Physical Function and Pain Interference Levels of Hallux Rigidus Patients Before and After Synthetic Cartilage Implant vs Arthrodesis Surgery

Abstract

Background: Hallux rigidus is a common and painful degenerative condition of the great toe limiting a patient’s physical function and quality of life. The purpose of this study was to investigate pre- and postoperative physical function (PF) and pain interference (PI) levels of patients undergoing synthetic cartilage implant hemiarthroplasty (SCI) vs arthrodesis (AD) for treatment of hallux rigidus using the Patient-Reported Outcomes Measurement Information System (PROMIS). Methods: PROMIS PF and PI t scores were analyzed for patients who underwent either SCI or AD. Postoperative final PROMIS t scores were obtained via phone survey. Linear mixed model analysis was used to assess differences in PF and PI at each follow-up point. Final follow-up scores were analyzed using independent sample t tests. Results: Total 181 (59 SCI, 122 AD) operatively managed patients were included for analysis of PROMIS scores. Final phone survey was performed at a minimum of 14 (mean 33, range, 14-59) months postoperatively, with 101 patients (40 SCI, 61 AD) successfully contacted. The mean final follow-up was significantly different for SCI and AD: 27 vs 38 months, respectively ( P < .01). The mean age of the SCI cohort was lower than the AD cohort (57.5 vs 61.5 years old, P = .01). Average PF t scores were higher in the SCI cohort at baseline (47.1 and 43.9, respectively, P = .01) and at final follow-up (51.4 vs 45.9, respectively, P < .01). A main effect of superior improvement in PF was noted in the SCI group (+4.3) vs the AD group (+2) across time intervals ( P < .01). PI t scores were similar between the 2 procedures across time points. Conclusion: The SCI cohort reported slightly superior PF t scores preoperatively and at most follow-up time points compared with the arthrodesis group. No differences were found for PI or complication rates between the 2 treatment groups during this study time frame. Level of Evidence: Level III.

Effect of Prior Cheilectomy on Outcomes of First Metatarsophalangeal Joint Fusion for Treatment of Hallux Rigidus

“…The improvements were comparable to outcomes reported in the literature after MTP fusion, as previous studies also found significant improvement in PROMIS physical function at 38 months’ follow-up, which lends to the validity of our analysis. 15 The improvements seen in our study cohorts were also clinically significant when compared to estimated minimal clinically important difference (MCID) values of 4.5 for PROMIS physical function and 4.1 for PROMIS pain interference in a study of patients undergoing foot and ankle surgery. 13 Although there are no studies specifically estimating MCIDs after an MTP fusion, MCIDs for cheilectomy in patients with hallux rigidus have been reported.…”

Surgical Outcomes of Synthetic Cartilage Implant Hemiarthroplasty for Metatarsophalangeal Arthropathy

“…The literature reports SCI procedures cause significantly less post-operative pain and significantly higher functional scores in the first six months post-surgery [ 11 , 23 ], with significantly reduced operative time and need for anesthesia [ 13 ], demonstrating a possibly faster initial recovery. However, these short-term benefits are found to reach no further significant difference at later follow-up (one and two years) [ 11 , 13 , 23 ] with evidence of significantly higher VAS pain scores in patients receiving an SCI [ 11 ]. The difference in rates of complication and adverse events requiring further treatment do not reach significance [ 11 , 23 ].…”

“…However, these short-term benefits are found to reach no further significant difference at later follow-up (one and two years) [ 11 , 13 , 23 ] with evidence of significantly higher VAS pain scores in patients receiving an SCI [ 11 ]. The difference in rates of complication and adverse events requiring further treatment do not reach significance [ 11 , 23 ]. Interestingly, Brandao et al reported no significant difference in FAAM sport scores and advised varying return to leisure activities, with patients undergoing arthrodesis more commonly returning to gym exercises, patients undergoing SCI more commonly returning to walking exercise and similar numbers returning to running [ 16 ], despite the known limitations on ROM following arthrodesis.…”

“…At both short and mid-term follow-ups, there is strong evidence to demonstrate a significant improvement in physical function, abilities in activities of daily living, walking, standing, sports, and social interaction [ 4 , 11 , 13 , 17 , 18 , 20 , 24 , 27 ] with one study presenting 96% of patients reaching normal or nearly normal levels of function at five years follow-up [ 19 ]. Conversely, An et al reported their PROMIS scores at final follow-up to equate to a moderate physical dysfunction [ 15 ] with others demonstrating no significant difference in sporting abilities or PROMIS physical function scores from baseline to final follow-up [ 23 , 25 ]. The lack of homogeneity in rating scales makes interstudy comparisons difficult.…”

“…However, despite these significant improvements, a plethora of studies still report patients experience persistent pain [ 26 ]. Chrea et al reported significantly improved PROMIS pain scores but 11.7% of participants experienced persistent postoperative pain [ 18 ] and Joo et al found a similar trend with 10% still experiencing significant pain at the final follow-up [ 23 ]. The rates of persistent post-operative pain requiring further investigation have reached as high as 29.7% [ 14 ] with others reporting this persistence to moderately interfere with activities of daily living [ 15 ].…”