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Published on: January 19, 2022
Cheilectomy Alone in Patients With Elevatus Yields Poor 5-Year Survival Rate
Anthony Mollica1, William Bennett2, Joshua Rhodenizer3
1Podiatric Surgeon, Ascension St John Hospital, Detroit, MI.
Insights
Cheilectomy surgery outcomes depend on Seiberg's index, a measure of elevatus. A Seiberg's index greater than 0.20 cm indicates a higher risk of cheilectomy failure, suggesting alternative treatments may be needed.
Area of Science:
- Orthopedic Surgery
- Podiatry
- Biomechanical Engineering
Background:
- Hallux rigidus is a common degenerative condition affecting the first metatarsophalangeal joint.
- Cheilectomy is a surgical procedure to treat hallux rigidus by removing dorsal osteophytes.
- The degree of elevatus, a dorsal elevation of the first metatarsal, may influence surgical outcomes.
Purpose of the Study:
- To evaluate the efficacy of cheilectomy for varying degrees of elevatus.
- To determine the correlation between Seiberg's index and the long-term success of cheilectomy.
- To identify predictive factors for cheilectomy failure in hallux rigidus patients.
Main Methods:
- Retrospective analysis of patients undergoing cheilectomy by a single surgeon.
- Calculation of Seiberg's index from pre- and postoperative radiographs.
- Assessment of patient outcomes using Visual Analog Pain (VAS) scores and Foot and Ankle Ability Measure (FAAM) via telephone surveys.
Main Results:
- Seiberg's index significantly influenced the 5-year survival rate of cheilectomy (p ≤ .05).
- Patients with Seiberg's index < 0.20 cm showed 87.0% 5-year survival with favorable FAAM and VAS scores.
- A Seiberg's index between 0.20 and 0.40 cm resulted in 62.0% 5-year survival, while index > 0.40 cm had 0.0% survival.
Conclusions:
- Seiberg's index is a critical factor in predicting cheilectomy success for hallux rigidus.
- A Seiberg's index greater than 0.20 cm suggests cheilectomy alone may have a higher risk of failure.
- Consideration of alternative or adjunctive treatments is recommended for patients with elevated Seiberg's index values.
Abstract:
This study was performed to evaluate the efficacy of the cheilectomy procedure for different degrees of elevatus. The study was Institutional Review Board approved and patients were evaluated retrospectively at Ascension St. John Hospital, St. John Surgery Center and St. John Macomb Township Surgery Center between 9/8/2012 and 1/8/2016. These were all performed by the same surgeon. The pre- and postoperative radiographs were analyzed and Seiberg's index was calculated. Charts were also reviewed, and demographic information was obtained. A telephone survey was performed, and Visual Analog Pain score and Foot and Ankle Ability Measure was obtained. Body mass index, age, calcaneal inclination angle, Seiberg's index, Foot and Ankle Ability Measure, and visual analog score were analyzed using chi-square test, bivariate regression analysis and independent t test. Seiberg's index had a statistically significant influence on 5-year survival rate for the cheilectomy procedure (p ≤ .05). For patients with Seiberg's index less than 0.20 cm demonstrated FAAM, and VAS p values .18 and .37 with 87.0% 5-year survival. Seiberg's index between 0.20 and 0.40 cm had FAAM and VAS scores with p values <.01 and .02 with 62.0% 5-year survival. Seiberg's index ≤0.40 cm p values <.01 and .55 with 5-year survival rate of 0.0%. Therefore, if Seiberg's index is greater than 0.20 cm based on this research a cheilectomy alone as a sole treatment is at greater risk of failure.
