Clinical results of capsular interposition arthroplasty for severe hallux rigidus

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: There is no established surgical treatment for severe hallux rigidus (HR). Hamilton suggested capsular interposition arthroplasty (CIA), performed using an articular capsule and extensor hallucis brevis as a biologic spacer, as an alternative to metatarsophalangeal (MTP) joint fixation to treat severe HR. CIA is a preservation procedure that relieves pain and maintains joint function. We present the results of CIA performed at our facility to treat severe HR. Methods: In the present study, we further divided Hattrup’s grade II HR into two subtypes on the basis of joint space narrowing of 1stMTP. We recorded the severity of patients’ condition using our modified Hattrup’s classification. In this study, we did a follow-up of 8 cases in which CIA was performed to treat severe HR. The cases were followed up for 1 year or longer. The mean age of patients at surgery was 63.8 years, and the mean follow-up period was 7.1 years. Surgery was performed using a modified Hamilton method, which involves making an incision on the dorsal instead of the medial side and a manipulating the articular capsule in a different manner. Clinical outcomes were evaluated using the Japanese Society for Surgery of the Foot standard rating system (JSSF) scale. We investigated the pre- and post-operative ROM of the MTP joints and verified the presence or absence of complications. Results: It was observed that pain had reduced significantly in all cases after surgery. Following CIA, the mean ROM at extension was noted to have improved from 27.5° to 48.8° and the mean ROM at flexion had improved from 11.9° to 21.9°. The mean JSSF scale score has improved from 59.5 to 97.5 points. No complications were observed. Conclusion: This procedure is beneficial for pain relief and acquisition or maintenance of articular ROM and is a better choice for patients desiring preservation of ROM and articular function. It is imperative that patients follow proper rehabilitation for ROM and muscular strength preservation.