Judith F Baumhauer1, Dishan Singh2, Mark Glazebrook3, Chris M Blundell4, Gwyneth De Vries5, Ian L D Le6, Dominic Nielsen7, M Elizabeth Pedersen8, Anthony Sakellariou9, Matthew Solan10, Guy Wansbrough11, Alastair S E Younger12, Timothy R Daniels13. 1. 1 Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. 2. 2 Stanmore Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK. 3. 3 Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada. 4. 4 Northern General Hospital, Sheffield, UK. 5. 5 Dalhousie University and Memorial University of Newfoundland, Fredericton, New Brunswick, Canada. 6. 6 University of Calgary, Calgary, Alberta, Canada. 7. 7 St George's Hospital, London, UK. 8. 8 University of Alberta, Edmonton, Alberta, Canada. 9. 9 Frimley Park Hospital, Frimley, Camberley, Surrey, UK. 10. 10 Royal Surrey County Hospital, Guildford, Surrey, UK. 11. 11 Torbay Hospital, Torquay, Devon, UK. 12. 12 Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada. 13. 13 Division of Orthopaedic Surgery, St Michael's Hospital, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Grading systems are used to assess severity of any condition and as an aid in guiding treatment. This study examined the relationship of baseline motion, pain, and observed intraoperative cartilage loss with hallux rigidus grade. METHODS: A prospective, randomized study examining outcomes of arthrodesis compared to synthetic cartilage implant was performed. Patients underwent preoperative clinical examination, radiographic assessment, hallux rigidus grade assignment, and intraoperative assessment of cartilage loss. Visual analog scale (VAS) score for pain was obtained preoperatively and at 24 months. Correlation was made between active peak dorsiflexion, VAS pain, cartilage loss, and hallux rigidus grade. Fisher's exact test was used to assess grade impact on clinical success ( P < .05). RESULTS: In 202 patients, 59 (29%), 110 (55%), and 33 (16%) were classified as Coughlin grades 2, 3, and 4, respectively. There was no correlation between grade and active peak dorsiflexion (-0.069, P = .327) or VAS pain (-0.078, P = .271). Rank correlations between grade and cartilage loss were significant, but correlations were small. When stratified by grade, composite success rates between the 2 treatments were nearly identical. CONCLUSIONS: Irrespective of the grade, positive outcomes were demonstrated for both fusion and synthetic cartilage implant. Clinical symptoms and signs should be used to guide treatment, rather than a grade consisting of radiographic, symptoms, and range of motion factors. LEVEL OF EVIDENCE: Level II, randomized clinical trial.
RCT Entities:
BACKGROUND: Grading systems are used to assess severity of any condition and as an aid in guiding treatment. This study examined the relationship of baseline motion, pain, and observed intraoperative cartilage loss with hallux rigidus grade. METHODS: A prospective, randomized study examining outcomes of arthrodesis compared to synthetic cartilage implant was performed. Patients underwent preoperative clinical examination, radiographic assessment, hallux rigidus grade assignment, and intraoperative assessment of cartilage loss. Visual analog scale (VAS) score for pain was obtained preoperatively and at 24 months. Correlation was made between active peak dorsiflexion, VAS pain, cartilage loss, and hallux rigidus grade. Fisher's exact test was used to assess grade impact on clinical success ( P < .05). RESULTS: In 202 patients, 59 (29%), 110 (55%), and 33 (16%) were classified as Coughlin grades 2, 3, and 4, respectively. There was no correlation between grade and active peak dorsiflexion (-0.069, P = .327) or VAS pain (-0.078, P = .271). Rank correlations between grade and cartilage loss were significant, but correlations were small. When stratified by grade, composite success rates between the 2 treatments were nearly identical. CONCLUSIONS: Irrespective of the grade, positive outcomes were demonstrated for both fusion and synthetic cartilage implant. Clinical symptoms and signs should be used to guide treatment, rather than a grade consisting of radiographic, symptoms, and range of motion factors. LEVEL OF EVIDENCE: Level II, randomized clinical trial.
Entities:
Keywords:
First metatarsophalangeal joint; arthritis; cheilectomy; first MTP fusion; hallux rigidus; hemiarthroplasty; synthetic cartilage implant
Authors: Stephanie K Eble; Oliver B Hansen; Bopha Chrea; Taylor N Cabe; Jonathan Garfinkel; Mark C Drakos Journal: Foot Ankle Int Date: 2020-07-10 Impact factor: 2.827
Authors: William M Engasser; J Chris Coetzee; Patrick B Ebeling; Bryan D Den Hartog; Jeffrey D Seybold; Scott M Holthusen; Rebecca Stone McGaver; Kayla J Seiffert; M Russell Giveans Journal: Foot Ankle Orthop Date: 2020-08-06