Long-term Effects of Cheilectomy, Keller’s Arthroplasty, and Arthrodesis for Symptomatic Hallux Rigidus on Patient-Reported and Radiologic Outcome

Abstract

<jats:sec><jats:title>Background:</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> Level III, comparative study. </jats:p></jats:sec>

Relationship Between Preoperative PROMIS Scores and Postoperative Outcomes in Hallux Rigidus Patients Undergoing Cheilectomy

“…14,16 Although existing literature reports good overall outcomes of cheilectomy in earlystage hallux rigidus, a meaningful subset of patients does not significantly improve after cheilectomy and may require conversion to arthrodesis of the great toe MTP joint because of inadequate symptomatic relief. 20 Sidon et al reported a 70.4% survival rate, defined as painless at the time of latest followup, for a cheilectomy for hallux rigidus at a minimum of 5year followup (average 6.6 years), with 4% of patients undergoing an arthrodesis. 19 Thus, a method of determining which patients are likely to experience significant improvement after cheilectomy would be clinically useful for surgeons as they counsel patients on surgical options for treatment.…”

Minimally Invasive Dorsal Cheilectomy and Hallux Metatarsal Phalangeal Joint Arthroscopy for the Treatment of Hallux Rigidus

“…7,15 End-stage first metatarsophalangeal (MTP) osteoarthritis with mid-range symptoms are best served with arthrodesis. 2,[3][4][5][6]9,11,13,15,16,20,21,27,31 Patients with mild to intermediate-grade changes who lack midrange pain have traditionally had excellent outcomes including improved pain and range of motion with open dorsal cheilectomy. 10,12,17,24,26,27 Minimally invasive dorsal cheilectomy (MIDC) has become an increasingly popular alternative to the open approach.…”

“…2,[3][4][5][6]9,11,13,15,16,20,21,27,31 Patients with mild to intermediate-grade changes who lack midrange pain have traditionally had excellent outcomes including improved pain and range of motion with open dorsal cheilectomy. 10,12,17,24,26,27 Minimally invasive dorsal cheilectomy (MIDC) has become an increasingly popular alternative to the open approach. Commonly using a dorsomedial stab incision and percutaneous instrumentation, the dorsal osteophyte resection can be performed under fluoroscopic guidance.…”

Patient Satisfaction Following Hallux Rigidus Treatment With a Synthetic Cartilage Implant

“…5-9 However, for advanced stage hallux rigidus (grade IIIb or IV), Coughlin and Shurnas 10 recommend arthrodesis instead. First MTP joint arthrodesis has long been considered the gold standard of hallux rigidus treatment because of its reliability in relieving pain and achieving excellent functional outcomes for patients 11-14 ; however, sacrifice of first MTP joint mobility is an inevitable consequence of the procedure. Rising concern over altered postoperative forefoot biomechanics, reduced capacity for certain activity types, and restricted footwear selection has fueled the search for surgical treatments capable of mitigating pain while preserving joint motion, such as hemiarthroplasty or total joint arthroplasty with silicon, metal, and ceramic implants.…”