[Intermediate and long-term outcome after total joint replacement for hallux rigidus : a retrospective analysis].

Background: The treatment options for advanced hallux rigidus include arthrodesis, excision arthroplasty (Keller-Brandes) and joint arthroplasty and based on the literature, arthrodesis still appears to be the gold standard. In recent years, technical advances and higher patient demands have led to an increasing use of total joint replacement but comparative data on patient satisfaction and clinical outcome of different forms of treatment are rare.
Material and Methods: Between 1995 and 2005 a total of 27 patients were treated with 28 joint replacements of the first metatarsophalangeal joint (MTPJ) in a surgical practice (Bio-Action Great Toe Implant, OsteoMed, Addison, TX). The mean age of the patients was 63.7 years. In a retrospective analysis patients were examined clinically and radiologically after a mean follow-up period of 8.8 years and asked about their satisfaction with surgical results using a questionnaire.
Results: After joint replacement 15 patients (53.6%) were free of pain, 8 (28.6%) reported marked improvement, 12 (42.9%) had no limitations in any activity and another 5 (17.9%) had no restrictions in activities of daily life. The maximum walking distance was improved in 21 patients (75%) and walking on rough ground in 24 (85.7%). Of the patients 11 (39.3%) had a good range of motion in the MTPJ, 13 (46.4%) reported a slight restriction, 24 (85.7%) were satisfied or very satisfied with the postoperative result and 22 stated that they would undergo joint replacement again. The results of the Wilcoxon test showed a significant increase in postoperative modified American Orthopaedic Foot and Ankle Society (AOFAS) scores compared with preoperative scores. There was loosening of the phalangeal component in 3 patients (11%), and 2 had to undergo revision.
Conclusions: Many recent studies reported good to excellent long-term results of arthrodesis of the MTPJ for stage III and IV hallux rigidus. The results of this study suggest that similar results can be achieved by an experienced foot surgeon with total joint replacement in strictly selected patients.