Follow-up results 17 years after resection arthroplasty of the great toe.

Abstract

Resection arthroplasty of the first metatarsophalangeal joint is a well-known operation. The follow-up results more than 17 years after arthroplasty for hallux valgus are reported and discussed. Between 1971 and 1980, 335 resection arthroplasties were performed on 205 patients. The sole indication for resection arthroplasty of the great toe in this study was hallux valgus. The technique involved removal of the proximal one-third of the phalanx with interposition of a capsular flap, occasionally including temporary Kirschner wire fixation. After 17.6 years on average, 102 patients were re-examined clinically and radiographically. Questionnaire assessment revealed a significantly prolonged walking distance, and 70% of the patients were pain-free at follow-up investigation, whereas 67% suffered from severe pain before the operation. Clinical evaluation showed diminished weight-bearing of the great toe during walking and a reduced range of motion of the resected first metatarsophalangeal joint. Radiographic shortening of the proximal phalanx was 37%. The average hallux valgus angle was 23 degrees at follow-up and 34 degrees prior to surgery. The unacceptably high rate of hallux valgus relapse, especially due to a high intermetatarsal angle, emphasizes the unsatisfactory long-term results of the resection arthroplasty. We now recommend this operation for older patients only, and a differentiated approach using reconstructive procedures according to the clinical and radiographical situation for younger patients.