Nonimplant Arthroplasty for the Treatment of End-Stage Hallux Rigidus

Surgical management of end-stage hallux rigidus involves joint-sparing techniques, including cheilectomy and decompression osteotomies, and joint-destructive procedures, including arthroplasty (resection, interpositional, implant, Valenti) and arthrodesis. Joint-destructive procedures have traditionally been reserved for the end stages of hallux rigidus involving grade 3 and 4. We present a modification of the previously reported Valenti arthroplasty with short-term patient outcomes. We performed a retrospective review of the medical records of 96 patients who had undergone the nonimplant arthroplasty procedure for treatment of end-stage hallux rigidus with a minimum follow-up period of 6 months. The preoperative and postoperative dorsiflexion of the first metatarsophalangeal joints and visual analog scale (VAS) scores were compared. Of the 96 medical records, 27 (28%) met the inclusion criteria. The mean patient age was 60.2 (range 48 to 73) years, and the mean follow-up period was 12 (range 6 to 23) months. The mean preoperative range of motion for first metatarsophalangeal joint dorsiflexion was 4.69° (range -3° to 10°), and the mean postoperative dorsiflexion was 48.23° (range 30° to 65°), with a mean difference of 43.54° (range 25° to 60°). The preoperative VAS score averaged 6.46° (range 4° to 10°), and the postoperative VAS score averaged 0.69° (range 0° to 3°). Nonimplant arthroplasty was found to increase first metatarsophalangeal joint dorsiflexion and significantly decrease patient pain. Thus, it is a viable option for the treatment of end-stage hallux rigidus.