Metatarsal head resurfacing for advanced hallux rigidus

Area of Science:

• Orthopedic Surgery
• Podiatric Medicine
• Biomaterials Engineering

Background:

• Advanced first metatarsophalangeal (MTP) arthritis often requires arthroplasty or arthrodesis.
• Arthrodesis shows superior outcomes to metallic joint replacement but has complications.
• Metallic resurfacing of the MTP joint offers a potential alternative for advanced arthritis.

Purpose of the Study:

• To evaluate the outcomes of metallic resurfacing for advanced first MTP arthritis (hallux rigidus).
• To assess improvements in range of motion (ROM), function, and health survey scores.
• To determine patient satisfaction and implant survivorship at medium-term follow-up.

Main Methods:

• A prospective case series of 26 patients (30 implants) with stage II or III hallux rigidus.
• Patients underwent metatarsal-side metallic resurfacing using the HemiCAP® implant.
• Pre- and postoperative data included radiographs, ROM, American Orthopedic Foot and Ankle Society (AOFAS) scores, and Short Form 36 Health Survey (SF-36) scores, assessed at 27 and 60 months.

Main Results:

• Statistically significant improvements observed in ROM, AOFAS, and SF-36 scores at 27 months (P < .05).
• Mean AOFAS scores improved from 51.5 to 94.1; mean active ROM increased from 19.7 to 47.9 degrees.
• At 60 months, 87% implant survivorship was noted, with all patients reporting excellent satisfaction and willingness to repeat the procedure.

Conclusions:

• Metallic resurfacing of the first MTP joint yields promising 5-year results for advanced hallux rigidus.
• The procedure effectively preserves joint motion, alleviates pain, and improves function.
• Minimal joint resection allows for simpler conversion to arthrodesis if future intervention is needed.