Interpositional arthroplasty of the first MTP joint using a regenerative tissue matrix for the treatment of advanced hallux rigidus.
BACKGROUND
Treatment options are limited for young and active patients with hallux rigidus of the first metatarsophalangeal (MTP) joint. Soft-tissue interpositional arthroplasty is a promising alternative.


METHODS
The surgical technique for interpositional arthroplasty utilizing a human acellular dermal regenerative tissue matrix as a spacer is described. A retrospective review of a consecutive series of the first nine patients with Coughlin grade 3 halux rigidus who underwent this procedure is presented. Five patients were female and four were male, with a mean age of 53.3 years, a mean body mass index of 28.6, and a mean duration of symptoms of 3.1 years.


RESULTS
The mean length of followup was 12.7 months, with no reported complications or failures. The mean total AOFAS score and pain sub-score were significantly higher at the most recent followup (87.9 and 34.4, respectively) versus preoperatively (63.9 and 17.8, respectively).


CONCLUSIONS
These excellent early results and lack of complications may be due to the minimal bone resection associated with the procedure. This technique does not require autograft harvesting, is bone-sparing by preserving the plantar plate, and maintains the natural intrinsics of the joint by preserving its associated tendons and the FHB insertion. The sesamoid articulation also is resurfaced. Although further followup is needed, this technique may offer the young and active patient with advanced hallux rigidus an opportunity to maintain an active lifestyle, while retaining the possibility for more surgical options should the condition progress.
Berlet
Gregory C
GC
Ohio State University Department of Orthopedics, Orthopedic Foot and Ankle Center, Columbus, Ohio 43231, USA. gberlet@aol.com
Hyer
Christopher F
CF
Lee
Thomas H
TH
Philbin
Terrence M
TM
Hartman
Jodi F
JF
Wright
Michelle L
ML
D001178:Arthroplasty; D001672:Biocompatible Materials; D005260:Female; D005500:Follow-Up Studies; D020859:Hallux Rigidus / Q000601:surgery*; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D012720:Severity of Illness Index; D023822:Tissue Engineering; D016896:Treatment Outcome
D001672:Biocompatible Materials