Hallux rigidus treated by carbon fibre arthroplasty of the proximal phalanx

Abstract

A porous pad of carbon fibre made into implants of 3 mm thickness was used in a study of the surgical management for the painful condition of hallux rigidus. The convex surface of the proximal phalanx was excavated to produce an undermined trough with its base parallel to the joint surface and 3 mm deep. A trial material was fashioned to fit the created recessed defect and used to shape the carbon fibre pad. With a pair of specially designed flat angled forceps the small pads, typically 10 mm diameter, were introduced into the recess and kept in position by the overhanging periphery of the phalanx. Sectional histology of a small sample of removed joints post mortem showed excellent ingrowth of new bone into the deeper region of the implants and restoration of the joint surface by a fibrocartilage type repair. Seventy-three patients underwent this procedure by the same surgeon (DSM) over a 10-year period (mean follow-up of 9.2 years). Forty-eight of these patients were reviewed with 80% showing a considerable improvement in pain relief, with a restoration of function and improved range of motion. We believe this procedure has many advantages over other methods of management for this painful condition.