title: Long-Term Follow-up of Arthrodesis vs Total Joint Arthroplasty for Hallux Rigidus.
abstract: BACKGROUND
  The optimal operative management of hallux rigidus is still a matter for debate among surgeons. Despite arthrodesis widely considered to be the gold standard treatment, many surgeons advocate arthroplasty as a suitable alternative. There are, however, few long-term or high-quality studies evaluating these modalities. We present the 15-year follow-up of a randomized controlled trial.
  
  
  METHODS
  This data is the follow-up to the original study published in 2005. In the original study, 63 patients (77 toes) were recruited to and randomized to have either metatarsophalangeal joint (MTPJ) arthrodesis or arthroplasty. The primary outcome measure was a decrease in pain on a visual analog scale (VAS) at 24 months. In the present study, data were available for all surviving patients (52 patients, 66 toes). Data were collected in the form of satisfaction scores, VAS for pain, the VAS foot and ankle and survivorship data.
  
  
  RESULTS
  The results of the original study demonstrated that pain relief was greater following arthrodesis at 2 years. At 15 years, patients with an arthrodesis experienced less pain and were more satisfied compared to those with an arthroplasty. No functional differences were seen between these 2 groups. There were more revisions in the arthroplasty group.
  
  
  CONCLUSIONS
  Despite the hope of better function, less pain, and greater satisfaction from MTPJ replacement, this was not found in our patient population. The long-term results of our study showed that arthrodesis outperformed arthroplasty. If an arthroplasty failed, then salvage was likely to be technically difficult, with significant potential for complications.
  
  
  METHODS
  Level I, randomized controlled trial.
authors.affiliation: 1 Edinburgh Royal Infirmary, Edinburgh, United Kingdom.
authors.forename: Oliver D
authors.initials: OD
authors.lastname: Stone
authors.affiliation: 1 Edinburgh Royal Infirmary, Edinburgh, United Kingdom.
authors.forename: Robbie
authors.initials: R
authors.lastname: Ray
authors.affiliation: 1 Edinburgh Royal Infirmary, Edinburgh, United Kingdom.
authors.forename: Colin E
authors.initials: CE
authors.lastname: Thomson
authors.affiliation: 1 Edinburgh Royal Infirmary, Edinburgh, United Kingdom.
authors.forename: J N Alastair
authors.initials: JN
authors.lastname: Gibson
mesh_terms: D001174:Arthrodesis / Q000379:methods*; D019643:Arthroplasty, Replacement / Q000379:methods*; D005500:Follow-Up Studies; D020859:Hallux Rigidus / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D010147:Pain Measurement; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome
keywords: arthrodesis; arthroplasty; metatarsophalangeal joint; randomized controlled trial