Interpositional arthroplasty using a dermal tissue spacer shows efficacy for treating hallux rigidus

The technique preserves the plantar plate, metatarsophalangeal joint tendons and flexor hallucis brevis insertion.

Performing interpositional arthroplasty using a spacer composed of human acellular dermal regenerative tissue matrix appears effective for treating hallux rigidus of the first metatarsophalangeal joint, according to a small study published in Foot & Ankle International.

"Although further follow-up is needed, this technique may offer the young and active patient with advanced hallux rigidus an opportunity to maintain an active lifestyle, while retaining the possibility for more surgical options should the condition progress," the authors wrote in the study.

Gregory C. Berlet, MD, and colleagues reviewed outcomes for nine patients treated with interpositional arthroplasty for Coughlin Grade-3 hallux rigidus. The study included five women and four men who averaged 53 years of age and had experienced symptoms for an average of 3.1 years.

All patients had failed previous conservative treatments, the study authors noted.

"The material we used is tissue derived from human skin. There are alternatives to this material which can also be used. The favorable material properties for use include good handling characteristics, minimal antigenic response and resistance to enzymatic destruction. These characteristics can be met with both allografts and xenografts. There have not been any concerns so far with graft availability with either allografts or xenografts," Berlet stated in a press release from the American Orthopaedic Foot & Ankle Society (AOFAS).

Berlet and colleagues found that surgery significantly improved pain, with no reported complications or failures.

Preoperatively, the total AOFAS score averaged 63.9 points and the AOFAS pain sub-score averaged 17.8 points. At 12.7 months mean follow-up, the total AOFAS score had improved to an average of 87.9 points and the AOFAS pain sub-score had improved to an average of 34.4 points, according to the study.

"These excellent early results and lack of complications may be due to the minimal bone resection associated with the procedure. This technique does not require autograft harvesting, is bone-sparing by preserving the plantar plate, and maintains the natural intrinsics of the [metatarsophalangeal] joint by preserving its associated tendons and the [flexor hallucis brevis] insertion. The sesamoid articulation also is resurfaced," the authors wrote in the study.

"The technique needs to be compared to other interposition techniques. We compared the results with two studies in which the tissue graft was harvested from the patient. Our technique is comparable in outcomes to both of these studies, neither statistically worse nor better. All techniques have similar recovery times according to the research. The important difference is that there is no donor-site morbidity as the tissue graft is brought from outside instead of harvesting from the patient in our surgery," Berlet noted in the release.

For more information:
Berlet GC, Hyer CF, Lee TH, et al. Interpositional arthroplasty of the first MTP joint using a regenerative tissue matrix for the treatment of advanced hallux rigidus. Foot Ankle Int. 2008;29:10-21.