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Scientific Articles   |    
Treatment of Advanced Stages of Hallux Rigidus with Cheilectomy and Phalangeal Osteotomy
Martin Joseph O’Malley, MD1; Harpreet S. Basran, MD1; Yang Gu, BS1; Stephanie Sayres, BS1; Jonathan T. Deland, MD1
1 Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for M.J. O’Malley: omalleym@hss.edu
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Investigation performed at the Hospital for Special Surgery, New York, NY



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Apr 03;95(7):606-610. doi: 10.2106/JBJS.K.00904
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Abstract

Background: 

Surgical treatment of hallux rigidus has usually consisted of cheilectomy for mild to moderate disease and arthrodesis for more advanced disease. The reported failure rate for cheilectomy alone in patients with advanced disease is approximately 37.5%. We reported our results with the combination of cheilectomy and extension osteotomy at the proximal phalanx for the treatment of advanced hallux rigidus.

Methods: 

Between 2000 and 2007, eighty-one patients with advanced hallux rigidus (classified as Hattrup and Johnson Grade III) underwent a unilateral cheilectomy and great toe proximal phalangeal extension osteotomy. Outcome assessment was determined by comparison of preoperative and postoperative American Orthopaedic Foot & Ankle Society scores, radiographs, first metatarsophalangeal joint motion, and patient satisfaction. Sixty-four of the eighty-one patients had complete clinical and radiographic examinations at a minimum duration of follow-up of two years.

Results: 

The mean duration of follow-up was 4.3 years. The mean dorsiflexion of the first metatarsophalangeal joint improved significantly (p < 0.05), by 27.0°, from 32.7° preoperatively to 59.7° postoperatively. The average American Orthopaedic Foot & Ankle Society scores improved significantly (p < 0.05) from 67.2 points preoperatively to 88.7 points postoperatively. Radiographs of the interphalangeal joint made postoperatively showed no evidence of development of interphalangeal joint arthritis. Of the eighty-one patients, sixty-nine (85.2%) were satisfied with the results of treatment and four (4.9%) subsequently underwent arthrodesis to treat persistent symptoms at the first metatarsophalangeal joint.

Conclusions: 

To our knowledge, this study is the first to support the use of a combination of cheilectomy and extension osteotomy of the great toe proximal phalanx as an alternative to first metatarsophalangeal joint arthrodesis to manage patients with advanced hallux rigidus.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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