Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus. (February 2019)

• Record Type: Journal Article
• Authors: Teoh, Kar Hao; Tan, Wei Teen; Atiyah, Zeid; Ahmad, Aziz; Tanaka, Hiro; Hariharan, Kartik
• Is Part Of: Foot & ankle international. Volume 40:Number 2(2019)
• Page Start: 195
• Page End: 201
• Publication Date: 2019-02
• Subjects: minimally invasive surgery -- percutaneous -- hallux rigidus -- dorsal cheilectomy -- osteoarthritis first metatarsophalangeal joint -- minimally invasive technique -- patient-reported outcome measure; Foot -- Abnormalities -- Periodicals; Ankle -- Abnormalities -- Periodicals; Orthopedics -- Periodicals; 617.585
• DOI: 10.1177/1071100718803131
• Languages: English
• ISSNs: 1071-1007

Abstract

Background: Following failure of conservative treatment, a dorsal cheilectomy can be performed for patients in early stages of hallux rigidus by a traditional open approach or by a minimally invasive technique. We report our clinical outcomes following minimally invasive dorsal cheilectomy (MIDC). Methods: Eighty-nine patients (98 feet) with symptomatic hallux rigidus treated between 2011 and 2016 were included in this study. The average age was 54 years. Manchester-Oxford Foot Questionnaire (MOxFQ) scores and visual analog scale (VAS) pain scores were collected. The mean follow-up was 50 months. Results: The average VAS score improved from 8.0 preoperatively to 3 postoperatively. The mean MOxFQ summary index score decreased from 58.6 preoperatively to 30.5 postoperatively. All 3 MOxFQ domains also improved. Swelling took an average of 5.3 weeks to settle. There were 2 wound infections and 2 delayed wound healings. Two patients had transient nerve paraesthesia, while 2 patients had permanent numbness in the dorsomedial cutaneous nerve distribution. Twelve patients (12%) underwent reoperation, of which 7 had a first metatarsophalangeal joint arthrodesis for ongoing pain, 4 had repeat cheilectomy for residual impingement, and 1 had an open removal of loose bone. Conclusion: Our results suggest that MIDC resulted in improvement in patient-reported outcome measures and was a safe technique with minimal complications. The complications were similar to open cheilectomy. There was an associated learning curve as 5 of our reoperations were due to incomplete cheilectomy. Coughlin grade 1 did well with MIDC as with open cheilectomy as none went onto an arthrodesis. However, 10% (7/65) of our grade 2 and 3 cases went on to an arthrodesis. Level of Evidence: Level IV, retrospective case series.