What is it about?
Arthritis of the big toe (first metatarsophalangeal joint), or hallux rigidus, is often treated with fusion or arthrodesis, where the two bones are joined together to become one. However, a desire to preserve motion at the big toe joint prompted the development of several great toe implants. A new implant known as Cartiva, a polyvinyl alcohol (PVA) hydrogel has been compared against fusion in a recent prospective, randomized, multicenter, clinical trial of 202 patients, and showed substantially equivalent pain relief, functional outcomes, and safety to first MTPJ arthrodesis at 2 years’ follow-up, with no cases of implant fragmentation, wear, or bone loss. The purpose of the current study was to evaluate the data from this study to determine the association between patient factors, such as; gender; age; body mass index; hallux rigidus grade; preoperative pain or symptom duration; and the success or failure of these procedures.
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Why is it important?
Arthritis of the big toe (first metatarsophalangeal joint), or hallux rigidus, is a common problem affecting 1 in 40 people older than 50 years and almost 1 in 2 people aged over 75. There is very little in the literature on the outcomes of big toe arthritis and the patient factors that determine them. The data is from one of the largest prospective randomized controlled studies ever carried out in foot and ankle surgery.
Perspectives
Strengths of this study include the rigorous quality of the longitudinal data obtained as part of a large, multicenter, well-controlled, randomized clinical trial, the large sample sizes (hemiarthroplasty n=129; arthrodesis n=47), and the low rate of patients lost to follow-up (2%). Most previous comparative studies of operative treatment for hallux rigidus have small numbers in each treatment arm. The data from this study are broadly generalizable, as they represent patients enrolled by 49 surgeons from 12 centers in Canada and the United Kingdom. This study provides the first thorough evidence of the association between patient factors and clinical outcomes following hallux rigidus surgery.
Andrew Goldberg
UCL
Read the Original
This page is a summary of: Association Between Patient Factors and Outcome of Synthetic Cartilage Implant Hemiarthroplasty vs First Metatarsophalangeal Joint Arthrodesis in Advanced Hallux Rigidus, Foot & Ankle International, August 2017, SAGE Publications,
DOI: 10.1177/1071100717723334.
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