Arthrodesis and Hemiarthroplasty: Different Techniques in the Treatment of Hallux Rigidus—Surgery and Postoperative Rehabilitation

Abstract

Abstract:Hallux rigidus (HR) is a progressive degenerative pathology affecting the first metatarsophalangeal joint. The aim of the present study is to report our experience on the treatment of HR patients with two different surgical methods: arthrodesis and hemiarthroplasty. Twelve patients (14 HR) underwent surgery for HR from July 2004 to October 2009. Median age was 58 years (Interquartile Range (IQR) 52.75-65.0). At time of surgery, patients had different grades of HR, according to the Regnauld modified classification. The outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal (HMI) scale. Controls were performed at one month and then at mid-term follow-up (median 48 months; IQR 29.3-58.0). In the arthrodesis group (n = 6 HR) we observed a median improvement of 35.5 points (IQR 34.75-36.0; p = 0.036) at the early follow-up. In the hemiarthroplasty (n = 8 HR) group the median of differences at the one-month follow-up was 33 (IQR 30.5-33.0; p = 0.022). At mid-term follow-up the arthrodesis group showed the median difference score of 35 in comparison with the hemiarthroplasty group which showed a median score of 30.5 (IQR 28.0-32.5). Our results are consistent with the current understanding of two surgical techniques for the treatment of HR: nowadays, arthrodesis is considered the treatment of choice in grade III and IV. Hemiarthroplasty seems to be a promising option. Management of pain and joint flexibility are fundamental to prevent relapses and restore the Range Of Motion (ROM) in dorsal flexion. This article is a retrospective case series with a level of evidence 4.

Single and dual incision technique for acute distal biceps rupture: clinical and functional outcomes

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Joint preserving surgery for osteoarthritis of the big toe using a cartilage-like implant

“…2 Common causes include activity-related repetitive trauma (sports and occupational) and inappropriate footwear. 1,3 Other factors are direct toe injury, fractures, rheumatoid arthritis, increased age, long proximal phalanx of toe, hypermobile first ray, tarsal coalition, ankylosis of sesamoids to the first metatarsal head, irregular morphology, soft tissue contracture and family history.…”

“…2 Common causes include activity-related repetitive trauma (sports and occupational) and inappropriate footwear. 1,3 Other factors are direct toe injury, fractures, rheumatoid arthritis, increased age, long proximal phalanx of toe, hypermobile first ray, tarsal coalition, ankylosis of sesamoids to the first metatarsal head, irregular morphology, soft tissue contracture and family history.Treatment options of hallux rigidus remain controversial. These vary from cheilectomy, soft tissue release, first metatarsal osteotomies, arthrodesis, excisional arthroplasty; to hemiarthroplasty and total arthroplasty using different implants such as metal alloy, silastic and ceramic.…”