Outcomes Following Minimally Invasive vs Open Cheilectomy for Hallux Rigidus: A Systematic Review

IntroductionHallux rigidus is common and can be disabling for patients. Once conservative management is exhausted, surgical treatment is considered. For earlier stage hallux rigidus, cheilectomy can be offered to patients. Traditionally, open cheilectomy has been performed, but minimally invasive cheilectomy is becoming increasingly popular. The purpose of this systematic review is to compare the outcomes of minimally invasive vs open cheilectomy for hallux rigidus.MethodsTwo comprehensive literature searches of Ovid MEDLINE and EMBASE were performed for relevant publications from January 1, 1995 to April 9, 2024. Search terms focused on open and minimally invasive surgery (MIS) cheilectomy were used. All full-text, English-language, clinical studies reporting on MIS and open cheilectomy outcomes and/or complications were included. Article screening, critical appraisal, and data extraction were performed independently by 2 reviewers.ResultsNine MIS cheilectomy studies were identified, reporting on a total of 442 patients (95 males, 214 females, and 133 not reported) with 464 feet operated on. The weighted mean age and follow-up were 50.7 ± 4.6 years and 33. 5 ±14.0 months, respectively. Fifteen open cheilectomy studies were identified, yielding 720 patients (199 males, 319 females, and 202 not specified) and 763 operated feet. The weighted mean age and follow-up was 53.2 ± 4.7 years and 64.5 ± 28.3 months, respectively. Functional outcomes are similar following open or MIS cheilectomy. The MIS cheilectomy studies reported a total of 37 complications (8.2%) and 43 revision surgeries (9.3%). Complications and revision surgery following open cheilectomy were 14.7% (n = 112) and 5.0% (n = 38), respectively. Complications following open cheilectomy were higher than with MIS cheilectomy (P = .001). However, revision surgery was found to be higher in patients following MIS cheilectomy (P = .003).ConclusionSurgical complications following MIS cheilectomy were found to be less common when compared to open cheilectomy. However, there may be an increased risk of revision surgery following MIS cheilectomy.Level of Evidence:III (systematic review of level III-IV studies).