Distal Oblique Osteotomy vs Arthrodesis for Advanced Hallux Rigidus: A Matched Cohort Study.

Area of Science:

• Orthopaedic surgery
• Foot and ankle surgery
• Joint preservation techniques

Background:

• Arthrodesis is the standard for advanced hallux rigidus but sacrifices joint motion and carries risks.
• Distal oblique osteotomy (DOO) is a joint-preserving alternative addressing impingement and biomechanics.
• Limited direct comparisons exist between arthrodesis and DOO for advanced hallux rigidus.

Purpose of the Study:

• To compare the clinical outcomes of arthrodesis versus DOO in patients with advanced hallux rigidus.
• To evaluate patient satisfaction, complications, revision rates, pain, and function after both procedures.

Main Methods:

• Retrospective review of prospectively collected registry data from a single tertiary orthopaedic centre.
• Inclusion of patients with advanced hallux rigidus treated with arthrodesis or DOO after conservative treatment failure.
• Matching cohorts for key demographic and radiographic parameters, with assessment at a minimum of 24 months.

Main Results:

• Both arthrodesis and DOO improved pain and function, with similar high patient satisfaction rates.
• The DOO group had significantly lower overall complication rates (3.2% vs. 28.6%) and higher American Orthopaedic Foot & Ankle Society (AOFAS) scores.
• Range of motion (ROM) was greater in the DOO group, while postoperative visual analogue scale (VAS) pain scores were comparable.

Conclusions:

• Distal oblique osteotomy (DOO) may be a viable motion-preserving surgical option for select patients with advanced hallux rigidus.
• DOO demonstrated comparable patient satisfaction and pain relief to arthrodesis, with the added benefits of preserved joint motion and fewer complications.
• Further prospective studies are warranted to confirm these findings and establish DOO as a standard alternative treatment.