hallux rigidus is associated with a high complication rate and moderate failure rate at short-term follow-up: a systematic review
James J Butler et al
Eur J Orthop Surg Traumatol. 2024 Mar 30

Purpose: Moderate-to-severe hallux rigidus is a debilitating pathology that is optimally treated with surgical intervention. Arthrodesis produces reliable clinical outcomes but is limited by restriction in 1st metatarsophalangeal joint range of motion. The advent of polyvinyl alcohol hydrogel (PVA) implants have produced early promise based on initial trials, but more recent studies have called into question the efficacy of this procedure. The purpose of this systematic review was to evaluate the clinical and radiological outcomes following the use of PVA for hallux rigidus.

Methods: The MEDLINE, EMBASE and Cochrane library databases were systematically reviewed using the preferred reporting items for systematic reviews and meta-analyses guidelines. 18 studies were included.

Results: In total, 1349 patients (1367 feet) underwent PVA at a weighted mean follow-up of 24.1 ± 11.1 months. There were 168 patients (169 feet) included in the cheilectomy cohort and 322 patients (322 feet) included in the arthrodesis cohort. All 3 cohorts produced comparable improvements in subjective clinical outcomes. Postoperative imaging findings in the PVA cohort included joint space narrowing, peri-implant fluid, peri-implant edema and erosion of the proximal phalanx. The complication rate in the PVA cohort, cheilectomy cohort and arthrodesis cohort was 27.9%, 11.8% and 24.1%, respectively. The failure rates in the PVA cohort, cheilectomy cohort and arthrodesis cohort was 14.8%, 0.3% and 9.0%, respectively.

Conclusion: This systematic review demonstrated that PVA produced a high complication rate (27.9%) together with concerning postoperative imaging findings at short-term follow-up. In addition, a moderate failure rate (14.8%) and secondary surgical procedure rate (9.5%) was noted for the PVA cohort. The findings of this review calls into question the efficacy and safety of PVA for the treatment of hallux rigidus.
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NewsBot · Apr 25, 2024

Effect of Obesity on Patient-Perceived Outcomes After First Metatarsophalangeal Joint Arthrodesis
Alex R. Webb, et al
Source

Background:
While first metatarsophalangeal joint (MTPJ) arthrodesis is a common and effective procedure, there is a paucity of studies examining obesity’s effect on outcomes of 1st MTPJ arthrodesis. This study’s purpose was to evaluate patient-reported outcomes following 1st MTPJ arthrodesis in obese versus non-obese patients.
Methods:
A retrospective cohort study of 94 patients undergoing first MTPJ fusion over the age of 18 with a diagnosis of hallux valgus or hallux rigidus was performed. Surgical and postoperative outcomes were examined preoperatively and at 6 and 12 months follow-up via Visual Analog Pain scale (VAS), and Short Form 36 (SF-36) surveys, and data were stratified into 2 patient groups: BMI < 30 (n = 62, mean age 63.9 ± 9.1 and ≥ 30 (n = 32, mean age 61.9 ± 8.4).
Results:
Average overall VAS and SF-36 physical component scores improved significantly at 6 months (P < .001, .006) and 1 year postoperative visits (P < .001, .007) with no differences in survey scores, outcomes, or complications between weight groups.
Conclusion:
Our study showed first MTPJ fusion improves short-term pain and physical quality-of-life in arthritic obese and non-obese patients without differences in nonunion, complications, or patient-reported measures.
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NewsBot · May 28, 2024

First Metatarsophalangeal Joint Arthrodesis with Complete Resection of the Subchondral Bone Plate
Mark J Bullock et al
J Foot Ankle Surg. 2024 May 20:S1067-2516(24)00093-0

First metatarsophalangeal arthrodesis is associated with high union rates but there is a wide range of union incidence reported. Whether the subchondral plate is completely resected, is not reported by individual studies and without meticulous care, there is often residual subchondral plate. The primary aim was to report our union rate following first metatarsophalangeal arthrodesis with complete resection of the subchondral plate, locking plate fixation and immediate protected weight bearing. A retrospective case study of 2 surgeons was performed from August 2016 to June 2023. Our study was unique in that all patients had complete resection of the subchondral plate to trabecular bone. One hundred seventeen feet were identified for analysis, in 112 patients following exclusion criteria. Patients were excluded if they had less than 3 months follow-up, revisional surgery or charcot. Demographic data and indications for the procedure were reported. A single construct locking plate with an interfragmentary compression screw through the plate was used in 37 feet and a locking plate with separate interfragmentary compression screw was used in 80 feet. We reported a nonunion incidence of 0.9% (n=1) with a delayed union incidence of 0.9% (n=1) and a broken hardware incidence of 0.9% (n=1). Complete resection of subchondral plate with early weight bearing and locking plate fixation had a high union rate for first metatarsophalangeal arthrodesis. Our results compare favorably with union rates in the literature, where there is often residual subchondral plate.
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NewsBot · May 30, 2024

Sagittal Plane Alignment for First Metatarsal Phalangeal Arthrodesis Correlated with Postoperative Function: What is the optimal position?
Daniel J Hatch, DPM,FACFAS et al
May 30, 2024

There have been many reports describing the proposed alignment of a first metatarsal phalangeal arthrodesis to obtain optimum function. Most of these recommendations are based upon historical and anecdotal evidence. Furthermore, there are few reports directly comparing alignment to patient reported function. We studied radiographic sagittal plane alignment in a group of 60 patients (80 feet) who had undergone a first metatarsal phalangeal joint arthrodesis (20 of the 60 had bilateral arthrodesis) to better understand how this component of the arthrodesis position translates to real world function. The patients in this study had completed a functional survey in 2022 at a mean of 28.4 (median 27.8; range 13.2-45.7) months with very high satisfaction for return to activities of daily living and recreational sports. We measured the sagittal plane position of the first metatarsal relative to the proximal phalanx in this cohort with known post operative activity data. We found that a mean (standard of deviation) sagittal plane angle (angle between the anatomic axis of the first metatarsal and the proximal phalanx) of 15.4 (SD 7.4) degrees and a proximal phalanx head to ground height of 12.7 (SD 3.3) mm was present in this group. Comparing the functional and positional results we conclude that this sagittal plane position provides a good recommendation for alignment.
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NewsBot · Jun 4, 2024

Long-term outcomes of first metatarsophalangeal hemiarthroplasty for hallux rigidus
Serhat Akcaalan et al
Foot and Ankle Surgery; Volume 30, Issue 4, June 2024, Pages 338-342

Hallux rigidus (HR) is arthritis of the first metatarsophalangeal joint.First metatarsophalangeal joint hemiarthroplasty surgery is one of the treatment options for end stage hallux rigidus.The aim of this study is to evaluate the long-term outcomes of hemiarthroplasty of the first MTPJ with a metallic implant in patients with end-stage HR. Patients who underwent hemiarthroplasty surgery with the diagnosis of HR were included in the study. Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and Foot and Ankle Disability Index (FADI) scores were used in pre-operative and post-operative final follow-ups to evaluate the clinical status of the patients. Post-operative 1st metatarsophalangeal joint range of motion was measured and recorded separately for each patient. The intra-hospital and follow-up complications and revision surgeries of the patients were recorded. Thirty-five patients with a mean follow-up of 8.1 years were included in the study. There was a statistically significant positive change in both FADI and SAFE-Q scores compared to the pre-operative process(p = 0.0001). The average dorsiflexion angle at the final follow-up was 22.0 ± 8.2. Thus, it was determined that the 5-year and 8-year survival rates of patients in this study were 97.1% and 87.8%, respectively. In conclusion, the long-term results show that the use of hemiarthroplasty in the treatment of end-stage HR leads to high patient satisfaction, increased range of motion and a high survival rate.
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NewsBot · Jun 4, 2024

Cheilectomy and the Shortening PelCO for the Treatment of Low-grade Hallux Rigidus
Del Vecchio, Jorge J.et al
Techniques in Foot & Ankle Surgery 23(2) 95-100, June 2024. | DOI: 10.1097/BTF.0000000000000417

Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint resulting in stiffness and pain. Surgical treatments can be divided into joint-sparing and joint-sacrificing procedures. Cheilectomy has been recommended as an isolated procedure for the treatment of low-grade hallux rigidus (I and II, even III in some articles). First metatarsal shortening osteotomies are indicated in low-grade hallux rigidus. The Shortening Percutaneous, Intra-articular, Chevron Osteotomy resembles the Green-Watermann procedures regarding shortening and decompression. Shortening Percutaneous, Intra-articular, Chevron Osteotomy provides excellent clinical and functional results and represents a viable treatment option to decrease pain, improve function, and maintain motion for hallux rigidus grade I and II.
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NewsBot · Jun 5, 2024

Nonunion After First Metatarsophalangeal Joint
Arthrodesis: The Association With Shoe Size
Wout Füssenich , Martin Stevens , Julian R. Zwoferink , Jessie M. M. Schoenaker , Matthijs P. Somford ,
Gesine H. Seeber
Cureus

Introduction: First metatarsophalangeal joint (MTPJ) arthrodesis is a common treatment for various foot
conditions, with nonunion as a frequent complication. The incidence of nonunion varies widely in the
literature. In particular, males have a higher risk of nonunion than females. This is possibly due to
biomechanical and anatomical differences, as men have on average larger feet than women. This study
therefore aims to explore whether shoe size, as a proxy for foot size, affects nonunion rates and could
explain the gender disparity in nonunion rates.
Methodology: An exploratory analysis of retrospectively collected data from patients who underwent
primary first MTPJ arthrodesis in a single secondary hospital between January 2012 and December 2019.
Additional data on body weight, height, and shoe size were prospectively collected from patients.
Results: Among 261 included patients, 57 (21.8%) experienced nonunion. Nonunion incidence was higher in
males (18, 26.9%) than in females (39, 20.1%). Self-reported shoe size showed no significant association with
nonunion in both univariate and multivariate analyses.
Discussion: The study’s findings suggest that shoe size, as a proxy for foot size, is not associated with
nonunion after the first MTPJ arthrodesis. Despite observing a gender difference in nonunion rates, this
disparity could not be explained by shoe size.
Conclusions: Shoe size as a proxy for foot size appears to have no clinical association with nonunion
following the first MTPJ arthrodesis.
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NewsBot · Jun 25, 2024

Bilateral first metatarsophalangeal joint arthrodesis: An investigation of functional, surgical and radiological outcomes
Michael G. Curran et al
Foot and Ankle Surgery Volume 30, Issue 5, July 2024, Pages 411-416

Background
First metatarsophalangeal joint (MTPJ) arthrodesis is a commonly utilised procedure. In this study, the authors aim to explore functional outcomes of patients undergoing nonsynchronous bilateral first MTPJ arthrodesis under the care of a single surgeon using a compression screw/locking plate construct.

Methods
This is a prospectively collected, retrospectively analysed case series of fifty five patients who underwent bilateral nonsynchronous first MTPJ arthrodesis. Clinical and radiological outcomes were assessed preoperatively and at a minimum of two years postoperatively. Clinical outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), the Self-Reported Foot and Ankle Score (SEFAS) and the Sports Questionnaire version 1 (SQ). Postoperative radiographs were used to assess evidence of union and compare both hallux valgus and intermetatarsal angles. Removal of hardware, revision surgery and correction of deformities were also recorded.

Results
Fifty five patients were included in the study. There was statistically significant improvements in all five facets of the FAOS (p value < 0.05). The mean postoperative SEFAS was 45.1. In total, patients participated in thirteen different sporting activities. This represented 92 patient specific activities preoperatively and 104 postoperatively. The most common activities were walking, cycling and swimming. Overall, 94.5% (N = 52) of the cohort were satisfied with their return to sport while 98.2% (N = 54) would recommend bilateral first MTPJ arthrodesis. Mean reductions in hallux valgus angles and intermetatarsal angles were noted at 18.87 and 4.69 degrees respectively. There was one non-union in the cohort which required revision surgery. One patient required removal of hardware.

Conclusions
Bilateral first MTPJ arthrodesis is a safe and effective surgical option for patients with bilateral first MTPJ pathology. It has a high union rate, low complication rate and significantly improves clinical outcomes and allows patients reliably return to physical activities.
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NewsBot · Jun 25, 2024

Minimally invasive Dorsal cheilectomy and Hallux metatarsophalangeal joint arthroscopy for the treatment of Hallux Rigidus
Chase Gauthier et al
Foot and Ankle Surgery; Volume 30, Issue 5, July 2024, Pages 400-405

Background
Minimally invasive dorsal cheilectomy (MIDC) has become a popular alternative to an open approach for treating Hallux Rigidus (HR). To reduce some of the complications related to the MIDC approach, a first metatarsophalangeal (MTP) joint arthroscopy can be performed in addition to address the intra-articular pathology associated with Hallux Rigidus. This study aims to examine the effectiveness of MIDC with first MTP arthroscopy in patients with HR with a minimum 1-year follow-up.

Methods
This was a multicenter retrospective review for adult patients with Coughlin and Shurnass Grade 0–3 who were treated with MIDC and first MTP arthroscopy between 3/1/2020 and 8/1/2022, with at least one year of follow-up data. Demographic information, first MTP range of motion (ROM), visual analog scale (VAS), Manchester-Oxford Foot Questionnaire (MOXFQ), and EQ-5D-5 L scores were collected. Continuous data was expressed as a mean and standard deviation, categorical data was expressed as a percentage. Wilcoxon Rank Sum test was used to compare continuous variables. All P < 0.05 was considered significant.

Results
A total of 31 patients were included in the study. Average follow-up time was 16.5 months (range: 12 to 26.2). There was 1 (3.2%) undersurface EHL tendon tear, 2 (6.5%) conversions to an MTP fusion, and 1 (3.2%) revision cheilectomy and capsular release for MTP joint contracture. There was a significant improvement in patient’s ROM in dorsiflexion (50 vs 89.6 degrees, P = 0.002), postoperative VAS pain scores (6.4 vs 2.1, P < 0.001), MOXFQ pain scores (58.1 vs 30.7, P = 0.001), MOXFQ Walking/Standing scores (56.6 vs 20.6, P = 0.001), MOXFQ Social Interaction scores (47.3 vs 19.36, P = 0.002), and MOXFQ Index scores (54.7 vs 22.4, P < 0.001).

Conclusion
We found that MIDC with first MTP arthroscopy was effective at improving patient-reported outcomes at one year with low complication and revision rates. These results suggest that MIDC with first MTP arthroscopy is an effective treatment for early-stage HR.
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NewsBot · Jul 8, 2024

Nonunion After First Metatarsophalangeal Joint Arthrodesis: The Association With Shoe Size
Wout Füssenich et al
Cureus. 2024 May 31;16(5):e61448

Introduction: First metatarsophalangeal joint (MTPJ) arthrodesis is a common treatment for various foot conditions, with nonunion as a frequent complication. The incidence of nonunion varies widely in the literature. In particular, males have a higher risk of nonunion than females. This is possibly due to biomechanical and anatomical differences, as men have on average larger feet than women. This study therefore aims to explore whether shoe size, as a proxy for foot size, affects nonunion rates and could explain the gender disparity in nonunion rates.

Methodology: An exploratory analysis of retrospectively collected data from patients who underwent primary first MTPJ arthrodesis in a single secondary hospital between January 2012 and December 2019. Additional data on body weight, height, and shoe size were prospectively collected from patients.

Results: Among 261 included patients, 57 (21.8%) experienced nonunion. Nonunion incidence was higher in males (18, 26.9%) than in females (39, 20.1%). Self-reported shoe size showed no significant association with nonunion in both univariate and multivariate analyses.

Discussion: The study's findings suggest that shoe size, as a proxy for foot size, is not associated with nonunion after the first MTPJ arthrodesis. Despite observing a gender difference in nonunion rates, this disparity could not be explained by shoe size.

Conclusions: Shoe size as a proxy for foot size appears to have no clinical association with nonunion following the first MTPJ arthrodesis
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NewsBot · Jul 15, 2024

Outcomes following minimally invasive dorsal cheilectomy for hallux rigidus: A systematic review
Katherine Esser et al
World J Orthop. 2024 Jun 18;15(6):585-592.

Background: Cheilectomy of the 1st metatarsophalangeal joint (MTPJ) is one of the most common procedures for the management of hallux rigidus. However, there is no consensus regarding outcomes following minimally invasive dorsal cheilectomy (MIDC) for the management of hallux rigidus.

Aim: To evaluate outcomes following MIDC for the management of hallux rigidus.

Methods: During November 2023, the PubMed, EMBASE and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following MIDC for the management of hallux rigidus.

Results: Six studies were included. In total, 348 patients (370 feet) underwent MIDC for hallux rigidus at a weighted mean follow-up of 37.9 ± 16.5 months. The distribution of patients by Coughlin and Shurna's classification was recorded in 4 studies as follows: I (58 patients, 27.1%), II (112 patients, 52.3%), III (44 patients, 20.6%). Three studies performed an additional 1st MTPJ arthroscopy and debridement following MIDC. Retained intra-articular bone debris was observed in 100% of patients in 1 study. The weighted mean American orthopedic foot and ankle society score improved from a preoperative score of 68.9 ± 3.2 to a postoperative score of 87.1. The complication rate was 8.4%, the most common of which was persistent joint pain and stiffness. Thirty-two failures (8.7%) were observed. Thirty-three secondary procedures (8.9%) were performed at a weighted mean time of 8.6 ± 3.2 months following the index procedure.

Conclusion: This systematic review demonstrated improvements in subjective clinical outcomes together with a moderate complication rate following MIDC for the management of hallux rigidus at short-term follow-up. A moderate re-operation rate at short-term follow-up was recorded. The marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions.
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NewsBot · Jul 15, 2024

Minimally invasive Dorsal cheilectomy and Hallux metatarsophalangeal joint arthroscopy for the treatment of Hallux Rigidus
Chase Gauthier et al
Foot and Ankle Surgery; Volume 30, Issue 5, July 2024, Pages 400-405

Background
Minimally invasive dorsal cheilectomy (MIDC) has become a popular alternative to an open approach for treating Hallux Rigidus (HR). To reduce some of the complications related to the MIDC approach, a first metatarsophalangeal (MTP) joint arthroscopy can be performed in addition to address the intra-articular pathology associated with Hallux Rigidus. This study aims to examine the effectiveness of MIDC with first MTP arthroscopy in patients with HR with a minimum 1-year follow-up.

Methods
This was a multicenter retrospective review for adult patients with Coughlin and Shurnass Grade 0–3 who were treated with MIDC and first MTP arthroscopy between 3/1/2020 and 8/1/2022, with at least one year of follow-up data. Demographic information, first MTP range of motion (ROM), visual analog scale (VAS), Manchester-Oxford Foot Questionnaire (MOXFQ), and EQ-5D-5 L scores were collected. Continuous data was expressed as a mean and standard deviation, categorical data was expressed as a percentage. Wilcoxon Rank Sum test was used to compare continuous variables. All P < 0.05 was considered significant.

Results
A total of 31 patients were included in the study. Average follow-up time was 16.5 months (range: 12 to 26.2). There was 1 (3.2%) undersurface EHL tendon tear, 2 (6.5%) conversions to an MTP fusion, and 1 (3.2%) revision cheilectomy and capsular release for MTP joint contracture. There was a significant improvement in patient’s ROM in dorsiflexion (50 vs 89.6 degrees, P = 0.002), postoperative VAS pain scores (6.4 vs 2.1, P < 0.001), MOXFQ pain scores (58.1 vs 30.7, P = 0.001), MOXFQ Walking/Standing scores (56.6 vs 20.6, P = 0.001), MOXFQ Social Interaction scores (47.3 vs 19.36, P = 0.002), and MOXFQ Index scores (54.7 vs 22.4, P < 0.001).

Conclusion
We found that MIDC with first MTP arthroscopy was effective at improving patient-reported outcomes at one year with low complication and revision rates. These results suggest that MIDC with first MTP arthroscopy is an effective treatment for early-stage HR.
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NewsBot · Aug 20, 2024

“Scarfrodesis”—Simultaneously Addressing Hallux Valgus and Hallux Rigidus With a Scarf Osteotomy and First Metatarsophalangeal Joint Arthrodesis: A Case Report
Moore, David Mb BCh BAO, MCh; Shet, Sahil S. Mb BCh BAO, MCh; O’Neill, Barry MB, MCh, FRCSI (Tr & Orth)
Techniques in Foot & Ankle Surgery ():10.1097/BTF.0000000000000429, August 14, 2024. | DOI: 10.1097/BTF.0000000000000429

This case report described a novel procedure used to address a concomitant hallux valgus and hallux rigidus in a patient in her sixties with rheumatoid arthritis. Initial radiographs confirmed concomitant severe hallux valgus deformity with first metatarsophalangeal joint osteoarthritis. A scarf osteotomy was performed followed by a first metatarsophalangeal joint arthrodesis in what the authors have called a “Scarfrodesis” procedure. At 1-, 2-, and 3-year follow-ups, the patient had complete resolution of pain, no limitation in mobility, and had complete consolidation of her arthrodesis. Her AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale Score improved from 29 preoperatively to 72 at 1-year and 3-year follow-ups, with improvement in her Visual Analog Scale and SF-36 at 3-year follow-up. The authors advocate the use of this simple but elegant procedure, which has not been described in addressing the dual pathology in this cohort.
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NewsBot · Aug 23, 2024

A Comparison of PROMIS Scores of Metatarsophalangeal Joint Arthrodesis and Polyvinyl Alcohol Hydrogel Implant Hemiarthroplasty for Hallux Rigidus
Seif El Masry et al
JB JS Open Access. 2024 Aug 19;9(3):e23.00158

Background: The current literature shows similar clinical outcomes between first metatarsophalangeal (MTP) joint arthrodesis and synthetic cartilage implant (SCI) hemiarthroplasty in the treatment of hallux rigidus; however, prior studies have not reported validated patient-reported outcome measures (PROMs). To our knowledge, this is the first study to compare PROMs using 6 domains of the validated Patient-Reported Outcomes Measurement Information System (PROMIS) in patients treated for hallux rigidus with MTP joint arthrodesis and with SCI hemiarthroplasty. In addition, this novel study provides comparative data on the complication and revision rates for each procedure.

Methods: A single-center, retrospective registry search identified all patients with preoperative PROMIS scores who underwent MTP joint arthrodesis or SCI hemiarthroplasty for hallux rigidus between February 2016 and June 2021. The study aimed to determine if the 2 procedures showed statistically or clinically equivalent PROMIS scores in 6 domains: physical function, pain interference, pain intensity, global physical health, global mental health, and depression. A multivariable linear regression analysis was performed to compare adjusted 1-year postoperative PROMIS scores between the 2 cohorts. Complication and revision rates were also compared.

Results: The study included 82 patients who underwent SCI hemiarthroplasty and 101 who underwent MTP joint arthrodesis. Demographic data and preoperative hallux rigidus severity showed no significant differences between the cohorts. PROMIS scores were mostly comparable between the 2 groups, except for the pain intensity domain. The patients who underwent MTP joint arthrodesis exhibited significantly better pain relief at 1 and 2 years postoperatively, which was supported by adjusted postoperative PROMIS scores. At 2 years, the SCI group had worse pain intensity scores and lower global physical health scores. There were no differences between the cohorts in additional PROMIS scores or complication data.

Conclusions: While outcomes in most of the domains were similar, MTP joint arthrodesis was more effective at mitigating pain intensity compared with SCI hemiarthroplasty. This information can guide patient counseling and decision-making when considering surgical intervention for hallux rigidus.
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NewsBot · Sep 4, 2024

Arthroscopic Dorsal Cheilectomy, Plantar Capsular Release, Flexor Hallucis Brevis Release, and Sesamoid Cheilectomy for Management of Early Stages of Hallux Rigidus
Tun Hing Lui et al
Arthroscopy Techniques; 29 August 2024, 103198

In hallux rigidus, limitation of the dorsiflexion of the first metatarsophalangeal joint can be a result of dorsal impingement and plantar contracture of the joint. The purpose of this Technical Note is to describe the details of arthroscopic dorsal cheilectomy, plantar capsular release, flexor hallucis brevis release, and sesamoid cheilectomy for the management of early stages of hallux rigidus. This minimally invasive technique can deal with both dorsal and plantar pathologies of the first metatarsophalangeal joint.
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NewsBot · Sep 22, 2024

Comparing the Clinical Outcomes of Percutaneous Cheilectomy to Open Cheilectomy With Moberg Osteotomy for the Treatment of Hallux Rigidus
Grace M DiGiovanni et al
Foot Ankle Orthop. 2024 Sep 3;9(3)

Background: Both an open cheilectomy with a Moberg osteotomy and percutaneous cheilectomy have been successfully used to treat hallux rigidus and preserve motion.However, there have been no studies that have compared these 2 procedures using validated patient-reported outcomes such as the Patient Reported Outcome Measurement Information System.

Methods: A retrospective review of hallux rigidus patients between January 2016 and July 2021 collected 48 percutaneous cheilectomy (PC) patients and 71 open cheilectomy with Moberg (OCM) patients. Preoperative and minimum 1-year postoperative PROMIS scores were collected.

Results: The OCM and PC cohorts did not have significant differences in their postoperative PROMIS scores. Both cohorts had modest but significant improvements postoperatively in the physical function, pain interference, and pain intensity domains. The OCM group had a larger degree of improvement in physical function, pain interference, and pain intensity (P = .015, .011, .001, respectively). No significant difference was identified in the reoperation rate.

Conclusion: Patients undergoing an OCM had worse preoperative PROMIS scores and a modestly greater change in patient-reported outcomes than patients undergoing a PC.
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NewsBot · Oct 1, 2024

Mid-term efficacy of the Cartiva synthetic cartilage implant in symptomatic hallux rigidus
William R Fletcher et al
Bone Jt Open. 2024 Sep 24;5(9):799-805

Aims: The Cartiva synthetic cartilage implant (SCI) entered mainstream use in the management of first metatarsophalangeal joint (MTPJ) arthritis following the positive results of large trials in 2016. Limited information is available on the longer-term outcomes of this implant within the literature, particularly when independent from the originator. This single-centre cohort study investigates the efficacy of the Cartiva SCI at up to five years.

Methods: First MTPJ arthritis was radiologically graded according to the Hattrup and Johnson (HJ) classification. Preoperative and sequential postoperative patient-reported outcome measures (PROMs) were evaluated using the Manchester-Oxford Foot Questionnaire (MOXFQ), and the activities of daily living (ADL) sub-section of the Foot and Ankle Ability Measure (FAAM).

Results: Patients were followed up for a mean of 66 months (SD 7.1). Of an initial 66 cases, 16 did not return PROM questionnaires. A total of six failures were noted, with survival of 82%. Overall, significant improvement in both objective scores (MOXFQ and FAAM ADL) was maintained versus preoperatively: 18.2 versus 58.0 (p > 0.001) and 86.2 versus 41.1 (p > 0.001), respectively. The improvement was noted to be less pronounced in males. Subjective scores had deteriorated since early follow-up, with an interval decrease in patient satisfaction from 89% to 68%. Furthermore, a subset of cases demonstrated clinically important interval deterioration in objective scores. However, no specific patient factors were found to be associated with outcomes following analysis.

Conclusion: This study represents the longest-term independent follow-up in the literature. It shows reassuring mid-term efficacy of the Cartiva SCI with better-than-expected survival. However, deterioration in scores for a subset of patients and lower satisfaction may predict ongoing failure in this group of patients. Additionally, males were noted to have a lower degree of improvement in scores than females. As such, ongoing observation of the SCI to assess durability and survivability, and identify predictive factors, is key to improving patient selection.
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NewsBot · Oct 2, 2024 at 12:34 AM

Interposition arthroplasty may be alternative treatment option for hallux rigidus

Surgery for hallux rigidus

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Surgery for hallux rigidus

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NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

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