Patient-reported outcomes of joint-preserving surgery for moderate hallux rigidus: a 1-year follow-up of 296 patients from Swefoot.
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SUBMITTER: Coster ME
PROVIDER: S-EPMC7919882 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundHallux rigidus (HR) is a common source of forefoot pain and disability. For those who fail nonoperative treatment, minimally invasive dorsal cheilectomy (MIDC) is an increasingly popular alternative to the open approach with early positive results. Early failures may be due to lose bone debris from the MIDC as well as other intra-articular pathology that cannot be addressed with MIDC alone. Metatarsophalangeal (MTP) arthroscopy can be used in addition to MIDC to assess the joint after MIDC and address any intra-articular pathology while still maintaining the benefits of minimally invasive surgery. We report our clinical outcomes following MIDC combined with MTP arthroscopy.MethodsFrom November 2017 to July 2020, a retrospective analysis of all MIDC cheilectomies with MTP arthroscopy performed by the 2 senior authors was done. Wound complications, infections, revision rates, need for future surgery, conversion to fusion rates, pre- and postoperative range of motion, visual analog scale (VAS) scores, time to return to normal shoe, intraoperative arthroscopic findings, and operative time were collected. Follow-up average was 16.5 months (range 3-33 months).ResultsA total of 20 patients were included with an average follow-up of 16.5 months. The average VAS score improved from 7.05 preoperatively to 0.75 postoperatively (P < .05). Average range of motion in dorsiflexion increased from 32 to 48 degrees (P < .05) and plantarflexion increased from 15 to 19 degrees plantarflexion (P < .05). All patients were weightbearing as tolerated immediately after surgery in a postoperative shoe and transitioned to a regular shoe at average of 2.1 weeks. We had no wound infections, wound complications, revision surgeries, tendon injuries or nerve damage. One patient required conversion to a fusion 3 years after the index procedure. Average tourniquet time was 30.39 minutes (range 17-60 minutes) and total average operating room time was 59.7 minutes (range 40-87 minutes). On arthroscopic evaluation of the MTP joint after MIDC, 100% of patients had bone debris, 100% had synovitis, 10% had loose bodies, and 30% had large cartilage flaps within the joint.ConclusionMIDC and first MTP joint arthroscopy for treatment of hallux rigidus provide improved pain relief with minimal complications while still maintaining the benefits touted for minimally invasive operative procedures. Additionally, we have shown a high rate of intra-articular debris along with intra-articular pathology such as synovitis, loose chondral flaps, and loose bodies that exist after MIDC. This combined procedure has the potential for improving patient outcomes and may minimize risk of future revision surgeries compared with MIDC alone.Level of evidenceLevel IV, case series study.
| S-EPMC8702932 | biostudies-literature
Project description:BackgroundHallux rigidus (HR) is a common pathology of the first metatarsophalangeal (MTP) joint causing pain and stiffness. However, severity of symptoms and radiographic findings are not always concordant. A novel flexibility device, which measures the mobility of the MTP joint through its arc of motion, has been validated. This study compares flexibility in patients before and after cheilectomy (with or without proximal phalanx osteotomy) for HR.MethodsThis is a single-center study of adult patients with HR who were indicated for cheilectomy or cheilectomy and Moberg (dorsiflexion closing wedge) osteotomy of the proximal phalanx based on symptoms and radiographs from 2013 to 2015. Pre- and postoperatively, patients underwent testing with a validated flexibility protocol to generate flexibility curves. Parameters included early and late flexibility, laxity torque, and laxity angle. Patients completed Foot and Ankle Outcomes Scores (FAOS) pre- and postoperatively. Twelve operative patients underwent preoperative testing, with 9 completing postoperative testing (mean age, 53.0 years; 67% female; mean 2.8-year follow-up).ResultsPatients had significant improvements in early sitting and standing flexibility, sitting and standing laxity angles, standing laxity torque, and both sitting and standing maximum dorsiflexion after surgery (all P < .05). While preoperative early flexibility, laxity angle, and maximum dorsiflexion all differed significantly between patients and controls (P < .015), postoperative early flexibility was similar to controls (P > .279). FAOS scores for pain, symptoms, sport, and quality improved significantly after surgery.ConclusionSurgical treatment with cheilectomy was associated with significant improvements in nearly all flexibility parameters for sitting and standing positions. However, most postoperative flexibility parameters did not improve to the level of normal controls. Regardless, patients still experienced significant improvements in outcomes. This study demonstrated that surgical correction is associated with significant biomechanical and clinical results. The flexibility device can be used in further studies to assess outcomes after other HR procedures.Level of evidenceLevel II, prospective comparative study.
| S-EPMC8697098 | biostudies-literature
Project description:BackgroundInterposition arthroplasty of the first MTP joint has recently experienced renewed interest as a treatment for hallux rigidus. The purpose of this study was to systematically review the rapidly expanding literature on PRO following interposition arthroplasty of the first MTP joint.MethodsPubMed Central, Embase, and the Cochrane Central Register for Controlled Trials (CENTRAL) were searched. Inclusion criteria included length of time to follow-up, number of patients, outcome measure, and use of allogeneic or autogenous soft tissue or a synthetic matrix as interposition.Results20 studies were included in the review, comprising 498 patients and 539 feet with mean time to follow-up of 4.5 years. The most common substance used for interposition in the included studies was autogenous first MTPJ capsular tissue, a technique reported on in 12 (60.0%) of the included articles. In studies reporting preoperative and postoperative outcomes by way of a standardized outcome scoring system, mean group improvements exceed minimal clinically important differences in the majority of studies. Eighty-five percent of the studies included in this review were of Level IV quality evidence, and of this subset of studies, 70.6% were of a retrospective nature. Progression to further surgery was observed in 3.8% of toes. The most common complication reported was transfer metatarsalgia of 1 or more lesser toes, observed in up to 57.9% of patients in one study.ConclusionInterposition arthroplasty appears to be a viable option for the treatment of moderate to severe hallux rigidus in patients looking to salvage motion through the first metatarsophalangeal joint. A wide array of autogenous, allogeneic, and synthetic implant materials have surfaced in recent years, but long-term follow-up and prospective, comparative study designs with low risk of bias are limited.Level of evidenceLevel IV, systematic review of Level III-IV studies.
| S-EPMC8696831 | biostudies-literature
Project description:The objective of this study is to explore the effect of morbid obesity on patient-reported outcomes in primary total joint arthroplasty. We retrospectively reviewed 755 primary total joint arthroplasty cases with a minimum of 1-year follow-up. Two groups were compared: (1) patients with BMI < 40 and (2) those with BMI ? 40. The primary outcome was the difference in Short Form-12 physical component summary, Short Form-12 mental component summary, Western Ontario and McMaster Universities Osteoarthritis Index, and patient satisfaction. Multivariate analyses were performed to control for potential confounding factors. 37 patients (5%) were morbidly obese. Morbidly obese patients undergoing total knee arthroplasty had significantly lower net gains in their Short Form-12 physical component summary (P = .008), Short Form-12 mental component summary (P = .049), and Western Ontario and McMaster Universities Osteoarthritis Index (P = .009) in the first 6 months only. For total hip arthroplasty, morbid obesity did not affect any of the outcomes measured (P > .05). There was also no difference in patient satisfaction rates between the two groups (P = .401 and .143 for total hip arthroplasty and total knee arthroplasty, respectively). The impact of morbid obesity on patient-reported outcomes appears to be limited to total knee arthroplasty only in the initial 6 months after surgery.
| S-EPMC6920710 | biostudies-literature
Project description:BackgroundHallux rigidus is a common problem characterized by localized osteoarthritis and limited range of motion of the hallux. First metatarsophalangeal joint arthrodesis has been the accepted procedure for the treatment of late-stage disease. Despite the success of arthrodesis, some patients object to the notion of eliminating motion at the metatarsophalangeal joint. For this reason, motion-sparing procedures such as the modified oblique Keller capsular interpositional arthroplasty have been developed.MethodsWe compared a cohort of ten patients (ten toes) who had undergone the modified Keller arthroplasty with a group of twelve patients (twelve toes) who had undergone a first metatarsophalangeal joint arthrodesis at an average of sixty-three and sixty-eight months, respectively. Clinical outcomes were evaluated, and range of motion, great toe dynamometer strength, plantar pressures, and radiographs were assessed.ResultsClinical outcome differences existed between the groups, with the American Orthopaedic Foot and Ankle Society score being significantly higher for the arthroplasty group than for the arthrodesis group. The arthroplasty group had a mean of 54 degrees of passive and 30 degrees of active range of motion of the first metatarsophalangeal joint. The plantar pressure data revealed significantly higher pressures in the arthrodesis group under the great toe but not under the second metatarsal head.ConclusionsThe modified oblique Keller capsular interpositional arthroplasty appears to be a motion-sparing procedure with clinical outcomes equivalent to those of arthrodesis, and it is associated with a more normal pattern of plantar pressures during walking.Level of evidenceTherapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
| S-EPMC2918259 | biostudies-literature
Project description:Hallux rigidus is a progressive degenerative process of the first metatarsophalangeal joint characterized by altered joint mechanics and formation of dorsal osteophytes. Cheilectomy is the preferred operative intervention at early stages. Technologic advances, patient preference, and cost considerations combine to stimulate the development of minimally invasive and in-office interventions. This Technical Note highlights our technique for needle arthroscopy cheilectomy for hallux rigidus, which can be used either in the operating room or in the wide-awake office setting.
| S-EPMC8897605 | biostudies-literature
Project description:BackgroundThere is a clear call for improved patient-centered outcomes. The Foot and Ankle Outcome Score (FAOS) is a region-specific patient-reported measure that has been validated for a number of foot and ankle diagnoses, but not hallux rigidus.Questions/purposesThe aim of this study was to validate the FAOS in patients with hallux rigidus.MethodsFrom 2007 to 2013, 211 patients with hallux rigidus (HR) were included in the study. For the construct validity portion of the study, 125 patients completed a Short-Form 12 (SF-12) and FAOS survey. Forty additional HR patients were prospectively given questionnaires to assess the relevance of each FAOS question as it pertained to their HR. Reliability was assessed in 36 HR patients via administration of a second FAOS an average 1 month following the first. In 55 patients, preoperative and postoperative FAOS scores were compared to determine responsiveness.ResultsAll FAOS subscales demonstrated moderate correlation coefficients with the physical functioning, role physical, bodily pain, and physical health component scores of the SF-12, with all subscales demonstrating poor correlation with the SF-12 mental health-related domains. Content validity was high for all FAOS scores, with the exception of the daily activities subscale. All subscales achieved acceptable test-retest reliability with correlation coefficients of ?0.72. Furthermore, all subscales were rated as responsive to change in postoperative patients (p?<?0.001).ConclusionThis study demonstrates the acceptable construct and content validity, reliability, and responsiveness of the FAOS for hallux rigidus. Due to its broad applicability and proven validation across multiple foot and ankle pathologies, the FAOS represents a patient-centered outcome measure that can be reliably used for the assessment of patients with hallux rigidus.
| S-EPMC4733695 | biostudies-literature
Project description:A total of 118 feet with Hallux valgus and Hallux rigidus treated by the Keller-Brandes method were re-examined clinically and radiologically after 9.1 years (range: 1.7-24.3). Correction of the Hallux valgus angle was obtained from an average of 40 degrees to 23 degrees in the Hallux valgus group. Improvement in the postoperative range of motion was observed when the aftertreatment consisted of Kirschner-wire distraction instead of an axial Kirschner-wire transfixation. The patients who underwent Keller-Brandes surgery for Hallux valgus had less pain when the aftertreatment was carried out using an axial Kirschner wire, while those operated on for Hallux rigidus had less pain when the aftertreatment consisted of distraction. The percentage of satisfied or very satisfied patients with the cosmetic results of the Keller-Brandes arthroplasty was more than 66.7%. Patients with Hallux valgus and postoperative aftertreatment with Kirschner wire transfixation were the most satisfied patients, while patients with Hallux rigidus were very satisfied with the postoperative distraction. Our good results are comparable to those in other studies and confirm the success of the Keller-Brandes resection arthroplasty in Hallux valgus with osteoarthritis of the first metatarsophalangeal joint in older patients whose demand for movement is less, and in Hallux rigidus in less active older patients.
| S-EPMC2267583 | biostudies-other
Project description:BackgroundHallux rigidus is a common arthritic condition that has been addressed surgically with a range of techniques, from an isolated cheilectomy to first metatarsophalangeal (MTP) joint fusion. Recently, hemiarthroplasty with polyvinyl alcohol (PVA) hydrogel implant has been used as an alternative treatment to relieve pain while preserving motion of the first MTP joint. We retrospectively reviewed patient-reported outcome scores and clinical outcomes for patients treated for hallux rigidus with PVA hydrogel implant at an academic, multisurgeon center.MethodsA total of 103 patients who underwent first MTP hemiarthroplasty with PVA hydrogel implant between January 2017 and October 2018 were retrospectively reviewed (average, 26.2 months). Eight surgeons were represented. Baseline Patient-Reported Outcomes Measurement Information System (PROMIS) scores for the Physical Function, Pain Interference, Pain Intensity, Global Physical Health, Global Mental Health, and Depression domains were collected prospectively and compared with PROMIS scores collected at a minimum of 1 year postoperatively (average, 13.9 months). Seventy-three patients had both preoperative and postoperative scores. Ten of these patients had undergone a prior procedure of the first MTP, and 52 underwent concurrent Moberg osteotomy at the time of PVA hydrogel implantation.ResultsFor patients with baseline and postoperative PROMIS scores, significant pre- to postoperative improvement was detected for the Physical Function, Pain Interference, Pain Intensity, and Global Physical Health domains (P < .05). Patients who had undergone a prior procedure of the first MTP had significantly higher postoperative Pain Intensity scores compared with those who did not undergo a prior procedure. Patients undergoing concurrent Moberg osteotomy had significantly lower postoperative Pain Interference and Pain Intensity scores compared with those who did not undergo a Moberg. Two patients underwent revision procedures in the first 2 years postoperatively, one with revision hemiarthroplasty and one with conversion to arthrodesis.ConclusionOn average across our entire cohort, physical function and pain scores improved significantly pre- to postoperatively; however, postoperative pain scores were significantly higher for patients who had undergone a prior procedure of the first MTP and significantly lower for patients who underwent concurrent Moberg osteotomy. The implant displayed excellent survivorship in the first 2 years postoperatively, with only 2 revision procedures.Level of evidenceLevel III, comparative series.
| S-EPMC7549279 | biostudies-literature
Project description:BackgroundWhile metatarsus primus elevatus (MPE) has been implicated in the development of hallux rigidus, previous studies have presented conflicting findings regarding the relationship between MPE and arthritis. This may be due to the variety of definitions for MPE and the radiographic measurement techniques that are used to assess it. Additionally, previous studies have only assessed elevation of the first metatarsal with respect to the floor or the second metatarsal, and not with respect to the proximal phalanx. The aim of this study was to examine the reliability of new radiographic measurements that consider the elevation of the first metatarsal in relation to the proximal phalanx, rather than in relation to the second metatarsal as previously described, to assess for MPE. In addition, we aimed to determine whether the elevation of the first metatarsal was significantly different in patients with hallux rigidus than in a control population.MethodsA retrospective chart review was conducted from prospectively collected registry data at the investigators' institution to identify patients with hallux rigidus (n = 65). A size-matched control cohort of patients without evidence for first metatarsophalangeal (MTP) joint arthritis was identified (n = 65). Patients with a previous history of foot surgery, rheumatoid arthritis, or hallux valgus were excluded. Five blinded raters of varying levels of training, including 2 research assistants, 1 senior orthopedic resident, 1 foot and ankle fellowship-trained orthopedic surgeon, and 1 attending musculoskeletal fellowship-trained radiologist, evaluated 7 radiographic measurements for their reliability in assessing for MPE in hallux rigidus and control groups. Four of the 7 were newly designed measurements that include the relationship of the first MTP joint. Inter- and intrarater reliability were calculated using intraclass correlation coefficients (ICCs) and categorized by Landis and Koch reliability thresholds. The measurements between the hallux rigidus and control populations were compared using an independent t test.ResultsSix of the 7 radiographic measurements were found to have substantial to almost perfect interrater reliability (ICC, 0.800-0.953) between all levels of training, except for the proximal phalanx-first metatarsal angle, which showed moderate reliability (ICC, 0.527). Substantial to almost perfect intrarater reliability (ICC, 0.710-0.982) was demonstrated by the measurements performed by research assistants. All 7 of the measurements taken by the musculoskeletal fellowship-trained radiologist demonstrated significant differences in first metatarsal elevation between the hallux rigidus and control populations, with the hallux rigidus group showing increased elevation (P < .001-.019).ConclusionThis study confirmed the reliability of 7 radiographic measurements used to assess for MPE, including 3 previously established and 4 newly described measurements. Observers across all levels of training were able to demonstrate reliable measurements. In addition, the measurements were used to show that patients with hallux rigidus were more likely to have MPE compared with patients without radiographic evidence for first MTP arthritis. These measurements could be used in future work to examine how the presence of MPE relates to the etiology and progression of hallux rigidus, and how it affects the results of operative treatment.Level of evidenceLevel III, retrospective comparative study.
| S-EPMC8696814 | biostudies-literature