SLR - October 2012 - James P. Callahan
Reference: Hyer CF, Granata JD, Berlet GC, Lee TH. Interpositional Arthroplasty of the First Metatarsophalangeal Joint Using a Regenerative Tissue Matrix for the Treatment of Advanced Hallux Rigidus 5-Year Case Series Follow-up. Foot & Ankle Specialist, 5(4), 249-252; 2012
Scientific Literature Review
Reviewed by: James P. Callahan, DPM
Residency Program: Inova Fairfax Hospital, Falls Church, VA
Podiatric Relevance:
Management of hallux rigidus can be an arduous task for the foot and ankle surgeon, particularly when advanced disease presents in the younger, active patient. Surgical correction for hallux rigidus is divided amongst motion preserving procedures and arthrodesis. As sparse evidence exists in support of peri-articular osteotomies and implant arthroplasty, the implementation of these procedures remains controversial. Interpositional arthroplasty with regenerative tissue matrix (RTM) may provide preservation of function and possibly better outcomes than traditional methods for joint preservation as an alternative or delay to arthrodesis.
Methods:
The study design consists of a retrospective review of six patients who underwent aggressive cheilectomy and interpositional arthroplasty with RTM for Coughlin grade 3 hallux rigidus. The average follow-up was 5.4 years and the mean age of the cohort was 54.3 years. Preoperative modified AOFAS scores were retrospectively reviewed and postoperative AOFAS scores were obtained via telephone interview. The primary objective was to report subjective outcomes of patient satisfaction and to determine if subsequent operation, particularly fusion, had occurred.
Results:
There was a dramatic improvement in AOFAS scores at the five-year follow-up and all patients remained satisfied with their operation. The average pre-op modified AOFAS score was 38 out of a possible 68, while the average post-op AOFAS score was 65.8. No patients had subsequent operation within this time frame and all indicated they would undergo the procedure again. No clinical data was reported at this time.
Conclusions:
The options for surgical correction of hallux rigidus continue to evolve in an effort to provide durable, functional outcomes for patients with significant degeneration who wish to avoid or delay arthrodesis. Although this was a small case series and retrospectively reviewed, the preliminary results at five years are encouraging. The authors found interpositional arthroplasty with RTM to be an effective procedure to reduce pain, preserve function and delay arthrodesis among younger, active patients. Further follow-up and study will yield long-term results on the effectiveness of this procedure as compared to cheilectomy, implant arthroplasty, peri-articular osteotomy and arthrodesis in the treatment of hallux rigidus.