Minimally invasive cheilectomy

Abstract

Treatment of hallux rigidus by minimally invasive resection of the dorsal osteophytes, synovectomy and resection of the dorsal part of the metatarsal head. Hallux rigidus gradesII andIII CONTRAINDICATIONS: End-stage osteoarthritis of the first metatarsophalangeal joint with beginning ankylosis. Osteophytes around the metatarsophalangeal joint are removed using a1 cm incision dorsomedial, approximately 3 cm proximal of the joint space. The dorsal third of the metatarsal head is resected with aburr to improve dorsiflexion. The extent of bone resection is checked with an image intensifier. Loose bone fragments removed with arangeur. An arthroscopy can be performed to check the completeness of bone resection, the irrigation of the joint and, if needed, to extend the synovectomy. Removal of the sutures after 2weeks. Depending on pain, the patient can change from the postoperative shoe to anormal soft, comfortable and wide shoe after1-2weeks. Nonsteroidal drugs can be prescribed as needed. Active and passive mobilization of the metatarsophalangeal joint is also recommended. The technique allows asoft-tissue-preserving resection of the osteophytes and apartial resection of the metatarsal head. The main advantages are limited soft-tissue trauma and rapid rehabilitation. In all, 21women and 17men with hallux rigidus stagesII andIII (Vanore) underwent surgery. Minimum follow-up was 12months. In 1patient, injury of the extensor hallucis longus tendon was observed. Two patients underwent revision surgery. One patient was converted to ametatarsophalangeal fusion, while another patient received aresection arthroplasty. At the latest follow-up, the AOFAS (American Orthopaedic Foot & Ankle Society) score averaged 88.7points.