A comparison between metatarsal head-resurfacing hemiarthroplasty and total metatarsophalangeal joint arthroplasty as surgical treatments for hallux rigidus: a retrospective study with short- to midterm follow-up

Abstract

PurposeWe evaluated the short- to midterm outcomes of metatarsal head-resurfacing hemiarthroplasty and total metatarsophalangeal joint arthroplasty (total joint replacement [TJR]) as surgical treatments for advanced-stage hallux rigidus (HR).Patients and methodsFrom 2012 to 2014, all data from patients who underwent surgery for the treatment of grades 2–3 HR were retrospectively reviewed, and 45 patients were included in this study. Of these patients, 26 underwent metatarsal head-resurfacing hemiarthroplasty (Group I) and 19 underwent TJR (Group II). All patients were clinically graded prior to surgery and at their final follow-up visits using the American Orthopedic Foot and Ankle Society’s (AOFAS) hallux metatarsophalangeal–interphalangeal scale, a visual analog scale (VAS), and the “first metatarsophalangeal joint range of motion” (MTPJ ROM) score.ResultsMetatarsal head resurfacing was performed on 26 patients. Two patients underwent bilateral procedures, yielding a total of 28 cases in Group I. TJR was performed on 19 patients in Group II. Of the 26 Group I patients, 12 (46.2%) were male and 14 (53.8%) were female, with a mean age of 56.3±4.5 years (range: 47–63 years); the mean follow-up duration was 29.9±5.2 months. Of the 19 Group II patients, eight (42.1%) were male and eleven (57.9%) were female, with a mean age of 57.1±5.8 years (range: 45–66 years); the mean follow-up duration was 27.1±7.5 months. Significant improvements were evident in the AOFAS scores, and the VAS scores decreased, in both groups. No significant difference was evident between groups I and II.ConclusionAfter failure of conservative treatment in patients with moderate-to-severe HR, both MTPJ hemiarthroplasty and TJR were associated with effective recovery of toe function and MTPJ ROM, as well as good short- to midterm functional outcomes.

Hemiarthroplasty Versus Total Joint Arthroplasty for Hallux Rigidus: A Systematic Review and Meta-analysis

“…Range of motion was reported by 4 studies (138 patients,145 feet). 9,14,15,17 Total arthroplasty patients improved by an estimated 32.47° (95% CI = 29.86°, 35.08°) from a preoperative baseline value of 24.8°. Hemiarthroplasty patients experienced a more significant improvement of 42.95° (95% CI = 39.32°, 46.57°) from a preoperative mean of 24.47°.…”

“…Participant gender was reported in 10 studies (293 patients). 9,10,[13][14][15][16]18,19 In all, 61.2% of the patients were identified as female; the total joint replacement group being 63.8% (83) female 14,15,18,19 compared PRISMA flow diagram: an illustration of the overall search, exclusion, and inclusion methods performed in this article. We identified 11 unique studies that fit our criteria for further qualitative review.…”

“…with an MT head resurfacing hemiarthroplasty group that was 58.5% (38) female. 9,10,[13][14][15] Two studies (56 patients, 62 feet) reported the number of feet operated of each gender instead of patient number. 11,12 Out of 62 feet, 40 feet (64.5%) were of female patients.…”

Association Between Patient Factors and Outcome of Synthetic Cartilage Implant Hemiarthroplasty vs First Metatarsophalangeal Joint Arthrodesis in Advanced Hallux Rigidus

“…Most previous comparative studies of operative treatment for hallux rigidus have small numbers in each treatment arm. 9,10,16,17,19,22 The data from this study are broadly generalizable, as they represent patients enrolled by 49 surgeons from 12 centers across two countries. This study provides the first thorough evidence of the association between patient factors and clinical outcomes following hallux rigidus surgery.…”

“…Several studies have directly compared the short-to mid-term outcomes (i.e., 2 to 4 years) of first MTPJ hemiarthroplasty with various implants to MTPJ arthrodesis. 9,10,13,17,19,20,22 However, these studies either did not evaluate the association between patient factors and outcomes, 10,20,22 or the sample sizes were too small to permit such analyses. 9,17,19 FAI-17-0187-R2 2017-Jun5…”