Distally Based Capsule-Periosteum Interpositional Arthroplasty for Hallux Rigidus

Twelve patients (15 feet) with severe hallux rigidus underwent distally based capsule-periosteum interpositional arthroplasty of the first metatarsophalangeal joint (mean ± SD follow-up, 16.8 ± 7.0 months). Subjective evaluation was based on a modified version of the American Orthopaedic Foot and Ankle Society’s 100-point Hallux Metatarsophalangeal-Interphalangeal Joint Scale. Objective evaluation consisted of preoperative and postoperative physical examinations (first metatarsophalangeal joint range of motion and axial grind testing) and radiographic evaluations (joint space width). The short-term results of this novel procedure showed subjective patient improvement and satisfaction, increased first metatarsophalangeal joint dorsal range of motion, maintained hallux plantar range of motion and power, and improved joint space width on anteroposterior and lateral radiographs. None of the patients developed a hallux hammer toe or extensus deformity or lesser metatarsalgia, and none required further surgical intervention. After describing the indications of the procedure and the surgical technique, the authors compare the results with those of the various other procedures available for the surgical treatment of hallux rigidus. (J Am Podiatr Med Assoc 93(5): 349-366, 2003)

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Rolled Tendon Allograft Interposition Arthroplasty for Salvage Surgery of the Hallux Metatarsophalangeal Joint

Foot & Ankle International ◽

10.1177/1071100717746609 ◽

2018 ◽

Vol 39 (4) ◽

pp. 458-462 ◽

Cited By ~ 4

Author(s):

Danielle Thomas ◽

David Thordarson

Keyword(s):

Operative Procedure ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Joint Space ◽

Hallux Rigidus ◽

Salvage Treatment ◽

High Rate ◽

Interposition Arthroplasty ◽

First Metatarsophalangeal Joint ◽

Interpositional Arthroplasty

Background: Hallux rigidus is a common osteoarthritic disease of the first metatarsophalangeal joint (MTPJ). Few salvage treatment options exist that preserve motion for patients who have failed an initial procedure and who are not amenable to fusion, typically patients who are active or who would like to wear high heels. Allograft tendon interpositional arthroplasty is an unconventional salvage treatment option that may preserve motion and prevent bone loss. Methods: A retrospective chart review is reported of 19 patients who failed previous procedures and refused fusion who underwent allograft tendon interpositional arthroplasty of the hallux MTPJ by a single surgeon between 2012 and 2015. Outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale assessment as well as measurement of apparent joint space on anterior to posterior and lateral views. Results: The cumulative average AOFAS score for all patients was 68.5 preoperatively and 74.1 postoperatively. The average AOFAS pain subscore was 24.7 preoperatively and 26.8 postoperatively (SD = 7.7 and 13.8, respectively). Radiographically, patients had an increase in apparent joint space from pre- to postoperatively, most notable on the lateral view (0.6 to 4.7 mm; SD = 0.7 and 3.2 mm). Five patients required a second operative procedure, for an overall 26% reoperation rate. One patient underwent hallux MTPJ fusion after the interpositional arthroplasty. An additional 4 patients (21%) had symptoms requiring a steroid injection, and another 3 patients (16%) were recommended to undergo a revision procedure based on their symptoms. Conclusion: Rolled allograft tendon interposition arthroplasty performed poorly as a salvage strategy for failed previous hallux MTPJ surgery for hallux rigidus because of a high rate of complication and minimal benefits. The senior author has abandoned the technique. Level of Evidence: Level IV, retrospective case series.

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First Metatarsophalangeal Joint Interpositional Arthroplasty Using a Meniscus Allograft for the Treatment of Advanced Hallux Rigidus

Foot & Ankle Specialist ◽

10.1177/1938640011402821 ◽

2011 ◽

Vol 4 (3) ◽

pp. 157-164 ◽

Cited By ~ 13

Author(s):

Eugene L. DelaCruz ◽

Adam R. Johnson ◽

Benjamin L. Clair

Keyword(s):

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

First Metatarsophalangeal Joint ◽

Interpositional Arthroplasty ◽

Meniscus Allograft

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An Assessment of Hallux Limitus in University Basketball Players Compared with Noncompetitive Individuals

Journal of the American Podiatric Medical Association ◽

10.7547/0003-0538-104.5.468 ◽

2014 ◽

Vol 104 (5) ◽

pp. 468-472 ◽

Cited By ~ 1

Author(s):

Paul Trégouët

Keyword(s):

Range Of Motion ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

Artificial Turf ◽

Basketball Players ◽

First Metatarsophalangeal Joint ◽

Hallux Limitus ◽

Significant Difference ◽

Turf Toe ◽

The Difference

BackgroundInjuries of the first metatarsophalangeal joint have lately been receiving attention from researchers owing to the important functions of this joint. However, most of the studies of turf toe injuries have focused on sports played on artificial turf.MethodsThis study compared the range of motion of the first metatarsophalangeal joint in collegiate basketball players (n = 123) and noncompetitive individuals (n = 123).ResultsA statistically significant difference (P < .001) in range of motion was found between the two groups. The difference between the two sample means was 21.35°.ConclusionsWith hallux rigidus being a potential sequela of repeated turf toe injuries, it seems likely that subacute turf toe injuries occur in basketball players, leading to degenerative changes that result in hallux limitus.

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Interpositional Arthroplasty of the First Metatarsophalangeal Joint Using a Regenerative Tissue Matrix for the Treatment of Advanced Hallux Rigidus

Foot & Ankle Specialist ◽

10.1177/1938640012443285 ◽

2012 ◽

Vol 5 (4) ◽

pp. 249-252 ◽

Cited By ~ 27

Author(s):

Christopher F. Hyer ◽

Jaymes D. Granata ◽

Gregory C. Berlet ◽

Thomas H. Lee

Keyword(s):

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

First Metatarsophalangeal Joint ◽

Interpositional Arthroplasty ◽

Tissue Matrix

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Interpositional Arthroplasty of the First Metatarsophalangeal Joint with Bioresorbable Pldla Implant in the Treatment of Hallux Rigidus and Arthritic Hallux Valgus: A 9-Year Case Series Follow-Up

Scandinavian Journal of Surgery ◽

10.1177/1457496919893597 ◽

2019 ◽

pp. 145749691989359

Author(s):

N. Partio ◽

V. T. Ponkilainen ◽

V. Rinkinen ◽

P. Honkanen ◽

H. Haapasalo ◽

...

Keyword(s):

Lactic Acid ◽

Hallux Valgus ◽

Analogue Scale ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

First Metatarsophalangeal Joint ◽

Interpositional Arthroplasty ◽

The Mean ◽

End Stage

Background and Aims: The interpositional arthroplasty was developed to retain foot function and to relieve pain due to the arthritis of the first metatarsophalangeal joint. The bioabsorbable poly-L-D-lactic acid RegJoint® interpositional implant provides temporary support to the joint, and the implant is subsequently replaced by the patient’s own tissue. In this study, we retrospectively examined the results of the poly-L-D-lactic acid interpositional arthroplasty in a 9-year follow-up study among patients with hallux valgus with end-stage arthrosis or hallux rigidus. Material and Methods: Eighteen patients and 21 joints underwent interpositional arthroplasty using the poly-L-D-lactic acid implant between February 1997 and October 2002 at Tampere University Hospital. Of these, 15 (83.3%) (21 joints) patients were compliant with clinical examination and radiographic examination in long-term (average 9.4 years) follow-up. The mean age of the patients was 48.3 (from 28 to 67) years at the time of the operation. Six patients underwent the operation due to arthritic hallux valgus and nine patients due to hallux rigidus. Results: The mean Ankle Society Hallux Metatarsophalangeal–Interphalangeal Scale and visual analogue scale (VAS) for pain scores improved after the operation in all patients. The decrease of pain (visual analogue scale) after the operation was statistically significant (77.5 vs 10.0; p < 0.001). Postoperative complications were observed in 3 (14.3%) joints of two hallux rigidus patients. For these patients, surgery had only temporarily relieved the pain, and they underwent reoperation with arthrodesis. Conclusion: In conclusion, interpositional arthroplasty using a poly-L-D-lactic acid implant yielded good results. This study indicates that the poly-L-D-lactic acid interpositional implant may be a good alternative for arthrodesis for treatment of end-stage degeneration of the first metatarsophalangeal joint.

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A Soft-Tissue Interpositional Arthroplasty Technique of the First Metatarsophalangeal Joint for the Treatment of Advanced Hallux Rigidus Using a Human Acellular Dermal Regenerative Tissue Matrix

Techniques in Foot & Ankle Surgery ◽

10.1097/01.btf.0000235417.46038.2b ◽

2006 ◽

Vol 5 (4) ◽

pp. 257-265 ◽

Cited By ~ 14

Author(s):

Gregory C. Berlet ◽

Christopher F. Hyer ◽

Thomas H. Lee ◽

Terrence M. Philbin ◽

Jodi F. Hartman ◽

...

Keyword(s):

Soft Tissue ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

First Metatarsophalangeal Joint ◽

Interpositional Arthroplasty ◽

Tissue Matrix ◽

Acellular Dermal

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Outcomes After Interpositional Arthroplasty of the First Metatarsophalangeal Joint

Foot & Ankle International ◽

10.1177/1071100716687366 ◽

2017 ◽

Vol 38 (5) ◽

pp. 514-518 ◽

Cited By ~ 14

Author(s):

Michael C. Aynardi ◽

Lara Atwater ◽

Eric J. Dein ◽

Talal Zahoor ◽

Lew C. Schon ◽

...

Keyword(s):

Case Series ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

Level Of Evidence ◽

First Metatarsophalangeal Joint ◽

Interpositional Arthroplasty ◽

Significant Difference ◽

Patient Reported ◽

Functional Scores

Background: For patients with hallux rigidus seeking a motion-sparing procedure, interposition arthroplasty is an alternative to fusion. The purpose of this study was to report patient outcomes after interpositional arthroplasty for hallux rigidus. Methods: All patients undergoing interpositional arthroplasty at our institution from 2001 to 2014 were identified and a retrospective chart review was performed. Follow-up was conducted through a telephone survey to obtain survivorship, satisfaction, and functional scores. Survivorship of the interpositional arthroplasty procedure was defined as no subsequent surgery on the hallux after the index procedure. Patients were excluded for incomplete records. Complications were recorded. From 2001 to 2014, 183 patients were identified. Of these, 14 were excluded for incomplete data, leaving 169 patients. Of these, 133 had an average follow-up of 62.2 months (range, 24.3 months to 151.2 months). Results: The overall failure rate was 3.8% (5/133). Patient-reported outcome was rated as excellent in 65.4% (87/133) or good in 24.1% (32/133) of patients and fair or poor in 10.5% (14/133) of patients. Of 133 patients, 101 (76%) were able to return to fashionable or regular footwear. The infection rate was 1.5% (2/133). Patient-reported cock-up deformity of the first metatarsophalangeal joint (MTPJ) occurred in 4.5% (6/133) of patients. In addition, 17.3% (23/133) of patients reported metatarsalgia of the second or third MTPJ at the time of final follow-up, and there was no significant difference between interposition types ( P = .441). Conclusion: Interpositional arthroplasty for hallux rigidus was found to have excellent or good results in most patients at a mean follow-up of 62.2 months. Level of Evidence: Level IV, retrospective case series.

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Treatment of End-Stage Hallux Rigidus and Impact of Arthrodesis versus Arthroplasty on Patient Reported Outcomes

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000129 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Monique Chambers ◽

MaCalus Hogan ◽

Dukens LaBaze

Keyword(s):

Patient Reported Outcomes ◽

Surgical Intervention ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

First Metatarsophalangeal Joint ◽

Significant Difference ◽

Patient Reported ◽

Outcome Scores ◽

Vas Scores ◽

End Stage

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is a degenerative disease of the first metatarsophalangeal joint. Severe, end-stage hallux rigidus can become debilitating with surgical intervention becoming necessary once conservative measures and shoe modifications have failed. Joint salvage procedures include metatarsal phalangeal (MTP) arthrodesis and MTP arthroplasty. The purpose of this study was to assess for differences in patient reported outcomes in two cohorts who underwent fusion or joint reconstruction. Methods: This study was a retrospective review of prospectively collected data of 385 patients from an academic medical institution. Patients who underwent surgical intervention from July 2015 to November 2016 were identified based on CPT codes for MTP arthrodesis (28750) and arthroplasty (28293). We extracted outcome scores including SF12-M, SF12-P, FAAM, and VAS scores. Exclusion criteria included poly-trauma, revision procedures, and lack of pre and post-operative outcome scores. Mann- Whitney t-test was performed using GraphPad Prism version 7.0b for Mac to compare procedure groups, with significance define by a p-value of 0.05. Results: A total of eighteen patients met the inclusion criteria, with 6 who underwent arthroplasty and 12 arthrodesis. The average age was 63.7 amongst the cohort, with a total of 16 female and 2 males. Patients who underwent arthrodesis had better outcomes across all parameters. When comparing preoperative and postoperative scores, arthrodesis patients showed greater improvement of SF12-M (arthrodesis 9 vs arthroplasty -2, p=0.05), and SF12-P (9 vs -16, respectively p=0.05) scores. Arthroplasty patients were more likely to have a decrease in their SF-12 scores. VAS scores and FAAM scores showed no statistical difference between the two cohorts. Postoperative VAS scores were worse in 33% of arthroplasty patients despite surgical intervention, compared to 10% of arthrodesis patients. Conclusion: Our results suggests that both procedures provide a statistically significant difference in pain with several patients having a Global Rate of Change that is “very much better”. However, fusion of the metatarsophalangeal joint results in improved pain and functional outcomes for patients with severe hallux rigidus. These findings are consistent with current reports in the literature, which are mostly case series reports. Larger studies are needed to provide appropriate power and better support the findings of this study.

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