BACKGROUND: The hallux rigidus is an over 100-year-known pathology. Yet an overall accepted therapy regime does not exist. The aim of this prospective study was to analyze the long-term clinical outcome and patient satisfaction of joint preserving operative care in patients with symptomatic hallux rigidus. METHODS: We present a prospective study with 60 patients (60 feet) with symptomatic hallux rigidus. In cases with intraoperative dorsiflexion of less than 70 degrees after the cheilectomy, an additional Kessel-Bonney osteotomy was done. The first follow-up after 24 (10-31) months was done on 49 (81.7%) patients and the second after 96 (84-104) months on 46 (76.7%) patients. We recorded the pre- and post-operative Kitaoka score, range of motion, pain and patients satisfaction. The results were related to the operative procedure and the grade of hallux rigidus (according to Regnauld). RESULTS: Twenty patients were graded as I, 35 patients as II and 5 patients as III. At the follow-up, the mean dorsiflexion increased in grade I patients to about 21.7 degrees , in grade II patients about 23.7 degrees and in grade III patients about 26.3 degrees . At the first follow-up [24 (10-31) months], all patients of grade I, 63.3% patients of grade II and 75% of grade III patients had just occasional or no pain. At the second follow-up [96 (84-104) months], 77.8% of grade I and 73.9% of grade II patients had no pain. At the first (second) follow-up 53.3% (61.1%) of grade I, 43.3% (33.3%) of grade II and 50% (25%) of grade III patients were completely satisfied. In order to the operative procedure the patients were completely satisfied or satisfied: first (second) follow-up 52% (85.9%) of patients with cheilectomy and 85% (86.4%) of patients with cheilectomy and Kessel-Bonney osteotomy. In 51.4% of the patients, the Kitaoka Score was higher than 70.4 points. Four patients had a persistent hypaesthesia of the medial side of the great toe and three patients had a delayed wound healing. No revision was necessary. No further operation was done in all the investigated patients. CONCLUSION: The joint preserving operation in patients with grade I and II hallux rigidus shows an increase of dorsiflexion and decrease of daily pain. The long-term follow-up shows a persistent pain reduction and satisfaction of the patients. Our results recommend a joint preserving operation in grade I and II hallux rigidus. An additional osteotomy of the proximal phalanx should be done in cases of dorsiflexion less than 70 degrees after cheilectomy.
BACKGROUND: The hallux rigidus is an over 100-year-known pathology. Yet an overall accepted therapy regime does not exist. The aim of this prospective study was to analyze the long-term clinical outcome and patient satisfaction of joint preserving operative care in patients with symptomatic hallux rigidus. METHODS: We present a prospective study with 60 patients (60 feet) with symptomatic hallux rigidus. In cases with intraoperative dorsiflexion of less than 70 degrees after the cheilectomy, an additional Kessel-Bonney osteotomy was done. The first follow-up after 24 (10-31) months was done on 49 (81.7%) patients and the second after 96 (84-104) months on 46 (76.7%) patients. We recorded the pre- and post-operative Kitaoka score, range of motion, pain and patients satisfaction. The results were related to the operative procedure and the grade of hallux rigidus (according to Regnauld). RESULTS: Twenty patients were graded as I, 35 patients as II and 5 patients as III. At the follow-up, the mean dorsiflexion increased in grade I patients to about 21.7 degrees , in grade II patients about 23.7 degrees and in grade III patients about 26.3 degrees . At the first follow-up [24 (10-31) months], all patients of grade I, 63.3% patients of grade II and 75% of grade III patients had just occasional or no pain. At the second follow-up [96 (84-104) months], 77.8% of grade I and 73.9% of grade II patients had no pain. At the first (second) follow-up 53.3% (61.1%) of grade I, 43.3% (33.3%) of grade II and 50% (25%) of grade III patients were completely satisfied. In order to the operative procedure the patients were completely satisfied or satisfied: first (second) follow-up 52% (85.9%) of patients with cheilectomy and 85% (86.4%) of patients with cheilectomy and Kessel-Bonney osteotomy. In 51.4% of the patients, the Kitaoka Score was higher than 70.4 points. Four patients had a persistent hypaesthesia of the medial side of the great toe and three patients had a delayed wound healing. No revision was necessary. No further operation was done in all the investigated patients. CONCLUSION: The joint preserving operation in patients with grade I and II hallux rigidus shows an increase of dorsiflexion and decrease of daily pain. The long-term follow-up shows a persistent pain reduction and satisfaction of the patients. Our results recommend a joint preserving operation in grade I and II hallux rigidus. An additional osteotomy of the proximal phalanx should be done in cases of dorsiflexion less than 70 degrees after cheilectomy.
Authors: Leif Claassen; Christian Plaass; Marc-Frederic Pastor; Sarah Ettinger; Mathias Wellmann; Christina Stukenborg-Colsman; Sayyed Hadi Sayyed Hosseinian; Hazibullah Waizy Journal: Arch Bone Jt Surg Date: 2017-07