Metallic hemiarthroplasty or arthrodesis of the first metatarsophalangeal joint as treatment for hallux rigidus: A systematic review and meta-analysis

• Published in: Foot and ankle surgery 2022-02, Vol.28 (2), p.139-152
• Main Authors: de Bot, Robin T.A.L., Veldman, Hidde D., Eurlings, Roxanne, Stevens, Jasper, Hermus, Joris P.S., Witlox, Adhiambo M.
• Format: Article
• Language: English
• Subjects: Arthrodesis; Follow-Up Studies; Hallux rigidus; Hallux Rigidus - diagnostic imaging; Hallux Rigidus - surgery; Hemiarthroplasty; Humans; Meta-analysis; Metallic hemiarthroplasty; Metatarsophalangeal Joint - surgery; Patient-reported outcome; Retrospective Studies; Treatment Outcome
• ISSN: 1268-7731; 1460-9584
• DOI: 10.1016/j.fas.2021.03.004

•Hallux rigidus (HR) is a condition that is associated with pain, swelling and limited ROM of MTP1.•Metallic hemiarthroplasty and arthrodesis of the MTP1 joint are successful and safe surgical treatments for HR.•Arthrodesis is superior to metallic hemiarthroplasty in the reduction of pain of HR patients.•Metallic hemiarthroplasty restores the ROM of the MTP1 joint and may be preferred in active HR patients. Arthrodesis and metallic hemiarthroplasty are two surgical interventions for the treatment of end-stage osteoarthritis of the first metatarsophalangeal (MTP1) joint. This systematic review and meta-analysis aims to compare the two operations with regards to patient-reported outcomes, pain reduction, complications and revision rates. A systematic literature search identified all relevant studies. The methodological quality was assessed using two validated tools. Data of interest were derived and presented. For non-comparative studies, data was assessed for trends, while for comparative studies pooling statistics were performed. A total of 33 studies were included for analysis. The majority of studies (>75%) reported an AOFAS-HMI score greater than 80 points after both metallic hemiarthroplasty and arthrodesis. The lowest VAS pain score was observed after arthrodesis (weighted mean difference -1.58, 95% confidence interval (CI) −2.16 to −1.00 P< 0.00001). Comparable numbers of complications (odds radio 1.48, 95% CI 0.81 to 2.73, P = 0.21, favoring: hemiarthroplasty) and revisions (odds ratio 1.16, 95% CI 0.62 to 2.15 P = 0.64, favoring: hemiarthroplasty) were observed after both interventions. The included non-comparative studies seem to confirm these findings of the comparative studies. Metallic hemiarthroplasty and arthrodesis have excellent clinical outcomes and acceptable complication- and revision rates. Arthrodesis seems to be superior in pain reduction, while metallic hemiarthroplasty is a suitable alternative for patients performing activities that requires motion in the first metatarsophalangeal joint.