Arthrodesis versus arthroplasty of the first metatarsophalangeal joint in the treatment of hallux rigidus – comparative study

Abstract

Hallux rigidus is a degenerative disease of the first metatarsophalangeal joint (1MTF), which manifests itself with pain and decreased mobility. Surgical treatment is indicated when conservative treatment fails. The aim of this study is to compare the results of two surgical methods – arthrodesis versus 1MTF arthroplasty in the treatment of hallux rigidus. Between 2010 and 2015, 30 patients with hallux rigidus were treated (stage III and IV Coughlin and Shurnas classification). Twelve patients underwent arthrodesis with plate or/and screws and 18 patients underwent total 1MTF arthroplasty (using the same prosthesis, placed by the same surgeon). The mean age was 57.6 years in the group submitted to arthroplasty and 63.5 years in the group submitted to arthrodesis (P = 0.021). The mean follow-up was 47.7 months in the arthroplasty group and 40.1 months in the arthrodesis group. Pain was assessed using visual analogue scale (VAS) and functional status using the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal scale (AOFAS-HMI). All patients reported significant improvement in pain and functional status after surgery. Patients submitted to arthroplasty reported better functional results on the AOFAS-HMI scale (90.8 vs. 65.4, P = 0.001) and better pain control (1.6 vs. 4.1, P = 0.007) when compared to the group submitted to arthrodesis. All patients were satisfied, improved their quality of life and would accept to repeat surgery in the arthrodesis group and only 1 patient in the arthroplasty group wouldn‘t repeat surgery. There was one case of infection in the group of patients submitted to arthroplasty and 2 cases of pseudoarthrosis in the group submitted to arthrodesis. Arthrodesis provides pain relief and satisfactory results but alters the biomechanics of gait. Like arthrodesis, arthroplasty improves pain significantly, being a more physiological alternative to keep the mechanics of the foot more conserved. On the other hand, this technique is more expensive and is susceptible to wear and failure over time. The two surgical methods had satisfactory results. One MTF arthroplasty has shown superior results, so it is a great treatment option for this condition if we do a good patient selection.