New Alternative for Treatment of Advanced Hallux Rigidus

For Release: February 25, 2008
For further information, contact:
Peggy Reilly
Outreach Programs Manager
preilly@aofas dot org

Rosemont, IL – A big concern exists for the effective treatment of the younger and more active patients with advanced Hallux Rigidus of the first metatarsophalangeal (MTP) joint, or great toe. An exciting treatment option for this using interpositional arthroplasty was discussed in a recent study published in Foot & Ankle International, the official journal of the American Orthopaedic Foot & Ankle Society. This study, published in the January 2008 issue was conducted by lead author Gregory C. Berlet, MD, Chief, Section Foot and Ankle and Clinical Assistant Professor, Ohio State University Department of Orthopedics.

In this study, an allograft, or soft human tissue from a non-identical donor source, was used as an interposition on a group of nine patients with advanced hallus rigidus. Advanced hallus rigidus, an enlarged first toe joint from arthritis of the great toe, can be extremely debilitating especially to the younger, more active person. In the group studied, five of the patients were female and four were male with a mean age of 53 years with symptoms ongoing for an average of 3.1 years in which conservative treatment had failed and whose symptoms warranted surgical intervention. Interpositional arthroplasty , in which a biologic substance is used as a spacer in the first MTV joint was developed as an alternative for the treatment of advanced hallux rigidus. Dr. Berlet explains, "Using tissue as an interposition has been used for quite awhile. Dr. Hamilton published on his capsular interposition technique in 1997. The method we published was to use an allograft donor source which we began using in 2002. Our series reviewed patients from November 2003, thus the technique has been used successfully in our group for 6 years now." Dr. Berlet continued, "The material we used is tissue derived from human skin. There are alternatives to this material which can also be used. The favorable material properties for use include good handling characteristics, minimal antigenic response, and resistance to enzymatic destruction. These characteristics can be met with both allografts and xenografts (a transplant from a non-human species). There have not been any concerns so far with graft availability with either allografts or xenografts."

In the group studied, the mean follow-up at 12.7 months had no reported complications or failures with significantly less pain than before surgery. These excellent early results may be due to the minimal bone resection associated with the procedure. "The technique needs to be compared to other interposition techniques. We compared the results with two studies in which the tissue graft was harvested from the patient. Our technique is comparable in outcomes to both of these studies, neither statistically worse nor better. All techniques have similar recovery times according to the research. The important difference is that there is no donor site morbidity as the tissue graft is brought from outside instead of harvesting from the patient in our surgery," Dr. Berlet explained.

Although further follow-up is needed, this technique may offer the young and active patient with advanced hallux rigidus an opportunity to maintain an active lifestyle, while retaining the possibility for more surgical options should their condition progress. As Dr. Berlet comments, "Most surgeons have had a frustration with the type of patient this is geared towards. This patient is typically middle-age, athletic but has advanced arthritis. This technique is good for a patient with moderately severe arthritis (Coughlin grading scale 3) that historically would do poor with a more minor surgery (cheilectomy) but did not want a fusion. The interposition really offers an option for a problem where previously few options existed. The grade of arthritis is the key to patient selection so the technique can be generalized to the rest of the population, whether they are athletic or not."

Dr. Berlet is a member of the American Orthopaedic Foot & Ankle Society. The Society promotes quality, ethical and cost-effective patient care through education, research and training of orthopaedic surgeons and other health care providers. The AOFAS creates public awareness for the prevention and treatment of foot and ankle disorders. It provides leadership and serves as a resource for government, industry and the national and international health care community.

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