Metallic hemiarthroplasty or arthrodesis of the first metatarsophalangeal joint as treatment for hallux rigidus: A systematic review and meta-analysis

Bot, Robin T A L de; Veldman, Hidde D.; Eurlings, Roxanne; Stevens, Jasper; Hermus, Joris P.S.; Witlox, Adhiambo M.

doi:10.1016/j.fas.2021.03.004

Cited by 12 publications

(5 citation statements)

References 61 publications

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“…Previous investigations with dynamic pedobarography acknowledged that first MTP arthrodesis provides some restoration of the loadbearing role of the first ray during gait. 8 , 14 , 24 , 48 However, this statement was challenged by Stevens et al 44 In their study comparing patients with first MTP arthrodesis to healthy controls, they found higher PP beneath the lesser toes and lateral metatarsal heads in the arthrodesis group, whereas PTI was lower beneath the hallux and higher beneath the fourth metatarsal head. 44 They concluded to a load transfer from the first ray toward the lesser metatarsals.…”

Section: Discussionmentioning

confidence: 99%

“… 22 In such cases, arthrodesis is supposed to provide more effective pain relief when compared to several motion-preserving alternatives. 14 , 37 , 43 Satisfactory outcomes have been reported with various surgical techniques to achieve first MTP fusion. 8 , 10 , 17 , 18 , 20 , 23 , 38 , 47 , 50 Options essentially concern the surgical approach, joint preparation, and the fixation method.…”

Section: Introductionmentioning

confidence: 99%

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Primary Isolated Arthrodesis of the First Metatarsophalangeal Joint for Hallux Rigidus: Clinical, Radiologic, and Pedobarographic Evaluation

Fragnière,

Kameni-Hekam,

Cissé

et al. 2024

Foot & Ankle Orthopaedics

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Background: Arthrodesis of the first metatarsophalangeal joint is an effective treatment of advanced hallux rigidus. Numerous options have been described for performing this intervention. The aim of this study was to evaluate the outcomes following a consistent surgical technique of joint preparation with hand tools and fixation with 2 crossed screws and a dorsal compression plate. Methods: Thirteen patients (16 feet) who underwent primary isolated arthrodesis of the first metatarsophalangeal joint between March 2019 and June 2021 were available for clinical, radiologic, and pedobarographic evaluation at a minimum of 12 months after surgery. American Orthopaedic Foot & Ankle Society scores, numerical pain rating scale, the radiologic hallux valgus and intermetatarsal 1-2 angles as well as the distribution of plantar pressure during gait were compared between the pre- and postoperative conditions. Results: After an average follow-up period of 26 months, union was achieved in all cases and the mean AOFAS score raised significantly by 39 points. All the patients were satisfied with the result. Only 1 patient complained of mild residual pain at walk. Hardware removal was performed in 2 cases. The mean hallux valgus angle dropped from 12.3 to 6.3 degrees. The mean postoperative dorsiflexion angle was 21.6 degrees. After the procedure, peak pressure was significantly higher beneath the first metatarsal head and heel, whereas pressure-time integral was significantly lower beneath the hallux and medial lesser toes. Conclusion: Arthrodesis of the first metatarsophalangeal joint with 2 crossed screws and a dorsal compression plate is a safe and effective treatment of advanced hallux rigidus. This procedure provides adequate pain relief and functional improvement of gait. Level of Evidence: Level IV, therapeutic, retrospective case series.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Primary Isolated Arthrodesis of the First Metatarsophalangeal Joint for Hallux Rigidus: Clinical, Radiologic, and Pedobarographic Evaluation

Fragnière,

Kameni-Hekam,

Cissé

et al. 2024

Foot & Ankle Orthopaedics

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“…The joint-sparing nature of cheilectomy allows room, in the event of poor outcomes, for revision surgery or conversion to joint-sacrificing arthrodesis or arthroplasty. In addition, cheilectomy avoids the possible complications of arthrodesis such as the risk of non-union and implant prominence causing pain [ 16 ]. Lastly, many patients are reluctant to undergo fusion due to having to lose movement at the joint.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study Assessing the Clinical Outcomes After Cheilectomy and Subchondroplasty for Hallux Rigidus

Koh¹,

Chandrakumara²,

Socklingam³

et al. 2023

Cureus

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Introduction Hallux rigidus (HR) refers to osteoarthritis of the first metatarsal phalangeal joint, resulting in stiffness, pain, and limitation in daily function. Surgery of HR is indicated in those who have failed a trial of non-operative management and is typically divided into joint-preserving (JP) and joint-sacrificing procedures. Cheilectomy is the most commonly practiced JP procedure, often done in conjunction with associated procedures for HR. Our paper aims to report the clinical outcomes after cheilectomy and cheilectomy done with subchondroplasty (SCP) performed for HR. Methods All patients who underwent cheilectomy for HR between 2017 and 2022 were identified and had their outcomes evaluated at the time of this review. The patients had their pre-operative radiographs and clinical and operative notes analyzed for the grading of HR. Functional outcomes were assessed with the use of the visual analog scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores, as well as comparing the pre-operative and post-operative degree of dorsiflexion of the affected first metatarsophalangeal joint. This study was approved by the SingHealth Institutional Review Board (IRB) Institution with approval number 2021/2629. Results A total of 19 patients and 20 feet were included in our study at a mean follow-up of 29.8 months. There was an increase in dorsiflexion of the first MTP joint by 27.2 degrees (p-value = <0.0001) . Patients who underwent cheilectomy alone (Group 1) had a mean improvement in VAS scores of 5.46 ( p-value = <0.0001 ). Patients who underwent SCP of the first metatarsal head along with cheilectomy (Group 2) had an improvement in VAS scores by 5.78 ( p-value = 0.0007 ). There was a mean improvement in AOFAS scores of 25.6 ( p-value = <0.0001 ) for patients in Group 1. Patients in Group 2 had a mean improvement in AOFAS scores of 31.0 ( p-value = 0.0003 ). Conclusion Both cheilectomy and cheilectomy performed with SCP for HR show good outcomes at short-term follow-up (mean 29.8 months). Cheilectomy is a viable alternative to arthrodesis for the surgical treatment of HR even in patients with higher grades. The use of SCP should be further explored as an adjunct in the surgical treatment of HR.

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“…1 When conservative treatment is ineffective, surgical treatment is offered, which may include joint-sparing procedures such as cheilectomy, interposition arthroplasty, and synthetic cartilage implantation or joint-sacrificing procedures such as first MTP arthrodesis. [2][3][4][5][6][7][8] The choice of surgical treatment is determined by the severity and nature of the patient's symptoms, the degree of radiographic MTP joint deterioration, and most importantly, the patient's postoperative goals. 9 Cheilectomy is a popular procedure for early-to moderate-stage hallux rigidus as it is the least invasive treatment, allows relatively easy conversion to arthrodesis if necessary, and has been shown to meaningfully reduce pain and improve function.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Patient-Reported Outcome-Based Comparison of Cheilectomy With and Without Proximal Phalangeal Dorsiflexion Osteotomy for Hallux Rigidus

Kim

Rajan

Fuller

et al. 2023

Foot & Ankle Specialist

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Introduction This study provides the first comparison of patient-reported outcomes between isolated cheilectomy (C) and cheilectomy with Moberg (CM) osteotomy for hallux rigidus. Methods A single-center, retrospective registry search identified all patients with preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores who underwent cheilectomy, with and without concomitant proximal phalangeal dorsiflexion osteotomy, for hallux rigidus between January 2016 and December 2020. Because there were far fewer isolated cheilectomies (62), all C patients were compared with a commensurate number of consecutive CM cases (67) using preoperative, 1-year, and 2-year PROMIS scores for physical function, pain interference, pain intensity, global physical health, global mental health, and depression, as well as complication and revision data from a chart review. A multivariable linear regression analysis was performed to compare adjusted postoperative PROMIS scores between the 2 cohorts. Results There were no differences between groups among the demographic and preoperative variables compared. The CM cohort reported worse pain interference scores preoperatively (P < .001) and at 1 year postoperatively (P = .01). However, the C cohort reported worse pain intensity scores preoperatively (P < .001) and at 1 year postoperatively (P < .001). Adjusted postoperative PROMIS score comparison demonstrated that the CM cohort had better 1-year postoperative pain intensity scores (P < .05). However, there were no differences between cohorts for additional PROMIS scores or complications data. Conclusion The addition of a Moberg osteotomy does not appear to significantly change short- to medium-term outcomes of cheilectomy for hallux rigidus treatment. Levels of Evidence: Level III: Retrospective comparative study

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Metallic hemiarthroplasty or arthrodesis of the first metatarsophalangeal joint as treatment for hallux rigidus: A systematic review and meta-analysis

Cited by 12 publications

References 61 publications

Primary Isolated Arthrodesis of the First Metatarsophalangeal Joint for Hallux Rigidus: Clinical, Radiologic, and Pedobarographic Evaluation

Primary Isolated Arthrodesis of the First Metatarsophalangeal Joint for Hallux Rigidus: Clinical, Radiologic, and Pedobarographic Evaluation

A Retrospective Study Assessing the Clinical Outcomes After Cheilectomy and Subchondroplasty for Hallux Rigidus

A Patient-Reported Outcome-Based Comparison of Cheilectomy With and Without Proximal Phalangeal Dorsiflexion Osteotomy for Hallux Rigidus

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