Quantitative review of operative management of hallux rigidus.
BACKGROUND
Surgical techniques for the management of hallux rigidus include cheilectomy, Keller resection arthroplasty, arthrodesis, Silastic implantation, phalangeal or metatarsal osteotomy, capsular arthroplasty, partial or total joint replacement, interposition arthroplasty. However, the optimal management is controversial.


METHODS
We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 2 November 2010. Sixty-nine articles published in peer reviewed journals were included in this comprehensive review.


RESULTS
Cheilectomy and first metatarsal or phalangeal corrective osteotomy may provide better outcome for patients with early and intermediate hallux rigidus (Stages I-II), while arthrodesis or arthroplasty are indicated to manage more severe conditions. The Coleman Methodology Score showed great heterogeneity in terms of study design, patient characteristics, management methods and outcome assessment and generally low methodological quality.


RESULTS
Definitive conclusions on the use of these techniques for routine management of patients with hallux rigidus are not possible. Given the limitations of the published literature, especially the extensive clinical heterogeneity, it is not possible to compare outcomes of patients undergoing different surgical procedures and determine clear guidelines.


CONCLUSIONS
To assess whether benefits from surgery, validated and standardized measures should be used to compare the outcomes of patients undergoing standard surgical procedures.


METHODS
There is a need to perform appropriately powered randomized clinical trials of using standard diagnostic assessment, common and validated scoring system comparing reported outcomes and duration of follow-up >2 years.
Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, UK. n.maffulli@qmul.ac.uk
Nicola
N
Maffulli
Rocco
R
Papalia
Alessio
A
Palumbo
Angelo
A
Del Buono
Vincenzo
V
Denaro
D000328:Adult; D001174:Arthrodesis / Q000379:methods; D001178:Arthroplasty / Q000379:methods; D020859:Hallux Rigidus / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010027:Osteotomy / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome