Interpositional Arthroplasty in the Treatment of Hallux Rigidus: A Systematic Review

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is a common degenerative joint condition of the foot. In advanced stages of the disease, extensive procedures have been utilized including Keller arthroplasty, interpositional arthroplasty (IPA), arthrodesis, total joint replacement or synthetic cartilage replacement. IPA is a surgical procedure that attempts to maintain joint motion through insertion of a biologic spacer into the joint. However, there is still a paucity of overall clinical data regarding outcomes and complication rates following IPA procedure for the treatment of hallux rigidus.The purpose of the current study was to systematically review the outcomes of IPA in the treatment of hallux rigidus. Methods: A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes collected and analysed included: AOFAS score, VAS score, SF36 score, range of motion, radiographic parameters, and postoperative complications. The level and quality of evidence were recorded and assessed. Results: Sixteen studies with a total of 433 patients met inclusion/exclusion criteria. The mean AOFAS improved from 56.8±7.3 (range, 43.2-64.3) preoperatively to 84.0±6.7 (range, 71.6-90.0) postoperatively. The preoperative weighted mean total ROM was 37.7±16.2 degrees and the postoperative weighted mean total ROM was 60.3±13.4 degrees. Five studies examined joint space narrowing on plain radiographs. The mean preoperative joint space was 1.2±0.2 mm (range, 1 -1.5) and the mean postoperative joint space was 2.5±0.5 mm (range, 1.9-3). The complication rate was 18.2% with metatarsalgia as the most commonly reported complication. One study was Level III and 15 studies were Level IV. Conclusion: This systematic review demonstrates improvement in functional and ROM outcomes following IPA. The procedure however has a high complication rate. There is a low level and quality of evidence in the current literature with inconsistent reporting of data. Therefore, further well designed studies must be carried out to determine the efficacy of IPA in the treatment of hallux rigidus.

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Outcome Following Autogenous Soft Tissue Interpositional Arthroplasty for End-Stage Hallux Rigidus: A Systematic Review

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2010.02.014 ◽

2010 ◽

Vol 49 (5) ◽

pp. 475-478 ◽

Cited By ~ 12

Author(s):

Thomas S. Roukis

Keyword(s):

Systematic Review ◽

Soft Tissue ◽

Hallux Rigidus ◽

Interpositional Arthroplasty ◽

End Stage

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A Systematic Review of Total Arthroplasty or Arthrodesis for end-stage Hallux Rigidus – A biomechanical perspective

The Foot ◽

10.1016/j.foot.2021.101838 ◽

2021 ◽

pp. 101838

Author(s):

Rohan Rajan ◽

Arya Mishra

Keyword(s):

Systematic Review ◽

Hallux Rigidus ◽

Total Arthroplasty ◽

End Stage

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Arthrodesis of First Metatarsophalangeal Joint by Plate and Screws for Treatment of Hallux Rigidus (Systematic Review and Meta-Analysis)

QJM ◽

10.1093/qjmed/hcab104.016 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ossama Abdelraoof El Shazly ◽

Mohamed Mokhtar Abdellah ◽

Mostafa Abdelnabee Abouzaid

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Plate Fixation ◽

Meta Analysis ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

Superficial Infection ◽

First Metatarsophalangeal Joint ◽

Non Union ◽

Meta Analyses

Abstract Background With continued loss of dorsiflexion of the 1st MTP, degenerative changes occur within the joint with severe restriction of movement and increase in pain, which leads to the condition known as hallux rigidus. The amount of dorsiflexion may be reduced to 0-10 degrees with pain on both active and passive motion. Objectives Systematically reviewing available evidence from published articles to assess the effectiveness of arthrodesis of first metatarsophalangeal joint by plate and screws in hallux rigidus. The assessment also would encompass safety, side effects, and complications of this mode of treatment. Materials and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results Previous results for arthrodesis have been favourable with a union rate of almost 96%. In the present systematic review and meta-analysis, the overall effect estimates showed that the union rates after plate and screw arthrodesis for 1st MTPJ was 96.2% (95% CI 94 – 98.4%). In addition, the overall effect estimates showed that the non-union rates after plate and screw arthrodesis for 1st MTPJ was 4.2% (95% CI 2.4 – 6.1%). Moreover, the overall effect estimates showed that the satisfaction rates after plate and screw arthrodesis for 1st MTPJ was 94.5% (95% CI 90 – 99%). In the present study, the overall effect estimates showed that the overall complications rate after plate and screw arthrodesis for 1st MTPJ was 7.2% (95% CI 2.5 – 12%). The overall effect estimates showed that the malunion rates after plate and screw arthrodesis for 1st MTPJ was 2.7% (95% CI 0 – 6.4%). Additionally, the overall effect estimates showed that the hardware removal and superficial infection rates after plate and screw arthrodesis for 1st MTPJ were 2% and 2.9%, respectively. Conclusion Our analysis showed that plate and screws fixation is effective techniques that can be used for first MTPJ arthrodesis in patients with hallux rigidus. We found that the screw and plate fixation has a significantly lower rate of nonunion compared with the screw alone, as reported by the literature. However, owing to the small group sizes and methodologic shortcomings, we were unable to identify the clinically superior fixation technique for first MTPJ arthrodesis arthrodesis.

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Is interposition arthroplasty a viable option for treatment of moderate to severe hallux rigidus? — A systematic review and meta-analysis

Foot and Ankle Surgery ◽

10.1016/j.fas.2018.07.006 ◽

2019 ◽

Vol 25 (5) ◽

pp. 571-579 ◽

Cited By ~ 6

Author(s):

Harshadkumar A. Patel ◽

Rishi Kalra ◽

John L. Johnson ◽

Samuel R. Huntley ◽

Eva J. Lehtonen ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Hallux Rigidus ◽

Viable Option ◽

Interposition Arthroplasty

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Interposition Arthroplasty in the Treatment of End-Stage Hallux Rigidus: A Systematic Review

Foot & Ankle Specialist ◽

10.1177/19386400211053947 ◽

2021 ◽

pp. 193864002110539

Author(s):

Francesco Di Caprio ◽

Massimiliano Mosca ◽

Francesco Ceccarelli ◽

Silvio Caravelli ◽

Marco Di Ponte ◽

...

Keyword(s):

Systematic Review ◽

Hallux Rigidus ◽

Prosthetic Replacement ◽

Interposition Arthroplasty ◽

Level Of Evidence ◽

Advantages And Disadvantages ◽

Number Of Patients ◽

Pubmed Search ◽

End Stage

Purpose Patients affected by moderate to severe hallux rigidus may opt for interposition arthroplasty to avoid the movement restrictions of arthrodesis and the complications related to prosthetic replacement. The propose of this article was to review the current literature about interposition arthroplasty to examine the overall outcomes and to evaluate the advantages and disadvantages of different types of technique, compared with more consolidated procedures. Methods A literature PubMed search was performed. Studies reporting the results of interposition arthroplasty in moderate to severe hallux rigidus were included. The data were pooled and weighted for number of patients in every study. Results The overall results for interposition arthroplasties are comparable to other alternatives for end-stage hallux rigidus, providing better plantar load distribution than arthrodesis and avoiding the drawbacks of prosthetic replacement. Among the various interposition arthroplasty techniques, the Modified Oblique Keller Capsular Interposition Arthroplasty technique preserves toe length and flexor hallucis brevis function, showing the highest satisfaction rate, with lowest metatarsalgia and revision rate. Conclusion Although long-term randomized controlled trials are lacking for interposition arthroplasty, it represents a valid alternative for the treatment of end-stage hallux rigidus also in the young active patient who wants to avoid a definitive intervention immediately. Level of evidence III (systematic review of level III-IV-V studies)

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