The treatment of advanced hallux rigidus remains controversial, with many authors discussing arthrodesis versus arthroplasty. The purpose of this study is to report mid-term outcomes after implantation of a motion-preserving metatarsal head–resurfacing prosthetic and to present our technical considerations and modifications to the published technique to further enhance the clinical benefit of the procedure. Thirty-two implantations were performed in 30 patients. Twenty-three patients were women, 9 men. The average age was 62.8 years (range, 39-86 years). Patients were graded at baseline according to Hattrup and Johnson and completed the American Orthopaedic Foot & Ankle Surgery metatarsophalangeal clinical rating system preoperatively and postoperatively and a patient satisfaction question at final follow-up. Seventy-two percent of implantations were grade III hallux rigidus and 28% were grade II. The average follow-up was 27.3 months (range, 12-43 months). The mean change score for the overall American Orthopaedic Foot & Ankle Surgery scale was 236.8% (SD = 146.62, confidence interval [CI] = 186-287.6). A similar result was achieved between grade II (250.9%, SD = 240.3, CI = 93.9-407.9) and grade III (231.3%, SD = 95.83, CI = 195.14-270.46). No implants were revised or removed, and all patients stated that they were happy with their outcome and would repeat the procedure again if needed. In conclusion, metatarsal head resurfacing in combination with joint decompression, soft tissue mobilization, and debridement can achieve excellent results in grade II and III hallux rigidus. Salvage arthrodesis remains an option if future revisions are indicated.
Level of Clinical Evidence
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- Contraction of the metatarsophalangeal joint of the great toe.Br Med J. 1887; 1: 728
- Stiffness of the great toe in adolescents.Br Med J. 1888; 1: 1158
- Hallux rigidus. Grading and long-term results of operative treatment.J Bone Joint Surg Am. 2003; 85-A: 2072-2088
- A simple operation for hallux rigidus.Clin Orthop Relat Res. 1979; 142: 55-56
- Subjective results of hallux rigidus following treatment with cheilectomy.Clin Orthop Relat Res. 1988; 226: 182-191
- Phalangeal osteotomy versus first metatarsal decompression osteotomy for the surgical treatment of hallux rigidus: a prospective study of age-matched and condition-matched patients.J Foot Ankle Surg. 2005; 44: 2-12
- Functional outcome of arthrodesis of the first metatarsophalangeal joint using parallel screw fixation.Foot Ankle Int. 2005; 26: 140-146
- Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial.Foot Ankle Int. 2005; 26: 680-690
- Contemporary approaches to stage II and III hallux rigidus: the role of metallic hemiarthroplasty of the proximal phalanx.Foot Ankle Clin. 2005; 10 (ix–x): 713-728
- Outcomes after interposition arthroplasty for treatment of hallux rigidus.Clin Orthop Relat Res. 2006; 445: 210-215
- Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint.J Bone Joint Surg Am. 2007; 89: 1979-1985
- Hemiarthroplasty in the treatment of hallux rigidus.Foot Ankle Int. 2008; 29: 273-281
- Current concepts review: hallux rigidus.Foot Ankle Int. 2008; 29: 637-646
- Resurfacing of the first metatarsal head in the treatment of hallux rigidus.Tech Foot Ankle Surg. 2008; 7: 31-40
- Meta-analysis of first metatarsophalangeal joint implant arthroplasty.J Foot Ankle Surg. 2009; 48: 180-190
- Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.Foot Ankle Int. 1994; 15: 349-353
- First metatarsophalangeal joint replacement: the method of choice for end-stage hallux rigidus?.Foot Ankle Clin. 2003; 8 (vi): 711-721
- Capsular interposition arthroplasty for severe hallux rigidus.Foot Ankle Int. 1997; 18: 68-70
- Hallux rigidus: cheilotomy or implant?.Foot Ankle. 1981; 1: 315-320
- Orthotic management for disorders of the hallux.Foot Ankle Clin. 2005; 10: 191-209
- Surgical options for salvage of end-stage hallux rigidus.Foot Ankle Clin. 2002; 7: 49-73
- Hallux rigidus.J Bone Joint Surg Am. 2004; 86A: 119-130
- Technical considerations in hallux metatarsalphalangeal arthrodesis.Foot Ankle Clin. 2005; 10: 167-190
- Salvage of painful total ankle arthroplasty.Clin Orthop Relat Res. 1982; 170: 184-188
- The management of failed ankle replacement.J Bone Joint Surg. 2006; 88B: 1039-1047
- Ankle arthrodesis for failed total ankle replacement.J Bone Joint Surg. 2006; 88B: 1032-1038
- An approach to the failed ankle arthrodesis.Foot Ankle Clin. 2008; 13 (viii): 401-416
- Salvage of infected total knee fusion: the last option.Clin Orthop Relat Res. 2002; 404: 139-142
- Arthrodesis of the shoulder.J Am Acad Orthop Surg. 2006; 14: 145-153
- Use of titanium grommets in silicone implant arthroplasty of the hallux metatarsophalangeal joint.Foot Ankle Int. 1996; 17: 145-151
- First metatarsophalangeal joint replacement using the bio-action great toe implant: intermediate results.Foot Ankle Int. 2005; 26: 1033-1037
- Mid-term results of titanium hemi-great toe implants.Foot Ankle Int. 2006; 27: 922-929
- Arthroplasty of the first metatarsophalangeal joint with a double-stem silicone implant. Results in patients who have degenerative joint disease failure of previous operations, or rheumatoid arthritis.J Bone Joint Surg. 1992; 74A: 552-563
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Conflict of Interest: None reported.
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