Mid- and long-term results of the joint preserving therapy of hallux rigidus.

BACKGROUND

The hallux rigidus is an over 100-year-known pathology. Yet an overall accepted therapy regime does not exist. The aim of this prospective study was to analyze the long-term clinical outcome and patient satisfaction of joint preserving operative care in patients with symptomatic hallux rigidus.

METHODS

We present a prospective study with 60 patients (60 feet) with symptomatic hallux rigidus. In cases with intraoperative dorsiflexion of less than 70 degrees after the cheilectomy, an additional Kessel-Bonney osteotomy was done. The first follow-up after 24 (10-31) months was done on 49 (81.7%) patients and the second after 96 (84-104) months on 46 (76.7%) patients. We recorded the pre- and post-operative Kitaoka score, range of motion, pain and patients satisfaction. The results were related to the operative procedure and the grade of hallux rigidus (according to Regnauld).

RESULTS

Twenty patients were graded as I, 35 patients as II and 5 patients as III. At the follow-up, the mean dorsiflexion increased in grade I patients to about 21.7 degrees , in grade II patients about 23.7 degrees and in grade III patients about 26.3 degrees . At the first follow-up [24 (10-31) months], all patients of grade I, 63.3% patients of grade II and 75% of grade III patients had just occasional or no pain. At the second follow-up [96 (84-104) months], 77.8% of grade I and 73.9% of grade II patients had no pain. At the first (second) follow-up 53.3% (61.1%) of grade I, 43.3% (33.3%) of grade II and 50% (25%) of grade III patients were completely satisfied. In order to the operative procedure the patients were completely satisfied or satisfied: first (second) follow-up 52% (85.9%) of patients with cheilectomy and 85% (86.4%) of patients with cheilectomy and Kessel-Bonney osteotomy. In 51.4% of the patients, the Kitaoka Score was higher than 70.4 points. Four patients had a persistent hypaesthesia of the medial side of the great toe and three patients had a delayed wound healing. No revision was necessary. No further operation was done in all the investigated patients.

CONCLUSION

The joint preserving operation in patients with grade I and II hallux rigidus shows an increase of dorsiflexion and decrease of daily pain. The long-term follow-up shows a persistent pain reduction and satisfaction of the patients. Our results recommend a joint preserving operation in grade I and II hallux rigidus. An additional osteotomy of the proximal phalanx should be done in cases of dorsiflexion less than 70 degrees after cheilectomy.