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Arthrodesis versus Arthroplasty of the First Metatarsophalangeal Joint in the Treatment of Hallux Rigidus – A Comparative Study of Appropriately Selected Patients[∗]Article in several languages: português | English
12 July 2018
04 December 2018
02 March 2020 (online)
Objective Historical results of arthroplasty of the first metatarsophalangeal joint (1MTP) are relatively poor; however, improvements in the understanding of the normal foot biomechanics, implant materials and design currently make arthroplasty a reasonable option in appropriately selected patients. The present study aimed to compare the clinical and radiographic results of 1MTP arthrodesis and arthroplasty in the treatment of hallux rigidus and to present a rationale for patient selection for arthroplasty.
Methods A total of 36 patients (38 feet) with hallux rigidus submitted to surgery (12 arthrodesis and 26 arthroplasties) were prospectively included in the study. Pain was assessed using the visual analogue scale (VAS) and the functional status was assessed using the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI) scale. Complications and radiographic results were also analyzed, and survival rates were calculated for both procedures.
Results All of the patients reported significant improvement in pain and functional status after surgery. Patients submitted to arthroplasty had better functional results on the AOFAS-HMI scale (89.7 versus 65.7 points; p < 0.001) and better pain relief (VAS 1.6 versus 3.9 points; p = 0.002) when compared with the group submitted to arthrodesis. There was one case of infection in the arthroplasty group and 2 cases of pseudarthrosis in the arthrodesis group.
Conclusion Arthrodesis provides pain relief and satisfactory results but alters the biomechanics of gait. Like arthrodesis, arthroplasty improves pain significantly, being a more physiological alternative to preserve the biomechanics of the foot. While the two surgical methods yielded good clinical results, selected patients submitted to arthroplasty had better clinical scores and lower revision rates.
∗ Study conducted at Department of Orthopedics, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.
- 1 Coughlin MJ, Shurnas PS. Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int 2003; 24 (10) 731-743
- 2 Ho B, Baumhauer J. Hallux rigidus. EFORT Open Rev 2017; 2 (01) 13-20
- 3 Hamid KS, Parekh SG. Clinical Presentation and Management of Hallux Rigidus. Foot Ankle Clin 2015; 20 (03) 391-399
- 4 Polzer H, Polzer S, Brumann M, Mutschler W, Regauer M. Hallux rigidus: Joint preserving alternatives to arthrodesis - a review of the literature. World J Orthop 2014; 5 (01) 6-13
- 5 Coughlin MJ, Shurnas PS. Hallux rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg Am 2003; 85 (11) 2072-2088
- 6 Dülgeroğlu TC, Metineren H. Treatment of End-Stage Hallux Rigidus Using Total Joint Arthroplasty: A Short-Term Clinical Study. J Foot Ankle Surg 2017; 56 (05) 1047-1051
- 7 Beertema W, Draijer WF, van Os JJ, Pilot P. A retrospective analysis of surgical treatment in patients with symptomatic hallux rigidus: long-term follow-up. J Foot Ankle Surg 2006; 45 (04) 244-251
- 8 DeFrino PF, Brodsky JW, Pollo FE, Crenshaw SJ, Beischer AD. First metatarsophalangeal arthrodesis: a clinical, pedobarographic and gait analysis study. Foot Ankle Int 2002; 23 (06) 496-502
- 9 Konkel KF, Menger AG, Retzlaff SA. Mid-term results of Futura hemi-great toe implants. Foot Ankle Int 2008; 29 (08) 831-837
- 10 Swanson AB, Lumsden RM, Swanson GD. Silicone implant arthroplasty of the great toe. A review of single stem and flexible hinge implants. Clin Orthop Relat Res 1979; (142) 30-43
- 11 Brewster M. Does total joint replacement or arthrodesis of the first metatarsophalangeal joint yield better functional results? A systematic review of the literature. J Foot Ankle Surg 2010; 49 (06) 546-552
- 12 Cook E, Cook J, Rosenblum B, Landsman A, Giurini J, Basile P. Meta-analysis of first metatarsophalangeal joint implant arthroplasty. J Foot Ankle Surg 2009; 48 (02) 180-190
- 13 Sullivan MR. Hallux rigidus: MTP implant arthroplasty. Foot Ankle Clin 2009; 14 (01) 33-42
- 14 Dening J, van Erve RH. Arthrodesis of the first metatarsophalangeal joint: a retrospective analysis of plate versus screw fixation. J Foot Ankle Surg 2012; 51 (02) 172-175
- 15 Foote KM, Teasdall RD, Tanaka ML, Scott AT. First metatarsophalangeal arthrodesis: a biomechanical comparison of three fixation constructs. J Surg Orthop Adv 2012; 21 (04) 223-231
- 16 Mohammed R, Gadgil A. Molded arthrodesis of the hallux metatarsophalangeal joint using the crossed-screw technique: surgical technique, results and functional outcomes. Foot Ankle Surg 2012; 18 (02) 132-135
- 17 Silva LF, Sousa CV, Rodrigues Pinto R, Santos C, Geada JM. Preliminary Results from the Metis-Newdeal((R)) Total Metatarsophalangeal Prosthesis. Rev Bras Ortop 2015; 46 (02) 200-204
- 18 Baumhauer JF, Singh D, Glazebrook M, Blundell C, De Vries G, Le IL, Nielsen D, Pedersen ME, Sakellariou A, Solan M, Wansbrough G, Younger AS, Daniels T. ; for and on behalf of the CARTIVA Motion Study Group. Prospective, Randomized, Multi-centered Clinical Trial Assessing Safety and Efficacy of a Synthetic Cartilage Implant Versus First Metatarsophalangeal Arthrodesis in Advanced Hallux Rigidus. Foot Ankle Int 2016; 37 (05) 457-469
- 19 Donegan RJ, Blume PA. Functional Results and Patient Satisfaction of First Metatarsophalangeal Joint Arthrodesis Using Dual Crossed Screw Fixation. J Foot Ankle Surg 2017; 56 (02) 291-297
- 20 Horisberger M, Haeni D, Henninger HB, Valderrabano V, Barg A. Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux. Foot Ankle Int 2016; 37 (07) 755-765
- 21 Karlock LG, Berry L, Craft ST, Petrozzi R, Grahn AG, Casteel ML. First Metatarsophalangeal Joint Fusion With Use of Crossed Kirschner Wires and Intramedullary Steinmann Pin. J Foot Ankle Surg 2017; 56 (06) 1139-1142
- 22 Mirmiran R, Wilde B, Nielsen M. Retrospective analysis of the rate and interval to union for joint arthrodesis of the foot and ankle. J Foot Ankle Surg 2014; 53 (04) 420-425
- 23 Raikin SM, Ahmad J, Pour AE, Abidi N. Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint. J Bone Joint Surg Am 2007; 89 (09) 1979-1985
- 24 Erkocak OF, Senaran H, Altan E, Aydin BK, Acar MA. Short-term functional outcomes of first metatarsophalangeal total joint replacement for hallux rigidus. Foot Ankle Int 2013; 34 (11) 1569-1579
- 25 Gibson JN, Thomson CE. Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial. Foot Ankle Int 2005; 26 (09) 680-690
- 26 Pulavarti RS, McVie JL, Tulloch CJ. First metatarsophalangeal joint replacement using the bio-action great toe implant: intermediate results. Foot Ankle Int 2005; 26 (12) 1033-1037
- 27 Stevens J, de Bot RTAL, Hermus JPS, van Rhijn LW, Witlox AM. Clinical Outcome Following Total Joint Replacement and Arthrodesis for Hallux Rigidus: A Systematic Review. JBJS Rev 2017; 5 (11) e2
- 28 Stone OD, Ray R, Thomson CE, Gibson JN. Long-Term Follow-up of Arthrodesis vs Total Joint Arthroplasty for Hallux Rigidus. Foot Ankle Int 2017; 38 (04) 375-380
- 29 Kim PJ, Hatch D, Didomenico LA, Lee MS, Kaczander B, Count G, Kravette M. A multicenter retrospective review of outcomes for arthrodesis, hemi-metallic joint implant, and resectional arthroplasty in the surgical treatment of end-stage hallux rigidus. J Foot Ankle Surg 2012; 51 (01) 50-56