Interposition arthroplasty may be alternative treatment option for hallux rigidus
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Key takeaways:
- Interposition arthroplasty may be an alternative treatment option for advanced hallux rigidus.
- Modified oblique Keller capsular interposition arthroplasty yielded noninferior long-term outcomes vs. arthrodesis.
According to presented results, both metatarsophalangeal joint arthrodesis and modified oblique Keller capsular interposition arthroplasty may yield positive 10-year outcomes for patients with advanced hallux rigidus.
At the American Orthopaedic Foot & Ankle Society Annual Meeting, Jeffrey E. Johnson, MD, professor emeritus of orthopedic surgery at the Washington University School of Medicine in St. Louis, presented results from a study that compared metatarsophalangeal (MTP) joint arthrodesis, considered the “gold standard” for hallux rigidus according to Johnson, vs. a soft tissue interposition arthroplasty procedure.
“The surgical technique for the arthrodesis was a standard technique that many of you probably use, using concentric spherical reamers with a screw and plate configuration,” Johnson said. “[Interposition arthroplasty] involves doing a modest cheilectomy and then an oblique osteotomy resection of the base of the proximal phalanx to leave the plantar plate attached. Then the dorsal capsule is advanced down over the top of the metatarsal head and sutured to the plantar plate. We’re calling this the modified oblique Keller capsular interposition arthroplasty or MOKCIA.”
Johnson and colleagues performed a retrospective chart review of data for 12 patients (mean age, 70 years) who underwent arthrodesis and 14 patients (mean age, 74 years) who underwent MOKCIA for hallux rigidus between January 2005 and December 2018 with minimum 10-year follow-up.
At follow-up, Johnson and colleagues found both groups had similar outcomes on the foot and ankle ability measure, as well as similar patient-reported physical function, pain and anxiety scores. Johnson noted both groups had similar outcomes for gait speed, plantar flexion power, peak plantar pressure distribution and toe flexion grip strength at follow-up. He also noted no differences in varus or valgus alignment on weight-bearing radiographs between the groups.
However, Johnson said patients who underwent MOKCIA had significantly decreased VAS pain scores and significantly increased satisfaction compared with patients who underwent arthrodesis. Johnson and colleagues found one patient who underwent arthrodesis required hardware removal, while no patients who underwent MOKCIA required additional surgery.
“Is the MOKCIA the new gold standard for advanced hallux rigidus?” Johnson said. “I think that that is for surgeons and patients to decide, ultimately. But I think what we can say is that it's not necessary to sacrifice MTP joint range of motion to achieve long-term pain relief, satisfaction and toe alignment for advanced hallux rigidus.”
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Johnson JE, et al. What is the gold standard for advanced hallux rigidus? Minimum 10-year follow-up comparison of interposition arthroplasty and arthrodesis shows similar outcomes. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 11-14, 2024; Vancouver, British Columbia, Canada (hybrid meeting).
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