title: Metallic hemiarthroplasty for the treatment of end-stage hallux rigidus: mid-term implant survival, functional outcome and cost analysis.
abstract: OBJECTIVE
  To examine the mid-term outcome and cost utility of the BioPro metallic hemiarthroplasty for the treatment of hallux rigidius.
  
  
  METHODS
  We reviewed 97 consecutive BioPro metallic hemiarthroplasties performed in 80 patients for end-stage hallux rigidus, with a minimum follow-up of five years. There were 19 men and 61 women; their mean age was 55 years (22 to 74). No patient was lost to follow-up.
  
  
  RESULTS
  A total of 12 patients (15 first metatarso-phalangeal joints (MTPJs)) required a revision; one for infection, two for osteolysis and 12 for pain. The all cause rate of survival at five years was 85.6% (95% confidence interval (CI) 83.5 to 87.9). Younger age was a significant predictor of revision (odds ratio 1.09, 95% CI 1.02 to 1.17, p = 0.014) on excluding infection and adjusting for confounding variables (Cox regression). Significant improvements were demonstrated at five years in the Manchester Oxford Foot Questionnaire (13.9, 95% CI 10.5 to 17.2) and in the physical component of the Short Form-12 score (6.5, 95% CI 4.1 to 8.9). The overall rate of satisfaction was 75%. The cost per quality adjusted life year at five years, accounting for a 14% rate of revision was between £4431 and £6361 depending on the complexity and morbidity of the patient.
  
  
  CONCLUSIONS
  The BioPro hemiarthroplasty offers good short to mid-term functional outcome and is a cost effective intervention. The relatively high revision rate is associated with younger age and perhaps the use of this implant should be limited to older patients. Cite this article: Bone Joint J 2016;98-B:945-51.
authors.affiliation: Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: N D
authors.initials: ND
authors.lastname: Clement
authors.affiliation: Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: D
authors.initials: D
authors.lastname: MacDonald
authors.affiliation: Borders General Hospital, Melrose, Roxburghshire, TD6 9BS, UK.
authors.forename: G F
authors.initials: GF
authors.lastname: Dall
authors.affiliation: Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: I
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Duckworth
authors.affiliation: Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: H S
authors.initials: HS
authors.lastname: Shalaby
authors.affiliation: Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: J
authors.initials: J
authors.lastname: McKinley
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001174:Arthrodesis; D005260:Female; D005500:Follow-Up Studies; D020859:Hallux Rigidus / Q000601:surgery*; D062785:Hemiarthroplasty / Q000295:instrumentation*; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D019057:Quality-Adjusted Life Years; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult
keywords: BioPro; Failure; Hemiarthroplasty; Metallic; Outcome; Survival