SLR - November 2023 - Kingston
Title: Clinical Outcomes After Joint-Preserving and Joint-Sacrificing Surgery for Hallux RigidusReference: Koh, D., Chandrakumara, D., Socklingam, R., & Kon Kam King, C. (2023). Clinical Outcomes After Joint-Preserving and Joint-Sacrificing Surgery for Hallux Rigidus. Cureus, 15(7), e42155. https://doi.org/10.7759/cureus.42155
Level of Evidence: Level 6
Reviewed By: Kaitlin Kingston
Residency Program: Long Island Jewish- Forest Hills
Podiatric Relevance: Hallux Rigidus is a super common condition where when conservative management fails, surgical management is indicated; however, typically there are two approaches: Joint Preserving vs. Joint Sacrificing. This article looks at and compares both surgical options to give a better insight to procedure of choice as well as short and moderate term follow up for hallux rigidus surgical outcomes.
Methods: 26 patients were included in study between 2017 and 2022; there was a mean follow up of 31 months. The post-operative visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores were used to evaluate the outcomes after surgery. VAS was scored from 1-10 and was based on severity of pain while AOFAS looked at functional status by looking at subjective and objective information with scores ranging from 0-100. This same scoring was used before and after surgery. Post-surgery Institutional Review Board evaluated operative notes, xray reports (classified by Hattrup and Johnson’s classification stages) and clinical notes prior to data. Any patient suffering from a subsequent injury after surgery was excluded. Joint preserving procedure of choice was a cheilectomy with adjunct procedures like subchondral arthroplasty, interposition arthroplasty and PRP therapy if indicated. For joint sacrificing surgery, the technique was arthrodesis with plating and screws. 74% of patients underwent joint preserving surgery and 26% patients underwent joint sacrificing procedures.
Results: Of the 26 patients included in the study, the mean improvement in VAS score was .56 (p value = .0001) for joint preserving surgery and 5.7 (p value = .0012) in patients undergoing joint sparing surgery. Also, for joint preserving surgery, the mean increase was 28.1 points (p value = .0001) in AOFAS hallux score and a score of 27.29 (p value = .0066) for joint sparing procedure.
Conclusions: Overall, this study did show good outcomes for both joint sparing and sacrificing procedures. It has been noted that arthrodesis has been widely considered a treatment of choice for higher grades of hallux rigidus despite complications like non-union, joint stiffness complaints and metatarsalgia and little room for revision if other procedures are required whereas, joint sparing procedures have faster return to activity, lower complication rates and preservation of anatomy allowing adjunctive procedures. This study suggested that a cheilectomy had good outcomes even in patients with higher grade hallux rigidus. This study is of value to podiatric community because it challenges the common standard, arthrodesis for late-stage hallux rigidus as first line surgical therapy and supports consideration of joint sparing to be attempted surgically first rather than jumping to joint sacrificing. It also shows that surgical management of this pathology has good short and medium follow up outcomes further supporting this as treatment option of choice compared to conservative. Of note, the sample size was small and had more patients that underwent joint sparing surgeries in comparison to joint sacrificing which may have caused some bias in overall results.