[Cheilectomy and Kessel-Bonney procedure for treatment of initial hallux rigidus]
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Carsten Wingenfeld1, Mona Abbara-Czardybon, Dariusch Arbab
1Klinik für Orthopädie und Unfallchirurgie, Remigius-Krankenhaus-Opladen, Leverkusen, Germany. carstenwingenfeld@gmx.de
Objective:
Joint-preserving procedure for initial osteoarthritis of the first metatarsophalangeal joint for improvement of restricted joint motion and achievement of a harmonic gait.
Indications:
Hallux rigidus stage I and II according to Regnauld's classification.
Contraindications:
Hallux rigidus Regnauld stage III. General medical contraindications to surgical interventions and anesthesiological procedures.
Surgical Technique:
Operation in regional anesthesia (foot block). Tourniquet. Longitudinal skin incision over the dorsal aspect of the first metatarsophalangeal joint. Incision of the joint capsule with protection of the extensor hallucis longus tendon and the dorsal neurovascular bundle. Cheilectomy: removal of osteophytes at the metatarsal head and the base of the proximal phalanx. Resection of the dorsal third of the metatarsal head with an oscillating saw in plantar flexion of the proximal phalanx. Kessel-Bonney procedure: dissection of the proximal phalanx. Incomplete dorsal osteotomy with an oscillating saw at the metaphysis of the proximal phalanx and removal of a dorsal wedge with a base of 2-3 mm. Osteosynthesis with mini-plate or transosseous suture.
Postoperative Management:
Postoperative elevation of the operated foot. Analgesia with nonsteroidal anti-inflammatory drugs. Postoperative shoe for 3-4 weeks. Immediate weight bearing. Mobilization of the metatarsophalangeal joint with an elastic bandage. Taping in extension and elastic forefoot dressing for 3 weeks postoperatively. Clinical and radiologic controls after 6 and 12 weeks.
Results:
53 operations on 45 patients were performed. 39 patients (86%; 28 female, eleven male, mean age 43.6 years) were followed up. After a period of 26 months (range: 10-51 months), 32 of 39 patients (82%) were satisfied or very satisfied. The median preoperative range of motion was 12.3 degrees for dorsal extension and 17.1 degrees for plantar flexion. Function had increased to a dorsiflexion of 34.2 degrees and a plantar flexion of 32.8 degrees. All patients returned to a normal walking ability after a mean period of 3.7 weeks. Due to delayed wound healing, one revision was necessary. According to Kitaoka's Forefoot Score, the mean preoperative value of 44.3 (standard deviation [SD]: +/- 16) increased postoperatively to a mean value of 78.9 (SD: +/- 12).