Surgery for 1st MTP Osteoarthritis Save

Hallux rigidus, or osteoarthritis of the first metatarsophalangeal joint (MTPJ), is common, but the treatment options and future outcomes aer poorly known.  A 12 month clinical trial showed that irst MTPJ arthrodesis (compared to observation) was superior with significant reduction in walking-related pain at 12 months.

This Finnish study was a single-center, randomized, controlled, superiority trial comparing first MTPJ arthrodesis against watchful waiting in symptomatic adults with hallux rigidus. The primary outcome was walking-related pain  at 12 months. 

 

Patients (>40 years) had to have radiographically confirmed  (Coughlin–Shurnas grade I to III) hallux rigidus with walking pain score of 4 or higher (0-10). Patients with type 1 diabetes mellitus, rheumatoid arthritis, and hallux valgus angle greater than 15° were excluded. Surgical intervention was first MTPJ arthrodesis using lag-screw and dorsal plating vs. watchful waiting.

A total of 90 patients (45 per group) were randomized (mean age 58.1 years) and 89 participants completed the 12-month study. At 12 mos. there was significant improvement in the arthodeisis group (VAS pain 1.3 vs. 5.7) compared to the observation group.

In patients painful hallux rigidus, first MTPJ arthrodesis provides significant reduction in walking-related pain, compared with watchful waiting.