[Short-Term Results of Surgical Treatment of Patients with Hallux Rigidus]

PURPOSE OF THE STUDY Hallux rigidus is common and degenerative arthritis of the first metatarsophalangeal joint. The aim of this study was to assess the results of cheilectomy and total joint replacement (TJR) in patients with hallux rigidus. Minimum duration of followup was 18 months. MATERIAL AND METHODS The study included fifty-nine patients who underwent surgery at our Department due to hallux rigidus between January 2013 and December 2014. Thirty-seven patients underwent cheilectomy and twenty-two patients had total joint arthroplasty using METIS®. The outcomes were assessed by comparing preoperative and postoperative ranges of motion, VAS (Visual Analogue Scale), AOFAS-HMI (American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal) and patients' satisfaction with operative treatment. Preoperative and postoperative outcomes were compared for the individual types of surgery using the repeated measures ANOVA. The level of statistical significance was set at p < 0.01. RESULTS The mean age was 47.9 ± 7.0 years in patients who underwent cheilectomy and 62.5 ± 5.5 years in patients after TJR METIS®. There was a significant decrease (p < 0.001) in the VAS pain score and a significant improvement in dorsiflexion, range of movements, AOFAS-HMI scores in both the treatment groups. In both the groups more than 75% of patients reported good or excellent subjective results. DISCUSSION Our results are in agreement with findings of other studies assessing the results of cheilectomy and TJR surgery in patients with hallux rigidus. Direct comparison of the VAS pain score, AOFAS-HMI and ranges of motion across studies is difficult because of variability in the evaluation systems. Cheilectomy is mostly recommended for young active patients with mild osteoarthritis. Moreover, it is also possible to use minimally invasive surgery with early and reliable outcomes. At our Department, we perform cheilectomy also in younger patients with moderate osteoarthritis in order to extend the period of clinically acceptable results and thereby to postpone the TJR indication. TJR (similarly to arthrodesis of the first metatarsophalangeal joint) is a procedure performed in elderly patients with low physical activity and more advanced deformities. CONCLUSIONS Both the reported methods offer reliable and valuable short-term clinical outcomes with relatively low complication rate. Cheilectomy is undoubtedly more appropriate for younger patients with mild or moderate arthritic changes. Although it does not appear to alter the natural progression of the disease process, it provides satisfactory pain relief, motion improvement and overall patient gait comfort for patients in a short-term period. TJR seems to be a better solution for less active older patients to whom it provides a loadable, painless, and moving joint. Key words: hallux rigidus, first metatarsophalangeal joint, cheilectomy, arthroplasty, Metis®, surgical treatment.