Hallux rigidus: current concepts review and treatment algorithm with special focus on interposition arthroplasty

Main Article Content

Francesco Di Caprio https://orcid.org/0000-0002-4832-8852
Massimiliano Mosca https://orcid.org/0000-0002-3283-8735
Francesco Ceccarelli https://orcid.org/0000-0002-4457-0457
Silvio Caravelli https://orcid.org/0000-0001-9092-225X
Emanuele Vocale https://orcid.org/0000-0001-8692-2150
Stefano Zaffagnini https://orcid.org/0000-0002-2941-1407
Lorenzo Ponziani

Keywords

Hallux rigidus; Interposition; Arthroplasty; Treatment; Algorithm

Abstract

Background and aim of the work: Hallux rigidus represents a surgical challenge, with a multitude of possible surgical options, but with no ideal procedures.  The propose of this paper was to review the actual knowledge on the operative techniques, paying particular attention to the evolution of interposition arthroplasties, as an alternative to arthrodesis and prosthesis in the advanced stages of the disease.


Methods: A comprehensive literature PubMed search was performed, and the actual literature regarding hallux rigidus was overviewed. The operative and nonoperative options for HR were described. Studies on interposition arthroplasty were classified by publication year, summarizing the operative technique, results and complications.


Results: Among the various techniques for interposition arthroplasty, the Modified Oblique Keller Interposition Arthtoplasty (MOKCIA) showed the lower complication rate. It does not sacrifice the insertion of the flexor halluces brevis, maintaining the stability, length and strength of the big toe.


Conclusions: Although long-term randomized controlled trials are lacking for interposition arthroplasties, the reported results are comparable to the other alternatives for the treatment of end-stage hallux rigidus, making this technique a valid alternative also in the young active patient, without precluding other end-stage procedures in case of failure. Based on the current knowledge, a treatment algorithm was developed, according to the Coughlin classification.

Downloads

Download data is not yet available.
Abstract 57 | PDF Downloads 47

References

1. Gould N, Schneider W, Ashikaga T. Epidemiological survey of foot problems in the continental United States: 1978-1979. Foot Ankle 1980;1(1):8-10.
2. Davies-Colley, M. Contraction of the metatarsophalangeal joint of the great toe. Br Med J 1887;1:728.
3. Cotterill JM. The pathology of hallux rigidus. Br Med J 1903;2(2239):1400.
4. Lam A, Chan JJ, Surace MF, Vulcano E. Hallux rigidus: How do I approach it? World J Orthop 2017;8(5):364-71.
5. Hattrup SJ, Johnson KA. Subjective results of hallux rigidus following treatment with cheilectomy. Clin Orthop Relat Res 1988;(226):182-91.
6. Coughlin MJ, Shurnas PS. Hallux rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg Am 2003;85(11):2072-88.
7. Beeson P, Phillips C, Corr S, Ribbans W. Classification systems for hallux rigidus: a review of the literature. Foot Ankle Int 2008;29(4):407-14.
8. Coughlin MJ, Shurnas PS. Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int 2003;24(10):731-43.
9. DuVries, H. Static deformities. In: DuVries H, editor. Surgery of the Foot. St. Louis: Mosby; 1959: 392–8.
10. Perler AD, Nwosu V, Christie D, Higgins K. End-stage osteoarthritis of the great toe/hallux rigidus: a review of the alternatives to arthrodesis: implant versus osteotomies and arthroplasty techniques. Clin Podiatr Med Surg 2013;30(3):351-95.
11. Migues A, Slullitel G. Joint-preserving procedure for moderate hallux rigidus. Foot Ankle Clin 2012;17(3):459-71.
12. Lambrinudi C. Metatarsus Primus Elevatus. Proc R Soc Med 1938;31(11):1273.
13. Sanchez PJ, Grady JF, Lenz RC, Park SJ, Ruff JG. Metatarsus Primus Elevatus Resolution After First Metatarsophalangeal Joint Arthroplasty. J Am Podiatr Med Assoc 2018;108(3):200-4.
14. Deland JT, Williams BR. Surgical management of hallux rigidus. J Am Acad Orthop Surg 2012;20(6):347-58.
15. Feldman RS, Hutter J, Lapow L, Pour B. Cheilectomy and hallux rigidus. J Foot Surg 1983;22(2):170-4.
16. Solan MC, Calder JD, Bendall SP. Manipulation and injection for hallux rigidus. Is it worthwhile? J Bone Joint Surg Br 2001;83(5):706-8.
17. Kunnasegaran R, Thevendran G. Hallux Rigidus: Nonoperative Treatment and Orthotics. Foot Ankle Clin 2015;20(3):401-12.
18. Caravelli S, Mosca M, Massimi S, et al. A comprehensive and narrative review of historical aspects and management of low-grade hallux rigidus: conservative and surgical possibilities. Musculoskelet Surg 2018;102(3):201-11.
19. Mann RA, Coughlin MJ, DuVries HL. Hallux rigidus: A review of the literatureand a method of treatment. Clin Orthop Relat Res 1979;(142):57-63.
20. Bussewitz BW, Dyment MM, Hyer CF. Intermediate-term results following first metatarsal cheilectomy. Foot Ankle Spec 2013;6(3):191-5.
21. Moberg E. A simple operation for hallux rigidus. Clin Orthop Relat Res 1979;(142):55-6.
22. Waizy H, Czardybon MA, Stukenborg-Colsman C, et al. Mid- and long-term results of the joint preserving therapy of hallux rigidus. Arch Orthop Trauma Surg 2010;130(2):165-70.
23. Freeman BL, Hardy MA. Multiplanar phalangeal and metatarsal osteotomies for hallux rigidus. Clin Podiatr Med Surg 2011;28(2):329-44.
24. Horton GA, Park YW, Myerson MS. Role of metatarsus primus elevatus in the pathogenesis of hallux rigidus. Foot Ankle Int 1999;20(12):777-80.
25. Galois L, Hemmer J, Ray V, Sirveaux F. Surgical options for hallux rigidus: state of the art and review of the literature. Eur J Orthop Surg Traumatol 2020;30(1):57-65.
26. Youngswick FD. Modifications of the Austin bunionectomy for treatment of metatarsus primus elevatus associated with hallux limitus. J Foot Surg 1982;21(2):114-6.
27. Slullitel G, López V, Seletti M, Calvi JP, Bartolucci C, Pinton G. Joint Preserving Procedure for Moderate Hallux Rigidus: Does the Metatarsal Index Really Matter? J Foot Ankle Surg 2016;55(6):1143-7.
28. Kilmartin TE. Phalangeal osteotomy versus first metatarsal decompression osteotomy for the surgical treatment of hallux rigidus: a prospective study of age-matched and condition-matched patients. J Foot Ankle Surg 2005;44(1):2-12.
29. Lundeen RO, Rose JM. Sliding oblique osteotomy for the treatment of hallux abducto valgus associated with functional hallux limitus. J Foot Ankle Surg 2000;39(3):161-7.
30. Viegas GV. Reconstruction of hallux limitus deformity using a first metatarsal sagittal-Z osteotomy. J Foot Ankle Surg 1998;37(3):204-11.
31. Drago JJ, Oloff L, Jacobs AM. A comprehensive review of hallux limitus. J Foot Surg 1984;23(3):213-20.
32. LaMar L, Deroy AR, Sinnot MT, Haut R, Squire M, Wertheimer S. Mechanical comparison of the Youngswick, sagittal V, and modified Weil osteotomies for hallux rigidus in a sawbone model. J Foot Ankle Surg 2006;45(2):70-5.
33. Blitz NM. The versatility of the Lapidus arthrodesis. Clin Podiatr Med Surg 2009;26(3):427-41.
34. Roukis TS. Clinical outcomes after isolated periarticular osteotomies of the first metatarsal for hallux rigidus: a systematic review. J Foot Ankle Surg 2010;49(6):553-60.
35. Abraham JS, Hassani H, Lamm BM. Hinged external fixation distraction for treatment of first metatarsophalangeal joint arthritis. J Foot Ankle Surg 2012;51(5):604-12.
36. Watanabe M. Selfoc-Arthroscope (Watanabe no. 24 arthroscope). Tokyo: Teishin Hospital; 1972: 1-12.
37. Ferkel RD. Great-toe arthroscopy. In: Ferkel RD, editor. Arthroscopic Surgery: The Foot and Ankle. Philadelphia: Lippincott-Raven;1996:255-72.
38. Nakajima K. Arthroscopy of the First Metatarsophalangeal Joint. J Foot Ankle Surg 2018;57(2):357-363.
39. McNeil DS, Baumhauer JF, Glazebrook MA. Evidence-based analysis of the efficacy for operative treatment of hallux rigidus. Foot Ankle Int 2013;34(1):15-32.
40. Ellington JK, Jones CP, Cohen BE, Davis WH, Nickisch F, Anderson RB. Review of 107 hallux MTP joint arthrodesis using dome-shaped reamers and a stainless-steel dorsal plate. Foot Ankle Int 2010;31(5):385-90.
41. Doty J, Coughlin M, Hirose C, Kemp T. Hallux metatarsophalangeal joint arthrodesis with a hybrid locking plate and a plantar neutralization screw: a prospective study. Foot Ankle Int 2013;34(11):1535-40.
42. Hunt KJ, Ellington JK, Anderson RB, Cohen BE, Davis WH, Jones CP. Locked versus nonlocked plate fixation for hallux MTP arthrodesis. Foot Ankle Int 2011;32(7):704-9.
43. Fanous RN, Ridgers S, Sott AH. Minimally invasive arthrodesis of the first metatarsophalangeal joint for hallux rigidus. Foot Ankle Surg 2014;20(3):170-3.
44. Ho B, Baumhauer J. Hallux rigidus. EFORT Open Rev 2017;2(1):13-20.
45. Politi J, John H, Njus G, Bennett GL, Kay DB. First metatarsal-phalangeal joint arthrodesis: a biomechanical assessment of stability. Foot Ankle Int 2003;24(4):332-7.
46. Hyer CF, Glover JP, Berlet GC, Lee TH. Cost comparison of crossed screws versus dorsal plate construct for first metatarsophalangeal joint arthrodesis. J Foot Ankle Surg 2008;47(1):13-8.
47. Massimi S, Caravelli S, Fuiano M, Pungetti C, Mosca M, Zaffagnini S. Management of high-grade hallux rigidus: a narrative review of the literature. Musculoskelet Surg 2020;104(3):237-43.
48. Horisberger M, Haeni D, Henninger HB, Valderrabano V, Barg A. Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux. Foot Ankle Int 2016;37(7):755-65.
49. Gibson JN, Thomson CE. Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial. Foot Ankle Int 2005;26(9):680-90.
50. Stevens J, de Bot RTAL, Hermus JPS, van Rhijn LW, Witlox AM. Clinical Outcome Following Total Joint Replacement and Arthrodesis for Hallux Rigidus: A Systematic Review. JBJS Rev 2017 Nov;5(11):e2.
51. Stone OD, Ray R, Thomson CE, Gibson JN. Long-Term Follow-up of Arthrodesis vs Total Joint Arthroplasty for Hallux Rigidus. Foot Ankle Int 2017;38(4):375-80.
52. Stibolt RD, Patel HA, Lehtonen EJ, et al. Hemiarthroplasty Versus Total Joint Arthroplasty for Hallux Rigidus: A Systematic Review and Meta-analysis. Foot Ankle Spec 2019;12(2):181-93.
53. Schneider W, Kadnar G, Kranzl A, Knahr K. Long-term results following Keller resection arthroplasty for hallux rigidus. Foot Ankle Int 2011;32(10):933-9.
54. Colò G, Samaila EM, Magnan B, Felli L. Valenti resection arthroplasty for hallux rigidus: A systematic review. Foot Ankle Surg. 2020 Dec;26(8):838-44.
55. Patel HA, Kalra R, Johnson JL, et al. Is interposition arthroplasty a viable option for treatment of moderate to severe hallux rigidus? - A systematic review and meta-analysis. Foot Ankle Surg 2019;25(5):571-9.
56. Cosentino GL. The Cosentino modification for tendon interpositional arthroplasty. J Foot Ankle Surg 1995;34(5):501-8.
57. Hamilton WG, O'Malley MJ, Thompson FM, Kovatis PE. Roger Mann Award 1995. Capsular interposition arthroplasty for severe hallux rigidus. Foot Ankle Int 1997;18(2):68-70.
58. Barca F. Tendon arthroplasty of the first metatarsophalangeal joint in hallux rigidus: preliminary communication. Foot Ankle Int 1997;18(4):222-8.
59. Lau JT, Daniels TR. Outcomes following cheilectomy and interpositional arthroplasty in hallux rigidus. Foot Ankle Int 2001;22(6):462-70.
60. Ozan F, Bora OA, Filiz MA, Kement Z. Interposition arthroplasty in the treatment of hallux rigidus. Acta Orthop Traumatol Turc 2010;44(2):143-51.
61. Schenk S, Meizer R, Kramer R, Aigner N, Landsiedl F, Steinboeck G. Resection arthroplasty with and without capsular interposition for treatment of severe hallux rigidus. Int Orthop. 2009;33(1):145-50.
62. Coughlin MJ, Shurnas PJ. Soft-tissue arthroplasty for hallux rigidus. Foot Ankle Int 2003;24(9):661-72.
63. Roukis TS, Landsman AS, Ringstrom JB, Kirschner P, Wuenschel M. Distally based capsule-periosteum interpositional arthroplasty for hallux rigidus. Indications, operative technique, and short-term follow-up. J Am Podiatr Med Assoc 2003;93(5):349-66.
64. Mroczek KJ, Miller SD. The modified oblique Keller procedure: a technique for dorsal approach interposition arthroplasty sparing the flexor tendons. Foot Ankle Int 2003;24(7):521-2.
65. Clews CN, Kingsford AC, Samaras DJ. Autogenous capsular interpositional arthroplasty surgery for painful hallux rigidus: assessing changes in range of motion and postoperative foot health. J Foot Ankle Surg 2015;54(1):29-36.
66. Mackey RB, Thomson AB, Kwon O, Mueller MJ, Johnson JE. The modified oblique keller capsular interpositional arthroplasty for hallux rigidus. J Bone Joint Surg Am 2010;92(10):1938-46.
67. Sanhudo JA, Gomes JE, Rodrigo MK. Surgical treatment of advanced hallux rigidus by interpositional arthroplasty. Foot Ankle Int 2011;32(4):400-6.
68. Mackey RB, Johnson JE. Modified Oblique Keller Capsular Interposition Arthroplasty for Hallux Rigidus. JBJS Essent Surg Tech 2012;2(1):e3.
69. Kennedy JG, Chow FY, Dines J, Gardner M, Bohne WH. Outcomes after interposition arthroplasty for treatment of hallux rigidus. Clin Orthop Relat Res 2006;445:210-5.
70. Johnson JE, McCormick JJ. Modified oblique Keller capsular interposition arthroplasty (MOKCIA) for treatment of late-stage hallux rigidus. Foot Ankle Int 2014;35(4):415-22.
71. Berlet GC, Hyer CF, Lee TH, Philbin TM, Hartman JF, Wright ML. Interpositional arthroplasty of the first MTP joint using a regenerative tissue matrix for the treatment of advanced hallux rigidus. Foot Ankle Int 2008;29(1):10-21.
72. Hyer CF, Granata JD, Berlet GC, Lee TH. Interpositional arthroplasty of the first metatarsophalangeal joint using a regenerative tissue matrix for the treatment of advanced hallux rigidus: 5-year case series follow-up. Foot Ankle Spec 2012;5(4):249-52.
73. Hahn MP, Gerhardt N, Thordarson DB. Medial capsular interpositional arthroplasty for severe hallux rigidus. Foot Ankle Int 2009;30(6):494-9.
74. DelaCruz EL, Johnson AR, Clair BL. First metatarsophalangeal joint interpositional arthroplasty using a meniscus allograft for the treatment of advanced hallux rigidus: surgical technique and short-term results. Foot Ankle Spec 2011;4(3):157-64.
75. Heller E, Robinson D. Gelfoam first metatarsophalangeal replacement / interposition arthroplasty - a case series with functional outcomes. Foot (Edinb) 2011;21(3):119-23.
76. Givissis PK, Symeonidis PD, Kitridis DM, Daskalakis DN, Christodoulou AG. Minimal resection interposition arthroplasty of the first metatarsophalangeal joint. Foot (Edinb) 2017;32:1-7.
77. Vulcano E, Chang AL, Solomon D, Myerson M. Long-Term Follow-up of Capsular Interposition Arthroplasty for Hallux Rigidus. Foot Ankle Int 2018;39(1):1-5.
78. Thomas D, Thordarson D. Rolled Tendon Allograft Interposition Arthroplasty for Salvage Surgery of the Hallux Metatarsophalangeal Joint. Foot Ankle Int 2018;39(4):458-62.
79. Pisani G. Alluce rigido. In: Pisani G, editor. Trattato di chirurgia del piede. Torino: Minerva Medica;2004:364-367.
80. Galli MM, Hyer CF. Hallux rigidus: what lies beyond fusion, resectional arthroplasty, and implants. Clin Podiatr Med Surg 2011;28(2):385-403.

Most read articles by the same author(s)

1 2 3 4 5 > >>