Background: Multiple surgical options have been described for severe hallux rigidus. One option is capsular interpositional arthroplasty. We report our initial results with a technique using the thicker medial capsule as our interpositional material instead of the dorsal capsule and extensor hallucis brevis (EHB). Materials and Methods: Twenty-two patients with grade IV hallux rigidus underwent minimal proximal phalanx resection (modified Keller) with preservation of the flexor hallucis brevis (FHB) insertion and medial capsular interpositional arthroplasty. Results: Postoperative AOFAS hallux MTP-IP scores (mean 77.8), and SF-36 scores (mean 68.7 on physical function, 79.5 role limitations) demonstrated clinical improvement compared to historical controls. Alignment and stability were well maintained (mean preoperative HV angle of 11.8 degrees, mean postoperative HV angle of 13.0 degrees). Dorsiflexion/plantarflexion arc of motion showed sustained improvement (mean 38.4 degrees preoperative, mean 62.3 degrees postoperative). Conclusion: These results are comparable to other forms of interpositional arthroplasty and arthrodesis for end stage arthritis of the hallux MTPJ.
BarcaF: Tendon arthroplasty of the first metatarsophalangeal joint in hallux rigidus: preliminary communication.Foot Ankle Int.18:222–228, 1997.
2.
BerletGCHyerCFLeeTH: Interpositional Arthoplasty of the First MTP joint using Regenerative Tissue Matrix for the Treatment of Advanced Hallux Rigidus.Foot Ankle Int.29(1): 10–21, 2008.
3.
BrageMEBallST: Surgical options for salvage of end-stage hallux rigidus.Foot Ankle Clin. North Am.7:49–73, 2002.
4.
ClevelandMWinantEM: An end-result study of the Keller operation.J. Bone Joint Surg. Am.32A:163–175, 1950.
5.
CosentinoGL: The Cosentino modification for tendon interposition arthroplasty.J. Foot Ankle Surg.34:501–508, 1995.
6.
CoughlinMJAbdoRV: Arthrosdesis of the first metatarsophalangeal joint with Vitallium plate fixation.Foot Ankle Int.15:18–28, 1994.
7.
CoughlinMJMannRA: Arthodesis of the first metatarsophalangeal joint as salvage for failed Keller procedure.J. Bone Joint Surg. Am.85A:2072–2088, 1987.
8.
CoughlinMJShurnasPS: Soft-tissue arthroplasty for hallux rigidus.Foot Ankle Int.24:661–672, 2003.
CoughlinMJShurnasPS: Hallux rigidus: Grading and long term results of operative treatment.J Bone Joint Surg Am85(11):2072–2088, 2003.
11.
CracchioloAIISwansonASwansonGD: The arthritic toe metatarsophalangeal joint: a review of flexible silicone implant arthroplasty from two medical centers.Clin. Orthop. Relat. Res.157:64–69, 1981.
12.
Davies-ColleyN: Contraction of the metatarsophalangeal joint of the great toe.Br. Med. J.,1:728, 1887.
13.
FitzgeraldJAWilkinsonJM: Arthrodesis of the metatarsophalangeal joint of the great toe.Clin. Orthop. Relat. Res.157:70–77, 1981.
14.
FlavinRStephensMM: Arthrodesis of the first metatarsophalangeal joint usin a dorsal titanium contoured plate.FAI, Vol 25, No 11., 783–787, 2004.
15.
FreedJG: The increasing recongnition of medullary lysis, cortical osteophytic proliferation, and fragmentation of implanted silicone polymer implants.J Bone Joint Surg,32:171–179, 1993.
16.
FelthamGTHanksSEMarcusRE: Age-based outcomes of cheilectomy for the treatment of hallux rigidus.Foot Ankle Int.22:192–197, 2001.
17.
GeldwertJJRockGDMcGrathMPMancusoJE: Cheilectomy: still a useful technique for grade I and grade II hallux limitus/rigidus.J. Foot Surg.21:154–159, 1992.
18.
GanleyJVLynchFRDarriganRD: Keller bunionectomy with fascia and tendon graft.J. Am. Podiatr. Med. Assoc.76:602–610, 1986.
19.
GeldwertJJRockGDMcGrathMPMancusoJE: Cheilectomy: still a useful technique for grade I and grade II hallux limitus/rigidus.J. Foot Surg.21:154–159.
20.
GoucherNRCoughlinMJ: Hallux metatarsophalangeal joint arthrodesis using dome-shaped reamers and dorsal plate fixation: a prospective study, FAI: Vol 2, No. 11: 869–876, 2006.
21.
GudmundssonGRobertssonK: Silastic arthroplasty of the first metatarsophalangeal joint.Acta. Orthop. Scan.51:575–578, 1980.
22.
HamiltonWGO'MalleyMJThompsonFMKovatisPE: Capsular interposition arthroplasty for severe hallux rigidus.Foot Ankle Int.18:68–70, 1997.
23.
HanftJRMerrillTMarcinkoDE: Grand rounds: first metatarsophalangeal joint replacement.J. Foot Ankle Surg.35:78–85, 1996.
24.
HattrupSJJohnsonKA: Subjective results of hallux rigidus following treatment with cheilectomy.Clin. Orthop. Relat. Res.226:182–191, 1988.
25.
JenkingsonCCoulterAWrightL: Short form 36 (SF36) health survey questionnaire: normative data for adults of working age, BMJ, 306(6890):1437–40, 1993.
26.
JohanssonJEBarringtonTW: Cone arthrodesis of the first metatarsophalangeal joint.Foot Ankle.4:244–248, 1984.
27.
JohnsonKABuckPG: Total replacement arthroplasty of the first metatarsophalangeal joint.Foot Ankle1:307–314, 1981.
28.
JordanHHBordskyAE: Keller operation for hallux valgus and hallux rigidus. An end result study.AMA Arch. Surg.62:586–596, 1951.
29.
KitaokaHBAlexanderIJAdelaarRSNunleyJAMyersonMSSandersM: Clinical ratings systems for the ankle-hindfoot, midfoot, hallux and lesser toes.Foot Ankle Int.3: 187–188, 1997.
30.
LauJTDanielsTR: Outcomes following cheilectomy and interpositional arthroplasty in hallux rigidus.Foot Ankle Int.22:462–470, 2001.
31.
LombardiCMSilhanekADConnollyFGDennisLNKeslonkyAJ: First metatarsophalangeal arthrodesis for treatement of hallux rigidus: a retrospective study.J. Foot Ankle Surg.40:137–143, 2001.
32.
MannRAOatesJC: Arthrodesis of the first metatarsophalangeal joint.Foot Ankle.1:159–166, 1980.
33.
MobergE: A simple operation for hallux rigidus.Clin. Orthop.,142:55, 1979.
MroczekKJMillerSD: The modified oblique Keller procedure: a technique for dorsal approach interposition arthroplasty sparing the flexor tendons.Foot Ankle Int.24:521–522, 2003.
36.
PontellDGudasCJ: Retrospective analysis of surgical treatment of hallux rigidus/limitus: clinical and radiographic followup of hinged, silastic implant arthroplasty and cheilectomy.J. Foot Surg.27:503–510, 1988.
37.
RaikinSMAhmadJPourAEAbidiN: Comparison of arthrodesis and metallic hemiarthroplasty of the hallux metatarsophalangeal joint, JBJS, 89: 1979–1985, 2007.
38.
RoukisTSLandsmanASRingstromJBKirschnerPWuenschelM: Distally based capsule-periosteum interpositional arthroplasty for hallux rigidus. Indications, operative technique, and short-term followup.J. Am. Podiatr. Med. Assoc.93:349–366, 2003.
39.
ToolanBCWrightVJCunninghamBJBrageME: An evaluation of the use of retrospectively acquired AOFAS clinical rating scores to assess surgical outcome after elective foot and ankle surgery, Foot Ankle Int, 22(10):775–778, 2001.
WareJEJr.; KosinskiMKellerSD: SF-36 physical and mental health summary scales: a users manual. Boston: The Health Institute, New England Medical Center; 1994.
42.
WrightonJD: A ten-year review of Keller's operation.Clin. Orthop. Relat. Res.89:207–214, 1972.
