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Clinical Outcome Following Total Joint Replacement and Arthrodesis for Hallux Rigidus: A Systematic Review
Jasper Stevens1, Robin T A L de Bot1, Joris P S Hermus1
1Department of Orthopaedics, Maastricht University Medical Centre, Maastricht, the Netherlands.
JBJS Reviews
|November 15, 2017
Summary
Arthrodesis offers superior outcomes for hallux rigidus (stiff big toe) compared to total joint replacement, demonstrating better pain reduction and fewer complications. Further research is needed to confirm these findings for hallux rigidus treatment.
Area of Science:
- Orthopedic Surgery
- Foot and Ankle Surgery
- Reconstructive Surgery
Background:
- Hallux rigidus, a common cause of foot pain in the elderly, significantly impacts quality of life.
- Surgical interventions, including total joint replacement and arthrodesis of the first metatarsophalangeal joint, are considered for refractory cases.
- Optimal surgical approach for symptomatic hallux rigidus remains unclear regarding clinical outcomes and complication rates.
Purpose of the Study:
- To systematically compare the clinical outcomes and complication rates of arthrodesis versus total joint replacement for treating hallux rigidus.
- To evaluate the effectiveness of surgical interventions based on patient-reported outcome measures and complication data.
Main Methods:
- Systematic literature search of PubMed/MEDLINE, Embase, and Cochrane Library for relevant studies.
- Inclusion of studies assessing American Orthopaedic Foot & Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) score, Foot Function Index (FFI), visual analog scale (VAS) for pain, or Short Form-36 (SF-36).
- Qualitative and quantitative synthesis of data from 33 studies, including 741 arthrodeses and 555 total joint replacements, with risk-of-bias assessment.
Main Results:
- Arthrodesis demonstrated superiority in improving clinical outcomes (AOFAS-HMI: 43.8 vs. 37.7) and reducing pain (VAS: 6.56 vs. 4.65 points decrease) compared to total joint replacement.
- Lower rates of intervention-related complications (23.1% vs. 26.3%) and revisions (3.9% vs. 11%) were observed following arthrodesis.
- Pain was the most common complication after arthrodesis, while nonunion and prosthetic loosening were most frequent after total joint replacement.
Conclusions:
- Arthrodesis is a superior surgical option for hallux rigidus, offering better clinical outcomes, pain relief, and fewer complications than total joint replacement.
- The findings suggest arthrodesis as a preferred intervention for symptomatic hallux rigidus.
- Further prospective, randomized controlled trials are recommended to validate these conclusions.
