What did the study look at?
Hallux rigidus is arthritis of the joint at the base of the big toe (the first metatarsophalangeal joint), causing pain and reduced movement. In advanced cases, options include fusing the joint (arthrodesis) or implants that preserve joint motion. The study aimed to compare the mid-term functional results of metatarsal head resurfacing and total joint arthroplasty in advanced hallux rigidus.
How was it done?
- Fifty-one patients operated on for hallux rigidus between 2014 and 2016 were screened retrospectively; 7 who did not meet the criteria or were lost to follow-up were excluded.
- Patients with Hattrup and Johnson grade 2 or 3 disease who completed 3 years of follow-up were included. Those with marked hallux valgus, infection, osteomyelitis or inflammatory disease were excluded.
- Group 1 (21 patients) received resurfacing of the metatarsal head only; Group 2 (23 patients) received a total joint replacement of both surfaces. Two surgeons performed the operations.
- Function was assessed with the AOFAS hallux score and pain with a visual analogue scale (VAS). The mean age was 54.3 ± 7.8 years and the mean follow-up 41.2 ± 3.7 months.
What did it find?
- There was no significant difference in demographic characteristics between the groups (p > 0.05).
- The mean AOFAS score before surgery was 38.63 in Group 1 and 36.91 in Group 2. It was 88.23 versus 90.23 at 12 months, 83.34 versus 86.56 at 24 months and 81.54 versus 85.96 at 36 months.
- According to the abstract and table, the total replacement group had a significantly higher AOFAS score at 24 months (p = 0.013) and 36 months (p = 0.0017). (The results paragraph of the article mentions only 24 months as significant.)
- Pain (VAS) fell in both groups from about 9 before surgery to about 2 at 36 months, with no significant difference between groups.
The authors' conclusion
The authors state that resurfacing and total joint arthroplasty, both of which allow joint motion, lead to successful mid-term results in advanced hallux rigidus. They note that function scores were better in the total replacement group, while pain scores did not differ.
Limitations
According to the authors, the study was not prospective or randomised and was based on retrospective data. The follow-up was too short to observe possible long-term complications, and no scoring systems measuring patient satisfaction were used.
Reference
Gürsoy S, Akkaya M. (2019). Metatarsal Head Resurfacing versus Total Joint Arthroplasty in the Treatment of Hallux Rigidus. Merit Research Journal of Medicine and Medical Sciences, 7(3), 94–99. Zenodo repository licence: CC BY 4.0.
Free full text: zenodo.org (PDF)
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
