Description of atechnique that uses Lapidus arthrodesis plus osteochondral autotransplantation in the treatment of severe hallux rigidus

Abstract

The objective of this technique is the treatment asevere hallux rigidus deformity by reorientation of an elevated first metatarsal using arthrodesis of the first tarsometatarsal joint and performing aone-step transplantation of an osteochondral graft, which is harvested from the first cuneiform, to the head of the first metatarsal bone. Severe arthritis of the first metatarsophalangeal joint (MTP) stage3 and4 in the Vanore classification. General contraindications for afoot surgery; ankylosis of MTP joint; severe arthritis of the sesamoid joint; osteonecrosis; short first metatarsal; previous infection in the metatarsophalangeal joint; large cysts at the head of the first metatarsal. The first step is the preparation of the metatarsophalangeal and the first tarsometatarsal joint. After mobilizing the first metatarsal in amedioplantar direction, acartilage-bone cylinder is removed from the articular surface of the medial cuneiform using special osteochondral autograft transfer system (OATS) instruments (Small Joint OATS, Arthrex medical instruments GmbH, Munich, Germany). This is followed by the arthrodesis of the first tarsometatarsal joint with reorientation of the position of the first metatarsal bone. Then the removed osteochondral cylinder is implanted into the articular surface of the first metatarsal head. After that the capsule is closed and the skin sutured. Postoperative management is guided mainly by the requirements of the first tarsometatarsal arthrodesis. When aplantar plate is used pain orientated full weightbearing is allowed in apostoperative shoe with astiffened sole for 6-8weeks. Physiotherapy is prescribed to exercise the first metatarsophalangeal joint. In the study, 5 patients were treated with the method described in the years 2011-2012 and were followed up for aperiod of 2years. All of these patients were subjectively satisfied with the outcome of the operation. There were no relevant surgery-associated complications.