Coughlin, J Bone Joint Surg Am 2003 - Hallux Rigidus. Grading and Long-Term Results of Operative Treatment

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Hallux Rigidus. Grading and Long-Term Results of Operative Treatment

Coughlin, Shurnas·J Bone Joint Surg Am·2003·544 citations·Case series

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Background

There have been few long-term studies documenting the outcome of surgical treatment of hallux rigidus. The purposes of this report were to evaluate the long-term results of the operative treatment of hallux rigidus over a 19-year period in one surgeon's practice and to assess a clinical grading system for use in the treatment of hallux rigidus.

Methods

All patients in whom degenerative hallux rigidus had been treated with cheilectomy or metatarsophalangeal joint arthrodesis between 1981 and 1999 and who were alive at the time of this review were identified and invited to return for a follow-up evaluation.
At this follow-up evaluation, the hallux rigidus was graded with a new five-grade clinical and radiographic system.
Outcomes were assessed by comparison of preoperative and postoperative pain and AOFAS (American Orthopaedic Foot and Ankle Society) scores and ranges of motion.
These outcomes were then correlated with the preoperative grade and the radiographic appearance at the time of follow-up.

Results

110 of 114 patients with a diagnosis of hallux rigidus returned for the final evaluation.
80 patients (93 feet) had undergone a cheilectomy, and 30 patients (34 feet) had had an arthrodesis.
The mean duration of follow-up was 9.6 years after the cheilectomies and 6.7 years after the arthrodeses.
There was significant improvement in dorsiflexion and total motion following the cheilectomies (p = 0.0001) and significant improvement in postoperative pain and AOFAS scores in both treatment groups (p = 0.0001).
A good or excellent outcome based on patient self-assessment, the pain score, and the AOFAS score did not correlate with the radiographic appearance of the joint at the time of final follow-up.
Dorsiflexion stress radiographs demonstrated correction of the elevation of the first ray to nearly zero.
There was no association between hallux rigidus and hypermobility of the first ray, functional hallux limitus, or metatarsus primus elevatus.

Conclusions

97 percent (107) of the 110 patients had a good or excellent subjective result, and 92% (86) of the 93 cheilectomy procedures were successful in terms of pain relief and function. Cheilectomy was used with predictable success to treat Grade-1 and 2 and selected Grade-3 cases. Patients with Grade-4 hallux rigidus or Grade-3 hallux rigidus with <50% of the metatarsal head cartilage remaining at the time of surgery should be treated with arthrodesis.

Copyright remains with the authors and publisher.

Hallux Rigidus. Grading and Long-Term Results of Operative Treatment.

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Hallux Rigidus. Grading and Long-Term Results of Operative Treatment

Coughlin, Shurnas·J Bone Joint Surg Am·2003·544 citations·Case series

|

Background

There have been few long-term studies documenting the outcome of surgical treatment of hallux rigidus. The purposes of this report were to evaluate the long-term results of the operative treatment of hallux rigidus over a 19-year period in one surgeon's practice and to assess a clinical grading system for use in the treatment of hallux rigidus.

Methods

All patients in whom degenerative hallux rigidus had been treated with cheilectomy or metatarsophalangeal joint arthrodesis between 1981 and 1999 and who were alive at the time of this review were identified and invited to return for a follow-up evaluation.
At this follow-up evaluation, the hallux rigidus was graded with a new five-grade clinical and radiographic system.
Outcomes were assessed by comparison of preoperative and postoperative pain and AOFAS (American Orthopaedic Foot and Ankle Society) scores and ranges of motion.
These outcomes were then correlated with the preoperative grade and the radiographic appearance at the time of follow-up.

Results

110 of 114 patients with a diagnosis of hallux rigidus returned for the final evaluation.
80 patients (93 feet) had undergone a cheilectomy, and 30 patients (34 feet) had had an arthrodesis.
The mean duration of follow-up was 9.6 years after the cheilectomies and 6.7 years after the arthrodeses.
There was significant improvement in dorsiflexion and total motion following the cheilectomies (p = 0.0001) and significant improvement in postoperative pain and AOFAS scores in both treatment groups (p = 0.0001).
A good or excellent outcome based on patient self-assessment, the pain score, and the AOFAS score did not correlate with the radiographic appearance of the joint at the time of final follow-up.
Dorsiflexion stress radiographs demonstrated correction of the elevation of the first ray to nearly zero.
There was no association between hallux rigidus and hypermobility of the first ray, functional hallux limitus, or metatarsus primus elevatus.

Conclusions

97 percent (107) of the 110 patients had a good or excellent subjective result, and 92% (86) of the 93 cheilectomy procedures were successful in terms of pain relief and function. Cheilectomy was used with predictable success to treat Grade-1 and 2 and selected Grade-3 cases. Patients with Grade-4 hallux rigidus or Grade-3 hallux rigidus with <50% of the metatarsal head cartilage remaining at the time of surgery should be treated with arthrodesis.

Copyright remains with the authors and publisher.

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