Interpositional Arthroplasty of the First Metatarsophalangeal Joint Using a Regenerative Tissue Matrix for the Treatment of Advanced Hallux Rigidus

Abstract

Background. Painful osteoarthritis of the first metatarsophalangeal (MTP) joint, known as hallux rigidus, can be difficult to treat in young and active patients that who fail conservative treatment. The purpose of this study is to report the 5-year follow-up of a joint preservation technique for the treatment of advanced hallux rigidus. Methods. Preservation of the first MTP joint is performed using a human acellular dermal regenerative matrix as an interpositional arthroplasty graft. A retrospective chart review was performed and compared with follow-up modified American Orthopedic Foot and Ankle scores (AOFAS) obtained by telephone. Of the first 9 consecutive patients in the original study cohort, 6 patients were available for follow-up. The outcome measures include AOFAS modified for pain and function, reoperation rates, and overall satisfaction with the procedure. Results. The average follow-up was 5.43 years. No patient had a subsequent fusion or additional procedure performed on their first MTP joint. Average preoperative modified AOFAS were 38 (range, 34 to 43). Average postoperative AOFAS were 65.8 (range, 58 to 68). All patients were satisfied with their results. Conclusion. Interpositional arthroplasty of the first MTP joint using a regenerative tissue matrix has led to reliable pain relief and preserved function at an average follow-up of 5.4 years in 6 patients. The authors recommend this technique to active patients with advanced hallux rigidus who want to delay a fusion of their first MTP joint.

Levels of Evidence: Therapeutic, Level IV