El Masry Seif, Boden Allison L, DiGiovanni Grace M, Cororaton Agnes D, Ellis Scott J
Department of Foot and Ankle Surgery, the Hospital for Special Surgery, New York, NY.
JB JS Open Access. 2024 Aug 19;9(3). doi: 10.2106/JBJS.OA.23.00158. eCollection 2024 Jul-Sep.
The current literature shows similar clinical outcomes between first metatarsophalangeal (MTP) joint arthrodesis and synthetic cartilage implant (SCI) hemiarthroplasty in the treatment of hallux rigidus; however, prior studies have not reported validated patient-reported outcome measures (PROMs). To our knowledge, this is the first study to compare PROMs using 6 domains of the validated Patient-Reported Outcomes Measurement Information System (PROMIS) in patients treated for hallux rigidus with MTP joint arthrodesis and with SCI hemiarthroplasty. In addition, this novel study provides comparative data on the complication and revision rates for each procedure.
A single-center, retrospective registry search identified all patients with preoperative PROMIS scores who underwent MTP joint arthrodesis or SCI hemiarthroplasty for hallux rigidus between February 2016 and June 2021. The study aimed to determine if the 2 procedures showed statistically or clinically equivalent PROMIS scores in 6 domains: physical function, pain interference, pain intensity, global physical health, global mental health, and depression. A multivariable linear regression analysis was performed to compare adjusted 1-year postoperative PROMIS scores between the 2 cohorts. Complication and revision rates were also compared.
The study included 82 patients who underwent SCI hemiarthroplasty and 101 who underwent MTP joint arthrodesis. Demographic data and preoperative hallux rigidus severity showed no significant differences between the cohorts. PROMIS scores were mostly comparable between the 2 groups, except for the pain intensity domain. The patients who underwent MTP joint arthrodesis exhibited significantly better pain relief at 1 and 2 years postoperatively, which was supported by adjusted postoperative PROMIS scores. At 2 years, the SCI group had worse pain intensity scores and lower global physical health scores. There were no differences between the cohorts in additional PROMIS scores or complication data.
While outcomes in most of the domains were similar, MTP joint arthrodesis was more effective at mitigating pain intensity compared with SCI hemiarthroplasty. This information can guide patient counseling and decision-making when considering surgical intervention for hallux rigidus.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
当前文献表明，在治疗僵硬性拇趾时，第一跖趾关节（MTP）融合术与合成软骨植入（SCI）半关节成形术的临床结果相似；然而，先前的研究尚未报告经过验证的患者报告结局测量指标（PROMs）。据我们所知，这是第一项使用经过验证的患者报告结局测量信息系统（PROMIS）的6个领域来比较接受MTP关节融合术和SCI半关节成形术治疗的僵硬性拇趾患者的PROMs的研究。此外，这项新颖的研究提供了每种手术的并发症和翻修率的比较数据。
一项单中心回顾性登记研究，通过检索确定了2016年2月至2021年6月期间所有术前有PROMIS评分且因僵硬性拇趾接受MTP关节融合术或SCI半关节成形术的患者。该研究旨在确定这两种手术在6个领域（身体功能、疼痛干扰、疼痛强度、总体身体健康、总体心理健康和抑郁）的PROMIS评分是否在统计学上或临床上相当。进行多变量线性回归分析以比较两个队列术后1年调整后的PROMIS评分。还比较了并发症和翻修率。
该研究纳入了82例行SCI半关节成形术的患者和101例行MTP关节融合术的患者。两个队列的人口统计学数据和术前僵硬性拇趾严重程度无显著差异。除疼痛强度领域外，两组的PROMIS评分大多具有可比性。接受MTP关节融合术的患者在术后1年和2年的疼痛缓解明显更好，这得到了术后调整后的PROMIS评分的支持。在2年时，SCI组的疼痛强度评分更差，总体身体健康评分更低。两个队列在其他PROMIS评分或并发症数据方面没有差异。
虽然大多数领域的结果相似，但与SCI半关节成形术相比，MTP关节融合术在减轻疼痛强度方面更有效。这些信息可为考虑对僵硬性拇趾进行手术干预时的患者咨询和决策提供指导。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
