Correlation of Hallux Rigidus Grade With Motion, VAS Pain, Intraoperative Cartilage Loss, and Treatment Success for First MTP Joint Arthrodesis and Synthetic Cartilage Implant

Baumhauer, Judith F.; Singh, Dishan; Glazebrook, Mark; Blundell, Chris; Vries, Gwyneth de; Le, Ian; Nielsen, Dominic; Pedersen, M. Elizabeth; Sakellariou, Anthony; Solan, Matthew; Wansbrough, Guy; Younger, Alastair; Daniels, Timothy R.

doi:10.1177/1071100717735289

Cited by 43 publications

(33 citation statements)

References 12 publications

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“…In addition to patient-reported outcomes, other studies have also evaluated range of motion or radiographic outcomes, which were not evaluated in our study. 2 , 4 Our cohort was also not subdivided by grade of hallux rigidus, though indication for operative intervention with PVA implant at our institution typically includes patients with grade II or grade III hallux rigidus based on the Coughlin scale. 5 A prior study assessing hemiarthroplasty with PVA hydrogel implant based on hallux rigidus grade showed that the implant can be used successfully for patients with grade II, III, or IV hallux rigidus.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of the Polyvinyl Alcohol (PVA) Hydrogel Implant for Hallux Rigidus

et al. 2020

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Background: Hallux rigidus is a common arthritic condition that has been addressed surgically with a range of techniques, from an isolated cheilectomy to first metatarsophalangeal (MTP) joint fusion. Recently, hemiarthroplasty with polyvinyl alcohol (PVA) hydrogel implant has been used as an alternative treatment to relieve pain while preserving motion of the first MTP joint. We retrospectively reviewed patient-reported outcome scores and clinical outcomes for patients treated for hallux rigidus with PVA hydrogel implant at an academic, multisurgeon center. Methods: A total of 103 patients who underwent first MTP hemiarthroplasty with PVA hydrogel implant between January 2017 and October 2018 were retrospectively reviewed (average, 26.2 months). Eight surgeons were represented. Baseline Patient-Reported Outcomes Measurement Information System (PROMIS) scores for the Physical Function, Pain Interference, Pain Intensity, Global Physical Health, Global Mental Health, and Depression domains were collected prospectively and compared with PROMIS scores collected at a minimum of 1 year postoperatively (average, 13.9 months). Seventy-three patients had both preoperative and postoperative scores. Ten of these patients had undergone a prior procedure of the first MTP, and 52 underwent concurrent Moberg osteotomy at the time of PVA hydrogel implantation. Results: For patients with baseline and postoperative PROMIS scores, significant pre- to postoperative improvement was detected for the Physical Function, Pain Interference, Pain Intensity, and Global Physical Health domains ( P < .05). Patients who had undergone a prior procedure of the first MTP had significantly higher postoperative Pain Intensity scores compared with those who did not undergo a prior procedure. Patients undergoing concurrent Moberg osteotomy had significantly lower postoperative Pain Interference and Pain Intensity scores compared with those who did not undergo a Moberg. Two patients underwent revision procedures in the first 2 years postoperatively, one with revision hemiarthroplasty and one with conversion to arthrodesis. Conclusion: On average across our entire cohort, physical function and pain scores improved significantly pre- to postoperatively; however, postoperative pain scores were significantly higher for patients who had undergone a prior procedure of the first MTP and significantly lower for patients who underwent concurrent Moberg osteotomy. The implant displayed excellent survivorship in the first 2 years postoperatively, with only 2 revision procedures. Level of Evidence: Level III, comparative series.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of the Polyvinyl Alcohol (PVA) Hydrogel Implant for Hallux Rigidus

et al. 2020

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“…Cheilectomy, at times with proximal phalanx osteotomy, is typically reserved for mild to moderate hallux rigidus, 2,9,16,20 whereas arthrodesis is the most predictable procedure for severe hallux rigidus. 1,2,5,11,21…”

Section: Introductionmentioning

confidence: 99%

Effect of Age on Complication Rates and Outcomes Following First Metatarsophalangeal Arthrodesis for Hallux Rigidus

et al. 2020

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Background: Hallux rigidus is one of the most common toe pathologies in patients greater than 50 years old. Although metatarsophalangeal (MTP) arthrodesis is used to improve pain and function, older patients are often considered to be higher-risk operative candidates. There are minimal data on outcomes of MTP fusion and no studies comparing outcomes between geriatric and younger patients. Methods: This is a single-center, prospective study of all patients who underwent MTP fusion between August 1, 2015, and July 1, 2018. Patient-reported outcomes were assessed using the Short Form Health Survey (SF-36), Life-Space Assessment survey (LSA), and visual analog scale (VAS) for pain administered preoperatively as well as 6 months and 1 year postoperatively. Baseline characteristics and operative outcomes were collected from the electronic medical record. Clinical and patient-reported outcomes were compared between patients <65 years old and ≥65 years old. Of 143 included patients, 79 were in the younger group (mean of 56.5 years) and 64 were in the older group (mean of 72.0 years). Results: Compared with the younger group, the older group was more predominantly female (95.3% older group, 77.2% younger group, P = .002). More patients in the older group had hypertension (73.4% older group, 50.6% younger group, P = .005) and coronary artery disease (9.4% older group, 0.0% younger group, P = .005). Both age groups had similar rates of postoperative wound complications requiring operative irrigation and debridement, deep vein thrombosis, deformity recurrence, and revision surgery. No differences were detected in SF-36, LSA, and VAS surveys administered at baseline, 6 months postoperation, or 1 year postoperation between younger and older patients. Conclusion: Despite more comorbidities, older patients had similar rates of postoperative complications and reported similar outcomes for pain, function, and mobility following MTP fusion. These findings support increased implementation of MTP fusion surgery for older patients with hallux rigidus. Level of Evidence: Level II, prospective cohort.

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“…8 Arthrodesis remains the gold standard for severe hallux rigidus, although promising results have been shown recently with a synthetic cartilage implant. 1 A dorsal cheilectomy can be performed for patients in early stages of hallux rigidus. This can result in good relief of their symptoms provided that it mainly consists of impingement pain and stiffness in the absence of mid-range pain and a negative grind test.…”

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confidence: 99%

Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus

et al. 2018

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Background: Following failure of conservative treatment, a dorsal cheilectomy can be performed for patients in early stages of hallux rigidus by a traditional open approach or by a minimally invasive technique. We report our clinical outcomes following minimally invasive dorsal cheilectomy (MIDC). Methods: Eighty-nine patients (98 feet) with symptomatic hallux rigidus treated between 2011 and 2016 were included in this study. The average age was 54 years. Manchester-Oxford Foot Questionnaire (MOxFQ) scores and visual analog scale (VAS) pain scores were collected. The mean follow-up was 50 months. Results: The average VAS score improved from 8.0 preoperatively to 3 postoperatively. The mean MOxFQ summary index score decreased from 58.6 preoperatively to 30.5 postoperatively. All 3 MOxFQ domains also improved. Swelling took an average of 5.3 weeks to settle. There were 2 wound infections and 2 delayed wound healings. Two patients had transient nerve paraesthesia, while 2 patients had permanent numbness in the dorsomedial cutaneous nerve distribution. Twelve patients (12%) underwent reoperation, of which 7 had a first metatarsophalangeal joint arthrodesis for ongoing pain, 4 had repeat cheilectomy for residual impingement, and 1 had an open removal of loose bone. Conclusion: Our results suggest that MIDC resulted in improvement in patient-reported outcome measures and was a safe technique with minimal complications. The complications were similar to open cheilectomy. There was an associated learning curve as 5 of our reoperations were due to incomplete cheilectomy. Coughlin grade 1 did well with MIDC as with open cheilectomy as none went onto an arthrodesis. However, 10% (7/65) of our grade 2 and 3 cases went on to an arthrodesis. Level of Evidence: Level IV, retrospective case series.

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Correlation of Hallux Rigidus Grade With Motion, VAS Pain, Intraoperative Cartilage Loss, and Treatment Success for First MTP Joint Arthrodesis and Synthetic Cartilage Implant

Abstract: Level II, randomized clinical trial.

Cited by 43 publications

References 12 publications

Clinical Outcomes of the Polyvinyl Alcohol (PVA) Hydrogel Implant for Hallux Rigidus

Clinical Outcomes of the Polyvinyl Alcohol (PVA) Hydrogel Implant for Hallux Rigidus

Effect of Age on Complication Rates and Outcomes Following First Metatarsophalangeal Arthrodesis for Hallux Rigidus

Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus

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