Youngswick–Austin versus distal oblique osteotomy for the treatment of Hallux Rigidus. (August 2017) - Viladot, Antonio
Highlights: Level of evidence: prospective comparative study, level II. Youngswick-Austin and distal oblique osteotomy are both safe and allows a rapid recovery to function. These procedures are both valid for the treatment of the HR, with good-excellent clinical results. ABSTRACT: Background: Hallux Rigidus is the most common degenerative joint pathology of the foot. Several procedures are described for the management of this deformity. In this prospective study we compared Youngswick-Austin and distal oblique osteotomy in the treatment of grade II Hallux Rigidus, in terms of clinical outcomes, efficacy and complications. Material and methods: Forty-six patients (50 feet) with moderate Hallux Rigidus (Regnauld grade II) were recruited and operated between March 2009 and December 2012. Surgical technique was Youngswick-Austin osteotomy (Group A) or distal oblique osteotomy (Group B). Results: Mean follow-up was 42.7 ±12.2 (range, 24-70) months. Both groups achieved significant improvement of AOFAS score and first metatarsophalangeal joint range of motion (p value <.05). The mean AOFAS score improved from a preoperative score of 44.1 ±11.8 to 89.2 ± 9.4 (24 months) in Group A and from 40.9 ±11.3 to 89.5 ±7.2 (24 months) in Group B. At 24 months, the average improvement of first metatarsophalangeal joint range of motion was 20.9° in Group A and 22.4° in Group B. The postoperative AOFAS score and joint range of motion were comparable in both groups. Discussion: For this specific patient population Youngswick-Austin and distal oblique osteotomies provides subjective patient improvement and increases the first metatarsophalangeal joint range of motion. The results of grade II Hallux Rigidus treatment were comparable when using a Youngswick-Austin or distal oblique osteotomy. Level of evidence: Level II, prospective comparative study.