SLR - June 2011 - Brandon Slade (3)
Reference: Roukis, TS. (2010). Clinical Outcomes after Isolated Periarticular Osteotomies of the First Metatarsal for Hallux Rigidus: A Systematic Review. Journal of Foot & Ankle Surgery. 49; 553-560.
Scientific Literature Review
Reviewed by: Brandon Slade, DPM
Residency Program: DVA San Francisco
Podiatric Relevance:
Isolated periarticular osteotomies of the first metatarsal have been proposed for treatment of all grades of hallux rigidus. The safety and efficacy of this procedure is at question and in particular, the need for surgical revision after such procedure.
Methods:
The author undertook a systematic review of electronic databases and other relevant sources to identify materials relating to the clinical outcomes and need for surgical revision after isolated periarticular osteotomy of the first metatarsal for hallux rigidus. A prospective study design and a mean follow-up >12 months duration were among the inclusion criteria with a goal to obtain the highest quality studies available.
Results:
A total of 4 studies involving 93 isolated periarticular osteotomies of the first metatarsal for hallux rigidus met all the inclusion criteria. Peak dorsiflexion range of motion of the first metatarsaophalangeal joint increased 10.4 degrees. The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scoring Scale increased 39 points from a weighted mean of 47.2 preoperatiely to 86.2 postoperatively. For which it was reported, complete satisfaction or satisfaction with reservation was reported in 73.3% of patients, with the remainder being dissatisfied. A total of 21 patients (22.6%) underwent surgical revision. A total of 18 (30.5%) patients developed postoperative metatarsalgia or stress fracture.
Conclusions:
Based on the high incidence of complications from this systematic review, it was concluded that isolated periarticular osteotomy of the first metatarsal for hallux rigidus should be performed with caution or not at all.