Patient Satisfaction Following Hallux Rigidus Treatment With a Synthetic Cartilage Implant

Abstract

Background

There remains no clear consensus on patient satisfaction and functional outcomes following synthetic cartilage implant (SCI) implantation for hallux rigidus. The purpose of this study was to review our experience at a single academic institution using an SCI for treatment of hallux rigidus.

Methods

A retrospective review was performed of patients who underwent the SCI procedure for treatment of hallux rigidus between January 2017 and May 2019. Functional outcomes were evaluated using Patient-Reported Outcome Measures Informational System (PROMIS)-10 scores as well as a survey investigating patient satisfaction, self-reported clinical improvement, and changes in sporting ability. Patients were divided into satisfied versus unsatisfied subgroups, and between-group differences in preoperative variables and complications were reviewed. A total of 90 patients (96 implants) were included in this study. The mean follow-up time was 26.4 months.

Results

In all, 81.2% of patients reported that their foot was “much improved” (55.2%) or “improved” (26.0%) since undergoing the SCI procedure, whereas a slightly lower percentage, 74.0%, stated that they were “extremely satisfied” (41.7%) or “satisfied” (32.3%) at final follow-up. Patients were able to tolerate higher impact sporting activities after the procedure, and 75.0% of patients stated they would have the same surgery again. PROMIS-10 T-scores averaged 54.2 points for physical health and 57.4 points for mental health. Only 2.1% of patients required conversion to arthrodesis. Significant differences between the satisfied versus unsatisfied subgroups were found in preoperative corticosteroid injection use (21.1% vs 41.1%, respectively; P = .029) and preoperative VAS pain score (8.2 vs 7.1, respectively; P = .036).

Conclusion

The SCI procedure can be a viable option for treating hallux rigidus with high satisfaction overall, increased sport activity levels, and a very low revision rate. However, maximizing patient satisfaction may require more careful consideration of preoperative prognosticators and extensive patient counseling to ensure realistic expectations for recovery time and individual outcome.

Level of Evidence:

Level IV: Retrospective case series

Keywords

hallux rigidus arthritis first metatarsophalangeal joint synthetic cartilage implant

Get full access to this article

View all access options for this article.

References

Gould

Schneider

Ashikaga

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

Jacob

. Forces acting in the forefoot during normal gait—an estimate. Clin Biomech (Bristol, Avon). 2001;16:783-792.

Brandao

Aljawadi

Poh

Fox

Pillai

. Comparative study assessing sporting ability after arthrodesis and Cartiva hemiarthroplasty for treatment of hallux rigidus. J Orthop. 2020;18:50-52.

Grady

Axe

Zager

Sheldon

. A retrospective analysis of 772 patients with hallux limitus. J Am Podiatr Med Assoc. 2002;92:102-108.

Maes

DJA

De Vil

Kalmar

Lootens

. Clinical and radiological outcomes of hallux rigidus treated with cheilectomy and a Moberg-Akin osteotomy. Foot Ankle Int. 2020;41:294-302.

Seibert

Kadakia

. Surgical management of hallux rigidus: cheilectomy and osteotomy (phalanx and metatarsal). Foot Ankle Clin. 2009;14:9-22.

Sidon

Rogero

Bell

, et al. Long-term follow-up of cheilectomy for treatment of hallux rigidus. Foot Ankle Int. 2019;40:1114-1121.

Stevens

Bursnall

Chadwick

, et al. Comparison of complication and reoperation rates for minimally invasive versus open cheilectomy of the first metatarsophalangeal joint. Foot Ankle Int. 2020;41:31-36.

Teoh

Tan

Atiyah

Ahmad

Tanaka

Hariharan

. Clinical outcomes following minimally invasive dorsal cheilectomy for hallux rigidus. Foot Ankle Int. 2019;40:195-201.

10.

Coughlin

Shurnas

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

11.

Stevens

de Bot

RTAL

Witlox

, et al. Long-term effects of cheilectomy, Keller’s arthroplasty, and arthrodesis for symptomatic hallux rigidus on patient-reported and radiologic outcome. Foot Ankle Int. 2020;41:775-783. doi:10.1177/1071100720919681

12.

Da Cunha

MacMahon

Jones

, et al. Return to sports and physical activities after first metatarsophalangeal joint arthrodesis in young patients. Foot Ankle Int. 2019;40:745-752.

13.

Chraim

Bock

Alrabai

Trnka

. Long-term outcome of first metatarsophalangeal joint fusion in the treatment of severe hallux rigidus. Int Orthop. 2016;40:2401-2408.

14.

Goucher

Coughlin

. Hallux metatarsophalangeal joint arthrodesis using dome-shaped reamers and dorsal plate fixation: a prospective study. Foot Ankle Int. 2006;27:869-876.

15.

Gibson

Thomson

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

16.

Kline

Hasselman

. Resurfacing of the metatarsal head to treat advanced hallux rigidus. Foot Ankle Clin. 2015;20:451-463.

17.

McGraw

IWW

Jameson

Kumar

. Mid-term results of the Moje Hallux MP joint replacement. Foot Ankle Int. 2010;31:592-599.

18.

Garras

Durinka

Bercik

Miller

Raikin

. Conversion arthrodesis for failed first metatarsophalangeal joint hemiarthroplasty. Foot Ankle Int. 2013;34:1227-1232.

19.

Gross

Hsu

Lin

Holmes

Lee

. Revision MTP arthrodesis for failed MTP arthroplasty. Foot Ankle Spec. 2013;6:471-478.

20.

Stone

Ray

Thomson

Gibson

. Long-term follow-up of arthrodesis vs total joint arthroplasty for hallux rigidus. Foot Ankle Int. 2017;38:375-380.

21.

Dawson-Bowling

Adimonye

Cohen

Cottam

Ritchie

Fordyce

. MOJE ceramic metatarsophalangeal arthroplasty: disappointing clinical results at two to eight years. Foot Ankle Int. 2012;33:560-564.

22.

Baumhauer

Daniels

Glazebrook

. New technology in the treatment of hallux rigidus with a synthetic cartilage implant hemiarthroplasty. Orthop Clin North Am. 2019;50:109-118.

23.

Baker

Walsh

Schwartz

Boyan

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

24.

Noguchi

Yamamuro

Oka

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

25.

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;37:457-469.

26.

Glazebrook

Blundell

O’Dowd

, et al. Midterm outcomes of a synthetic cartilage implant for the first metatarsophalangeal joint in advanced hallux rigidus. Foot Ankle Int. 2019;40:374-383.

27.

Cassinelli

Chen

Charlton

Thordarson

. Early outcomes and complications of synthetic cartilage implant for treatment of hallux rigidus in the United States. Foot Ankle Int. 2019;40:1140-1148.

28.

Cassinelli

Charlton

Pfeffer

Thordarson

. Radiographic and magnetic resonance imaging of the symptomatic synthetic cartilage implant. Foot Ankle Int. 2020;41:25-30.

29.

Usuelli

Di Silvestri

D’Ambrosi

Maccario

Tan

. Return to sport activities after medial displacement calcaneal osteotomy and flexor digitorum longus transfer. Knee Surg Sports Traumatol Arthrosc. 2018;26:892-896.

30.

Younger

ASE

Baumhauer

Glazebrook

. Polyvinyl alcohol hemiarthroplasty for first metatarsophalangeal joint arthritis. Curr Orthop Pract. 2013;24:493-497.

31.

Younger

ASE

Baumhauer

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

32.

Hays

Spritzer

Thompson

Cella

. US general population estimate for “excellent” to “poor” self-rated health item. J Gen Intern Med. 2015;30:1511-1516.

33.

Goldberg

Singh

Glazebrook

, et al. Association between patient factors and outcome of synthetic cartilage implant hemiarthroplasty vs first metatarsophalangeal joint arthrodesis in advanced hallux rigidus. Foot Ankle Int. 2017;38:1199-1206.

34.

Glazebrook

Younger

ASE

Daniels

, et al. Treatment of first metatarsophalangeal joint arthritis using hemiarthroplasty with a synthetic cartilage implant or arthrodesis: a comparison of operative and recovery time. Foot Ankle Surg. 2018;24:440-447.

35.

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;38:243-247.

36.

Baumhauer

Singh

Glazebrook

, et al. Correlation of hallux rigidus grade with motion, vas pain, intraoperative cartilage loss, and treatment success for first MTP joint arthrodesis and synthetic cartilage implant. Foot Ankle Int. 2017;38:1175-1182.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.03 MB