Description of a technique that uses Lapidus arthrodesis plus osteochondral autotransplantation in the treatment of severe hallux rigidus

• Published in: Operative Orthopädie und Traumatologie 2021-12, Vol.33 (6), p.495-502
• Main Authors: Simons, Paul, Roth, Klaus Edgar, Klos, Kajetan
• Format: Article
• Language: ger
• ISSN: 1439-0981
• DOI: 10.1007/s00064-021-00748-1

OBJECTIVEThe objective of this technique is the treatment a severe hallux rigidus deformity by reorientation of an elevated first metatarsal using arthrodesis of the first tarsometatarsal joint and performing a one-step transplantation of an osteochondral graft, which is harvested from the first cuneiform, to the head of the first metatarsal bone. INDICATIONSSevere arthritis of the first metatarsophalangeal joint (MTP) stage 3 and 4 in the Vanore classification. CONTRAINDICATIONSGeneral contraindications for a foot surgery; ankylosis of MTP joint; severe arthritis of the sesamoid joint; osteonecrosis; short first metatarsal; previous infection in the metatarsophalangeal joint; large cysts at the head of the first metatarsal. SURGICAL TECHNIQUEThe first step is the preparation of the metatarsophalangeal and the first tarsometatarsal joint. After mobilizing the first metatarsal in a medioplantar direction, a cartilage-bone cylinder is removed from the articular surface of the medial cuneiform using special osteochondral autograft transfer system (OATS) instruments (Small Joint OATS, Arthrex medical instruments GmbH, Munich, Germany). This is followed by the arthrodesis of the first tarsometatarsal joint with reorientation of the position of the first metatarsal bone. Then the removed osteochondral cylinder is implanted into the articular surface of the first metatarsal head. After that the capsule is closed and the skin sutured. POSTOPERATIVE MANAGEMENTPostoperative management is guided mainly by the requirements of the first tarsometatarsal arthrodesis. When a plantar plate is used pain orientated full weightbearing is allowed in a postoperative shoe with a stiffened sole for 6-8 weeks. Physiotherapy is prescribed to exercise the first metatarsophalangeal joint. RESULTSIn the study, 5 patients were treated with the method described in the years 2011-2012 and were followed up for a period of 2 years. All of these patients were subjectively satisfied with the outcome of the operation. There were no relevant surgery-associated complications.