A comparison between metatarsal head-resurfacing hemiarthroplasty and total metatarsophalangeal joint arthroplasty as surgical treatments for hallux rigidus: a retrospective study with short- to midterm follow-up

Figures & data

Figure 1 Preoperative anteroposterior view of patient’s metatarsals.

Figure 2 Postoperative anteroposterior views of metatarsals of a patient in the metatarsal-resurfacing group.

Figure 3 Preoperative anteroposterior view of patient’s metatarsals.

Figure 4 Postoperative anteroposterior views of the metatarsals of a patient in the total joint replacement group.

Table 1 Baseline characteristics of cases in the two groups

Variable	Group I (n=26)	Group II (n=19)	P-value
Age, years (mean ± SD)	56.3±4.5	57.1±5.8	0.630a
Sex, n (%)			0.787b
Male	12 (46.2%)	8 (42.1%)
Female	14 (53.8%)	11 (57.9%)
Side, n (%)
Left	12 (46.2%)	11 (57.9%)	0.436b
Right	12 (46.2%)	8 (42.1%)	0.787b
Bilateral	2 (7.6%)	0	0.501c
Grade, n (%)			0.878b
2	9 (34.6%)	7 (36.8%)
3	17 (65.4%)	12 (63.2%)
Follow-up time, months (mean ± SD)	29.9±5.2	27.1±7.5	0.138a

Notes:

a Student’s t-test;

b chi-square test;

c Fisher’s exact test.

Abbreviation: SD, standard deviation.

Table 2 Pre- and postoperative clinical measurements

Variable	Preoperative	Postoperative	P-valuea	Difference	P-valueb
ROM score					0.632
Group I	27.5 (15–40)	75 (35–85)	<0.001	47.5 (10–65)
Group II	25 (15–35)	75 (70–85)	<0.001	50 (40–65)
AOFAS score					0.765
Group I	33 (22–48)	87.7 (72–96)	<0.001	54 (38–74)
Group II	31 (22–47)	83 (77–96)	<0.001	54 (32–67)
VAS score					0.549
Group I	8.5 (7–10)	2 (1–3)	<0.001	−6.5 (−9 to −4)
Group II	9 (7–10)	2 (1–3)	<0.001	−7 (−9 to −4)

Notes: Data in bold indicates statistical significance. Data presented as ROM score (range) (degrees), AOFAS score (range), VAS score (range), unless stated otherwise.

a The comparisons between pre- and postoperative clinical measurements within groups: Wilcoxon Sign–Rank test, according to the Bonferroni correction; P<0.025 was considered statistically significant;

b comparisons among groups in terms of differences in clinical measurements: Mann–Whitney U-test; P<0.05 was considered statistically significant.

Abbreviations: AOFAS, American Orthopedic Foot and Ankle Society; ROM, range of motion; VAS, visual analog scale.

Table 3 Differences in clinical measurements in terms of groups’ baseline characteristics

Variables	ΔROM	ΔAOFAS	ΔVAS
Sex
Male	50 (10–65)	53.5 (32–67)	−7 (−9 to −4)
Female	45 (35–65)	54 (39–74)	−7 (−9 to −4)
P-valuea	0.676	0.963	0.712
Side
Left	50 (10–65)	53 (32–67)	−6 (−8 to −4)
Right	47.5 (40–65)	53.5 (38–74)	−7 (−9 to −4)
Bilateral	51.2 (45–57.5)	56.5 (55.5–57.5)	−6.5 (−8 to −5)
P-valueb	0.771	0.768	0.248
Grade
2	45 (35–60)	51.5 (39–67)	−7 (−8 to −4)
3	50 (10–65)	55 (32–74)	−7 (−9 to −4)
P-valuea	0.399	0.476	0.408

Notes: Data presented as ROM score (range) (degrees), AOFAS score (range), VAS score (range), unless stated otherwise.

a Mann–Whitney U-test;

b Kruskal–Wallis test.

Abbreviations: AOFAS, American Orthopedic Foot and Ankle Society; ROM, range of motion; VAS, visual analog scale.

Table 4 The results of correlation analyses

Analysis	Correlation coefficient	P-valuea
Age vs ΔROM	−0.006	0.969
Age vs ΔAOFAS	0.146	0.339
Age vs ΔVAS	0.222	0.143
ΔROM vs ΔAOFAS	0.125	0.415
ΔROM vs ΔVAS	0.179	0.239
ΔAOFAS vs ΔVAS	0.046	0.765

Note:

a Spearman’s rank correlation test.

Abbreviations: AOFAS, American Orthopedic Foot and Ankle Society; ROM, range of motion; VAS, visual analog scale.

Table 5 Summary of previously published studies reporting clinical results of the surgical treatment of hallux rigidus

Study	Operation	Procedures	Mean age (years)	Mean follow-up (months)	Mean AOFAS score	Complication	Mean DROM (degrees)	Mean VAS pain score; AOFAS pain subscore
Fuhrmann et al^Citation41	Total MTP arthroplasty	43	N/A	25–28	90.0	9%, four conversions to fusion	45	AOFAS: 32.8/40
Gibson and Thomson^Citation8	Total MTP arthroplasty	39	55.5	24.0	N/A	15%, six phalangeal component loosening and revision	24.0	VAS: 2.7
Barták et al^Citation45	Total MTP arthroplasty	28	56.3	24	N/A	Asymptomatic osteolysis (three patients)	N/A	N/A
Daniilidis et al^Citation44	Total MTP arthroplasty	23	57	18	82.5	Radiolucency (three patients)	52.5	VAS: 1.7
Hasselman and Shields^Citation12	Metatarsal head resurfacing	25	51	20	96.1	Metallosis and infection in one patient each	65	N/A
Carpenter et al^Citation4	Metatarsal head resurfacing	32	62.8	27.3	89.3	None	89.3	AOFAS: 36.5/40
Aslan et al^Citation2	Metatarsal head resurfacing	27	58	37.6	85.1	None	54.3	VAS: 2.05
Meric et al^Citation47	Metatarsal head resurfacing	14	58.7	24.1	83.7	One revision to arthrodesis	69.6	VAS: 1.2
Kline and Hasselman^Citation48	Metatarsal head resurfacing	30	51	60.0	94.1	13%, three silastic implants at 3 years, one arthrodesis	66.3	AOFAS: 32/40

Note: Pain was reported either as VAS pain score (0= no pain, 10= worst pain) or AOFAS pain subscore (0= severe/almost always present, 40= no pain).

Abbreviations: AOFAS, American Orthopedic Foot and Ankle Society; DROM, dorsiflexion range of motion; MTP, metatarsophalangeal; N/A, not applicable; VAS, visual analog scale.

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