Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus

Teoh, Kar Hao; Tan, Wei Teen; Atiyah, Zeid; Ahmad, Aziz; Tanaka, Hiro; Hariharan, Kartik

doi:10.1177/1071100718803131

Cited by 37 publications

(46 citation statements)

References 15 publications

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“…We found only a few studies that describe the timing of the revision surgery. One of these studies, which described the long-term results of minimally invasive dorsal cheilectomy, 21 similarly found that most of the failures were within the first 2 years postsurgery. Another study reported a 4.9% failure rate, documented as revisions in mid- to long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Long-term Follow-up of Cheilectomy for Treatment of Hallux Rigidus

et al. 2019

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Background:Hallux rigidus is the most common arthritic condition in the foot. First metatarsophalangeal joint cheilectomy produces satisfactory results in retrospective studies with reported good to excellent results in up to 97% and pain relief and function in 92%. The results of cheilectomy for higher grades of hallux rigidus are less favorable. The purpose of this study was to evaluate the long-term functional results and survivorship of cheilectomy for treatment of hallux rigidus.Methods:This was a retrospective, questionnaire-based study investigating the long-term results of cheilectomy for treatment of hallux rigidus. The preoperative arthritic grade was graded retrospectively according to the Hattrup and Johnson (H&J) grading system. A questionnaire was administered via email or telephone that included questions regarding pain recurrence following surgery, current functional status, and satisfaction with the operation. Kaplan-Meier survival analysis was performed to estimate survival time between arthritic grades. We reviewed 165 patients (169 feet) with an average follow-up of 6.6 (5.0-10.9) years.Results:The overall survival rate (painless at the time of last follow-up) was 70.4% (119 feet), with no significant difference between the 3 H&J arthritic grades. Most of the recurrences (28 feet, 75%) were at the first 2 years following the surgery. Nine feet (5.3%) had a second procedure at a mean postoperative time of 3.6 (range, 1.6-7.4) years. Of the 169 feet, 117 (69.3%) reported being satisfied or very satisfied and 127 (75.1%) indicated they would repeat the operation under the same circumstances.Conclusion:Our study supports the use of cheilectomy for treatment of hallux rigidus (grade 1-3 Coughlin and Shurnas) as a reliable procedure with favorable results. At long-term follow-up, patients who underwent cheilectomy had a low revision rate and a moderately low rate of pain recurrence.Level of Evidence:Level IV, retrospective case-series.

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Section: Discussionmentioning

confidence: 99%

Long-term Follow-up of Cheilectomy for Treatment of Hallux Rigidus

et al. 2019

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“…3,7,13 In the present study, none of the patients undergoing open dorsal cheilectomy procedures required further surgery for dorsal impingement pain. Correspondingly, with MIS dorsal cheilectomy, using the technique advocated by Redfern et al, 18 the sole study in the literature with a relatively large number of patients 23 identified a failure to relieve symptoms in 12% of cases, with 4% requiring further dorsal cheilectomy surgery for dorsal impingement pain. These results from Teoh et al 23 reflect the findings of the present study, in which 3.8% (5/133) of patients had to undergo a further dorsal cheilectomy.…”

Section: Discussionmentioning

confidence: 99%

“…This is acknowledged as a “learning curve.” Within the literature, there are no references to a learning curve for performing an open dorsal cheilectomy, but it is readily accepted as being a straightforward operative technique. In the study by Teoh et al, 23 the technique for MIS dorsal cheilectomy appears to be subject to a learning curve. This was assessed by 2 endpoints: (1) attributing 42% of the cases requiring reoperation to poor technique and (2) observing a decreasing intraoperative fluoroscopic screening time as the case series progressed chronologically.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Complication and Reoperation Rates for Minimally Invasive Versus Open Cheilectomy of the First Metatarsophalangeal Joint

et al. 2019

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Background: Dorsal cheilectomy of the first metatarsophalangeal joint is an accepted treatment to alleviate dorsal impingement, pain, and reduced dorsiflexion in hallux rigidus. Traditionally performed via an open incision, this procedure has more recently been performed using minimally invasive techniques despite limited supportive published evidence. Methods: From December 2012 through December 2017, a retrospective analysis of all cheilectomies performed in our institution was done. The surgical technique was recorded along with any subsequent procedures performed for either persistent or recurrent pain, and complications were also noted. A comparison between open and minimally invasive outcomes was performed. In total, 171 cheilectomies were performed during this period. There were 38 open and 133 minimally invasive procedures. Results: At a mean 3-year follow-up, the reoperation rates of the 2 groups were different with only 1 (2.6%) of the open group requiring a fusion, while 17 (12.8%) of the minimally invasive surgical (MIS) group required further surgery (relative risk, 4.86; P = .059). In the open group, there was 1 (2.6%) complication, compared with 15 (11.3%) in the minimally invasive group (relative risk, 4.29; P = .076). Conclusion: While patients may opt for MIS cheilectomy with a proposed faster recovery time and better cosmesis, they should be counseled about the risks and benefits of both methods, and that the technique of MIS cheilectomy utilized in this study appears to have an increased relative risk of requiring a further procedure. Level of Evidence: Level III, retrospective comparative series.

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“…A sala cirúrgica estava equipada com um intensificador de imagem, um motor elétrico e os instrumentais necessários para a cirurgia percutânea (raspas, fresas, lâminas) (14,15) . O primeiro passo cirúrgico foi a queilectomia percutânea dos osteófitos dorsal e dorso-lateral (19) presentes na cabeça do primeiro metatatarsal (Figura 1), através de uma incisão com cerca de 1cm. Os detritos ósseos foram retirados pela compressão do hálux e a saída dos mesmos pela incisão prévia, além da limpeza com soro fisiológico em uma seringa inserida no portal (14,15) .…”

Section: Técnica Cirúrgicaunclassified

Percutaneous cheilectomy combined with Watermann and Moberg osteotomies for the treatment of hallux rigidus

Arruda

Baptista

2019

Sci J Foot Ankle

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Objective: To evaluate the clinical and functional outcomes of patients subjected to surgical treatment of hallux rigidus by the percutaneous cheilectomy combined with Watermann and Moberg osteotomies. Methods: Between May 2017 and August 2018, the clinical outcomes of 7 patients with a diagnosis of hallux rigidus (HR) treated using the percutaneous technique were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scale, the visual analogue scale (VAS) for pain and hallux metatarsophalangeal joint range of motion measurements during the pre- and postoperative periods. Clinical and functional outcomes were followed up for a minimum of 6 months (mean of 8 months). Results: The range of motion of the metatarsophalangeal joint during the pre- and postoperative periods showed the following results: dorsiflexion increased on average from 28.00º (± 15.63) to 44.43º (± 17.33) (p = 0.006), demonstrating an effective gain in dorsal articular movement. Plantar flexion ranged on average from 27.43º (± 2.22) to 24.43º (± 5.28) (p = 0.228), with no significant difference between the evaluated periods. The AOFAS score increased on average from 52.71 (± 9.63) to 88.00 (± 8.10) (p < 0.01), representing important functional improvement. The VAS score decreased on average from 7.00 (± 1.52) to 2.14 (± 2.19) (p = 0.002), indicating a significant improvement in patient pain. No patient presented postoperative complications. Conclusion: The results of the present study demonstrated that cheilectomy combined with percutaneous Watermann and Moberg osteotomies is an effective surgical treatment for hallux rigidus, with satisfactory clinical and functional outcomes. Level of Evidence IV; Therapeutic Studies; Case Series.

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Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus

Cited by 37 publications

References 15 publications

Long-term Follow-up of Cheilectomy for Treatment of Hallux Rigidus

Long-term Follow-up of Cheilectomy for Treatment of Hallux Rigidus

Comparison of Complication and Reoperation Rates for Minimally Invasive Versus Open Cheilectomy of the First Metatarsophalangeal Joint

Percutaneous cheilectomy combined with Watermann and Moberg osteotomies for the treatment of hallux rigidus

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