[Resection-interposition arthroplasty in symptomatic hallux valgus: a revision of indication and technique].
OBJECTIVE
Popularity of resection-interposition-arthroplasty is decreasing due to more specific procedures in hallux valgus surgery. Therefore we analysed the influence of preoperative parameters and technical details to reevaluate this classic procedure.


METHODS
In a retrospective, clinical and radiological long-term study (mean 9.6 years) 62 operated feet were examined and the assessed parameters were analysed, with focussing on the negative results. For comparison negative and positive outcome was defined by a hallux-metatarsal-interphalangeal scale (HMIS) and a subjective rating score (SRS).


RESULTS
Negative outcome, 34 % according to HMIS and 24 % according to SRS, was characterised in both scoring systems by pain (visual analogue scale), functional deficit (walking distance) and negative cosmetic result (hallux-valgus-angle) (p < 0.01 each). As negative predictive factors we observed an early degenerative arthritis (p < 0.05, HMIS) and a positive metatarsal index (p < 0.05, SRS). Unsatisfactory results were related to an increased resection level of the first phalanx when compared with good results (p < 0.01 in HMIS, p < 0.05 in SRS).


CONCLUSIONS
Resection-interposition arthroplasty in symptomatic hallux valgus seems an inadequate procedure in cases with early arthritis or a positive metatarsal index. However, in accordance with these criteria good results are probable, if resection of the first phalanx does not exceed one third of length.
Schulz
C U
CU
Orthopädische Klinik, Ludwig-Maximilians-Universität, München Klinikum Grosshadern, Germany. christoph.schulz@helios.med.uni-muenchen.de
Feitenhansl
A
A
Pellengahr
C
C
Maier
M
M
D000328:Adult; D000368:Aged; D001178:Arthroplasty / Q000009:adverse effects / Q000379:methods*; D006215:Hallux Valgus / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology; D017060:Patient Satisfaction; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome