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.