Abstract
If operative treatment is opted for grade 3 and 4 osteoarthritis of the first metatarsophalangeal
joint, arthrodesis is considered the standard of care. However, if preservation of
joint mobility is preferred, implant arthroplasty could be favored. Previous studies
have suggested hemiarthroplasty might result in less pain, better function, and greater
patient satisfaction compared with arthrodesis. However, these studies only evaluated
short-term results (range 2.2 to 6.6 years). The aim of our study was to determine
whether patients treated with hemiarthroplasty would show better postoperative outcomes
compared with those treated with arthrodesis after ≥5 years after surgery. The American
Orthopaedic Foot and Ankle Society hallux metatarsophalangeal interphalangeal (AOFAS-HMI)
scale score was used as the primary outcome measure. Secondary outcomes addressed
satisfaction rates, patient procedure recommendation, and number of unplanned repeat
surgical procedures. We also addressed the influence of the procedures on daily activities
(work and sports), the influence of smoking on the postoperative results, and the
costs for both procedures. A total of 47 primary arthrodeses and 31 hemiarthroplasties
performed between January 2005 and December 2011 were evaluated. After a mean follow-up
period of 8.3 (range 5 to 11.8) years, the mean AOFAS-HMI scale score after arthrodesis
and hemiarthroplasty was 72.8 ± 14.5 and 89.7 ± 6.6, respectively (p = .001). The patients were significantly more pleased after hemiarthroplasty (p < .001), and this procedure was recommended more often (p < .001). The number of unplanned repeat surgical procedures did not differ between
the 2 groups. Patients resumed sports activities significantly sooner after hemiarthroplasty
(p = .002). The overall crude costs were similar for both procedures. Our results have
shown more favorable postoperative outcomes for hemiarthroplasty compared with arthrodesis
as operative treatment of osteoarthritis of the first metatarsophalangeal joint after
a mean follow-up period of 8.3 years.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: January 22, 2018
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
