Patient-reported outcomes of joint-preserving surgery for moderate hallux rigidus: a 1-year follow-up of 296 patients from Swefoot

Abstract

Background and purpose — Hallux rigidus (HR) may cause decreased range of motion, joint pain, and gait disturbances. There is a lack of evidence regarding the outcome of different surgical procedures for moderate HR. We report patient-reported outcomes after joint-preserving surgical procedures for moderate HR. Patients and methods — We included 296 patients registered in Swefoot (Swedish national registry of foot and ankle surgery) who underwent primary surgery for moderate HR 2014 through 2018. We extracted information on anthropometrics, grading of HR, chosen surgical procedure, and patient-reported data including the PROMs SEFAS (summary score 0–48) and EQ-5D-3L (index 0–1) preoperatively and 1 year postoperatively. Results — 115 patients underwent metatarsal decompression (i.e., Youngswick) osteotomy (YOT) and 181 underwent cheilectomy. The mean improvement in SEFAS score 1 year after surgery was 12 points (95% CI 10 − 13) for YOT and 10 points (CI 9 − 12) for cheilectomy. Also, EQ-5D improved in both groups. Patients who underwent YOT were more satisfied with the procedure (84% vs. 70% for cheilectomy, p = 0.02). Interpretation — Surgically treated patients with moderate HR improved after both YOT and cheilectomy, according to patient-reported data from Swefoot. Patients who underwent a YOT were more satisfied with their procedure. One possible explanation may be that more patients in the YOT group had a concomitant hallux valgus; however, we have no information on this.

Baseline and 1-Year Follow-Up Data of Patients with End-Stage Hallux Rigidus Treated with an Arthrodesis Reported to Swefoot

“…The questions are presented in Figure 2. Additionally, the improvement in SEFAS score from before to after surgery is greater than we found when we compared patient-reported outcome for osteotomies or cheilectomies in patients with moderate HR 17 . In that study the delta SEFAS score was 12 units for osteotomy and 10 units for cheilectomy.…”

“…The difference in postoperative SEFAS compared to the general population in their age group is 4 or 2 units, less than the MIC of 5 units. Additionally, the mean postoperative SEFAS score was 36 after cheilectomy and 38 after osteotomy in the study by Cöster et al 17 , indicating that the arthrodesis patients rate their function to be equally good or better than patients surgically treated with cheilectomy or osteotomy. These findings are not what we expected because with a fused joint the mobility of the joint is eliminated which change the biomechanics for the whole foot and ankle and the gait pattern.…”

“…It offers pain relief and fast return to daily activities 1,9 . Youngswick osteotomy is a chevron-shaped decompression osteotomy of the first metatarsal where a slice of bone is removed in the dorsal arm of the osteotomy to achieve plantar and proximal displacement of the metatarsal head 16,17 . It is, like cheilectomy, mostly used in early stages of HR and offers increased mobility as well as pain relief 15 .…”

“…In addition to the PROMs, there are 4 complementary questions regarding pain, strength, appearance, and shoes. The postoperative questionnaires also include questions regarding how satisfied the patients are with the surgery as well as if there were any adverse events (figure 2) 17 .…”

Polyvinyl Alcohol Hydrogel Hemiarthroplasty of First Metatarsophalangeal Joint Hallux Rigidus

“…Treatment of this condition includes nonoperative and operative techniques, with nonoperative measures primarily aimed at shoe wear and lifestyle modification [3]. Given the rising demand for operative treatment of HR in an aging population, a variety of surgical techniques have been developed for the treatment of severe MTPJ arthritis [4][5][6][7][8][9][10]. These treatment modalities can be largely subdivided into jointsparing and joint-sacrificing techniques.…”