Association Between Patient Factors and Outcome of Synthetic Cartilage Implant Hemiarthroplasty vs First Metatarsophalangeal Joint Arthrodesis in Advanced Hallux Rigidus

Abstract

Background:

We evaluated data from a clinical trial of first metatarsophalangeal joint (MTPJ1) implant hemiarthroplasty and arthrodesis to determine the association between patient factors and clinical outcomes.

Methods:

Patients ≥18 years with hallux rigidus grade 2, 3, or 4 were treated with synthetic cartilage implant MTPJ1 hemiarthroplasty or arthrodesis. Pain visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM) sports and activities of daily living (ADL) scores, and Short Form-36 Physical Function (SF-36 PF) subscore were obtained preoperatively, and at 2, 6, 12, 24, 52, and 104 weeks postoperatively. Final outcome data, great toe active dorsiflexion motion, secondary procedures, radiographs, and safety parameters were evaluated for 129 implant hemiarthroplasties and 47 arthrodeses. The composite primary endpoint criteria for clinical success included VAS pain reduction ≥30%, maintenance/improvement in function, no radiographic complications, and no secondary surgical intervention at 24 months. Predictor variables included hallux rigidus grade; gender; age; body mass index (BMI); symptom duration; prior MTPJ1 surgery; preoperative hallux valgus angle, range of motion (ROM), and pain. Two-sided Fisher exact test was used (P < .05).

Results:

Patient demographics and baseline outcome measures were similar. Success rates between implant MTPJ1 hemiarthroplasty and arthrodesis were similar (P > .05) when stratified by hallux rigidus grade, gender, age, BMI, symptom duration, prior MTPJ1 surgery status, and preoperative VAS pain, hallux valgus, and ROM.

Conclusion:

Synthetic cartilage implant hemiarthroplasty was appropriate for patients with grade 2, 3, or 4 hallux rigidus. Its results in those with associated mild hallux valgus (≤20 degrees) or substantial preoperative stiffness were equivalent to MTPJ1 fusion, irrespective of gender, age, BMI, hallux rigidus grade, preoperative pain or symptom duration.

Level of Evidence:

Level II, randomized clinical trial.

Keywords

first metatarsophalangeal joint hallux rigidus hemiarthroplasty synthetic cartilage implant

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References

Angst

Aeschlimann

Stucki

Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Rheum. 2001;45(4):384-391.

Baker

Walsh

Schwartz

Boyan

BD.

A review of polyvinyl alcohol and its uses in cartilage and orthopedic applications. J Biomed Mater Res B Appl Biomater. 2012;100(5):1451-1457.

Baumhauer

Marcolongo

The science behind wear testing for great toe implants for hallux rigidus. Foot Ankle Clin. 2016;21(4):891-902.

Baumhauer

Singh

Glazebrook

et al . Prospective, randomized, multi-centered clinical trial assessing safety and efficacy of a synthetic cartilage implant versus first metatarsophalangeal arthrodesis in advanced hallux rigidus. Foot Ankle Int. 2016;37(5):457-469.

Coughlin

Shurnas

PS.

Hallux rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg Am. 2003;85(11):2072-2088.

Coughlin

Shurnas

PS.

Hallux rigidus. J Bone Joint Surg Am. 2004;86(suppl 1, pt 2):119-130.

Daniels

Younger

Penner

et al . Midterm outcomes of polyvinyl alcohol hydrogel hemiarthroplasty of the first metatarsophalangeal joint in advanced hallux rigidus. Foot Ankle Int. 2017;38(3):243-247.

Dworkin

Turk

Wyrwich

et al . Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9(2):105-121.

Erdil

Elmadag

Polat

et al . Comparison of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in the treatment of advanced hallux rigidus. J Foot Ankle Surg. 2013;52(5):588-593.

10.

Gibson

Thomson

CE.

Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial. Foot Ankle Int. 2005;26(9):680-690.

11.

Gould

Schneider

Ashikaga

Epidemiological survey of foot problems in the continental United States: 1978-1979. Foot Ankle. 1980;1(1):8-10.

12.

Baumhauer

Hallux rigidus. EFORT Open Rev. 2017;2(1):13-20.

13.

Kim

Hatch

Didomenico

et al . A multicenter retrospective review of outcomes for arthrodesis, hemi-metallic joint implant, and resectional arthroplasty in the surgical treatment of end-stage hallux rigidus. J Foot Ankle Surg. 2012;51(1):50-56.

14.

Madeley

Wing

Topliss

et al . Responsiveness and validity of the SF-36, Ankle Osteoarthritis Scale, AOFAS Ankle Hindfoot Score, and Foot Function Index in end stage ankle arthritis. Foot Ankle Int. 2012;33(1):57-63.

15.

Martin

Irrgang

Burdett

Conti

Van Swearingen

JM.

Evidence of validity for the Foot and Ankle Ability Measure (FAAM). Foot Ankle Int. 2005;26(11):968-983.

16.

McNeil

Baumhauer

Glazebrook

MA.

Evidence-based analysis of the efficacy for operative treatment of hallux rigidus. Foot Ankle Int. 2013;34(1):15-32.

17.

Mermerkaya

Adli

A comparison between metatarsal head-resurfacing hemiarthroplasty and total metatarsophalangeal joint arthroplasty as surgical treatments for hallux rigidus: a retrospective study with short- to midterm follow-up. Clin Interv Aging. 2016;11:1805-1813.

18.

Noguchi

Yamamuro

Oka

et al . Poly(vinyl alcohol) hydrogel as an artificial articular cartilage: evaluation of biocompatibility. J Appl Biomater. 1991;2(2):101-107.

19.

Raikin

Ahmad

Pour

Abidi

Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint. J Bone Joint Surg Am. 2007;89(9):1979-1985.

20.

Simons

van der Woude

Faber

van Kampen

Thomassen

BJ.

Short-term clinical outcome of hemiarthroplasty versus arthrodesis for end-stage hallux rigidus. J Foot Ankle Surg. 2015;54(5):848-851.

21.

van Saase

van Romunde

Cats

Vandenbroucke

Valkenburg

HA.

Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis. 1989;48(4):271-280.

22.

Voskuijl

Onstenk

Operative treatment for osteoarthritis of the first metatarsophalangeal joint: arthrodesis versus hemiarthroplasty. J Foot Ankle Surg. 2015;54(6):1085-1088.

23.

Yee

Lau

Current concepts review: hallux rigidus. Foot Ankle Int. 2008;29(6):637-646.

24.

Younger

ASE

Baumhauer

JF.

Polyvinyl alcohol hydrogel hemiarthroplasty of the great toe: technique and indications. Tech Foot Ankle Surg. 2013;12(3):164-169.

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