Outcomes Following Interposition Arthroplasty of the First Metatarsophalangeal Joint for the Treatment of Hallux Rigidus: A Systematic Review

Abstract

Background: Interposition arthroplasty of the first MTP joint has recently experienced renewed interest as a treatment for hallux rigidus. The purpose of this study was to systematically review the rapidly expanding literature on PRO following interposition arthroplasty of the first MTP joint. Methods: PubMed Central, Embase, and the Cochrane Central Register for Controlled Trials (CENTRAL) were searched. Inclusion criteria included length of time to follow-up, number of patients, outcome measure, and use of allogeneic or autogenous soft tissue or a synthetic matrix as interposition. Results: 20 studies were included in the review, comprising 498 patients and 539 feet with mean time to follow-up of 4.5 years. The most common substance used for interposition in the included studies was autogenous first MTPJ capsular tissue, a technique reported on in 12 (60.0%) of the included articles. In studies reporting preoperative and postoperative outcomes by way of a standardized outcome scoring system, mean group improvements exceed minimal clinically important differences in the majority of studies. Eighty-five percent of the studies included in this review were of Level IV quality evidence, and of this subset of studies, 70.6% were of a retrospective nature. Progression to further surgery was observed in 3.8% of toes. The most common complication reported was transfer metatarsalgia of 1 or more lesser toes, observed in up to 57.9% of patients in one study. Conclusion: Interposition arthroplasty appears to be a viable option for the treatment of moderate to severe hallux rigidus in patients looking to salvage motion through the first metatarsophalangeal joint. A wide array of autogenous, allogeneic, and synthetic implant materials have surfaced in recent years, but long-term follow-up and prospective, comparative study designs with low risk of bias are limited.

Capsular Interposition Arthroplasty With Percutaneous Suture Anchoring: A Pragmatic and Novel Surgical Technique for Hallux Rigidus

“…Our variation of the CIA involves percutaneous suturing of the graft through the plantar skin of the first MTPJ as a stabilizing mechanism to facilitate attachment to a vascular bed of bleeding subchondral bone. We believe this provides a safe and reliable advancement in the performance of this procedure, provides a viable surgical solution for stage 2 and 3 HR, with some evidence that it may have a place in stage 4 of the deformity [17]. This approach is technically straightforward and preserves the anatomic (osseous and vascular) integrity of the first MTPJ.…”

“…This lack of a standardized approach is due in part to the inherent technical difficulties associated with this procedure. Such difficulties include concerns with the stabilization of the graft, achieving adequate metatarsal head coverage, and blocking of the joint through a lack of decompression [17]. These difficulties and the variations in technique may be enough for some surgeons to refrain from using this procedure.…”

“…Capsular interposition arthroplasty (CIA) involves the removal of the osteophytic bone (cheilectomy) and the interposing of a split-thickness autogenous (MTPJ joint capsule) graft to re-surface the metatarsal head. Other graft tissue types have been described such as hamstring and synthetic variants [ 17 ]. The use of an interposition graft has been studied extensively, including in three systematic reviews [ 6 , 17 - 19 ].…”

“…Other graft tissue types have been described such as hamstring and synthetic variants [ 17 ]. The use of an interposition graft has been studied extensively, including in three systematic reviews [ 6 , 17 - 19 ]. These reviews highlight both the potential value of the procedure and concerns regarding the lack of a standardized approach to the procedures [ 2 , 6 , 12 ].…”