Hallux rigidus is a common arthritic foot disorder. It affects females more than males. The exact cause of hallux rigidus is not known but it is believed to be multifactorial.
Typically, patients complain of pain at the first MTP joint with limitation of its range of motion or shoe wear limitations. Diagnosis done by the clinical findings and radiological assessment. The condition is classified according to the clinical and radiological findings into 4 grades. Grade 1 includes occasional pain and dorsal osteophyte, grade 2 has moderate pain at the extreme dorsiflexion with dorsal and lateral osteophytes, grade 3 has severe pain with dorsal, lateral and medial osteophtes together with subchondral sclerosis and cystic changes, grade 4 includes radiological changes as grade 3 but clinically pain occurs at the mid-range of motion.
Untreated hallux rigidus, it may result in notable limitations in gait, activity level, and daily function. Positive outcomes can be achieved with nonsurgical management in the form of non-steroidal anti-inflammatory drugs, shoe modifications or injections.
Surgery is recommended for the sufficiently symptomatic patient for whom nonsurgical measures are unsuccessful. Surgery is selected based on grade of involvement.
Early to mid-stage hallux rigidus is best managed with cheilectomy or cheilectomy and proximal phalanx osteotomy. Grade 3 and grade 4 hallux rigidus demonstrates inferior results when treated with a cheilectomy procedure. Arthrodesis and arthroplasty are reserved for late-stage hallux rigidus.
Surgical options in patients with advanced hallux rigidus have traditionally included arthrodesis and implant arthroplasty. While arthrodesis offers good clinical outcomes, patients sometimes find it less desirable secondary to prolonged weight bearing restrictions postoperatively and shoe wear limitations once the arthrodesis has healed. Implant arthroplasty has been shown to have a high complication rate and is not recommended by many orthopedic surgeons.
For these reasons, interposition procedures have been advocated. Capsular interpositional arthroplasty is, therefore, more anatomically acceptable and has been shown to be viable for joints that might have previously been thought suitable only for arthrodesis. However, arthrodesis could be of use to salvage a failed capsular interpositional arthroplasty procedure.
This study concentrated on the outcome of modified oblique Keller interposition arthroplaty for the treatment of high grades hallux rigidus involving 20 patients in the period between December 2014 and June 2016 with a mean follow up 18 months.
Preoperative state and postoperative results were evaluated using VAS pain score, active range of motion including dorsiflexion and planter flexion and finally by AOFAS score.
This study show significant improvement in VAS score 6 weeks after surgery and further significant improvement after 12 months follow up. The preoperative VAS score was 5.65 and became 1.5 at 6 weeks postoperative and.35 at final assessment.
The active dorsiflexion range of motion had significant improvement after the first 6 weeks together with further significant improvement after 12 months. It was 10.85 degrees preoperatively and became 22.85 degrees 6 weeks postoperative and 27.9 degrees 12 months postoperative.
Active planter flexion is decreased after the first 6 weeks of surgery but significant improvement occurred after 12 months follow up which had not reach the preoperative values.
Significant improvement has been occurred in AOFAS score 12 months after surgery which became 89.2 postoperative from 57.85 preoperative.
The complication rate was 15% in this study, but these complications considered as minor complications compared to patient satisfaction.
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