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Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial
J N Alastair Gibson1, Colin E Thomson
1Department of Foot and Ankle Surgery, Royal Infirmary of Edinburgh, Old Dalkeith Road Edinburgh, EH16 4SU, United Kingdom. j.n.a.Gibson@ed.ac.uk
Foot & Ankle International
|September 22, 2005
Summary
First metatarsophalangeal joint (MTPJ) arthrodesis showed better pain relief and patient preference compared to total joint replacement arthroplasty for hallux rigidus. Arthrodesis also demonstrated a more favorable cost ratio and fewer complications.
Area of Science:
- Orthopedic Surgery
- Podiatric Medicine
- Biomechanical Engineering
Background:
- Hallux rigidus treatment often involves arthrodesis, but total joint replacement arthroplasty is also considered.
- Evaluating clinical outcomes of first metatarsophalangeal joint (MTPJ) arthrodesis versus arthroplasty is crucial.
Purpose of the Study:
- To compare the clinical outcomes of MTPJ arthrodesis and total joint replacement arthroplasty.
- To assess pain reduction, functional improvement, and cost-effectiveness of both surgical procedures.
Main Methods:
- A randomized controlled trial involving 63 patients with MTPJ arthritis.
- Patients were randomly assigned to undergo either MTPJ arthrodesis (38 toes) or arthroplasty (39 toes).
- Primary outcome was pain reduction (Visual Analogue Scale); functional outcomes and costs were assessed over 2 years.
Main Results:
- Both procedures improved pain, but arthrodesis yielded significantly greater pain reduction.
- All arthrodesis procedures united successfully with minimal complications.
- Arthroplasty had a high failure rate due to component loosening, poor range of motion, and altered weight-bearing, with a 2:1 cost advantage for arthrodesis.
Conclusions:
- Arthrodesis provided superior outcomes compared to arthroplasty for end-stage hallux rigidus.
- High rates of phalangeal component loosening compromised arthroplasty results.
- Even excluding failures, patients preferred arthrodesis over arthroplasty.
