Mid-term implant survival, clinical and patient reported outcomes following silastic arthroplasty for the treatment of end stage Hallux rigidus
E. Drampalos, T. Karim, T Clough
Aim: To examine the mid-term survival, clinical and patient reported outcomes of the silastic 1st metatarsophalangeal joint replacement for the treatment of end stage hallux rigidus.
Methods: We reviewed 83 consecutive silastic arthroplasties performed in 79 patients for end stage hallux rigidus. There were 3 men and 76 women; mean age 63 years (range 45-78 years). No patient was lost to follow up. Average follow-up was 5.3 years (1.1-11.3 years). The EQ 5D-5L Health index, Manchester-Oxford Foot Questionnaire (MOXFQ), visual analogue scale (VAS) of pain and overall satisfaction rate (Likert scale) were collected for patient reported outcomes.
Results: 2 patients required revision; 1 for early infection (2 months) and 1 for stem breakage (10 years 1 month). 5 patients reported lateral metatarsalgia, 2 patients reported neuropathic pain, 6 patients developed superficial infection which fully responded to oral antibiotics, and 1 patient developed interphalangeal joint pain. 2 patients died in the cohort. Pre-operative mean MOXFQ was 44, mean EQ5D Index was 0.564 and VAS was 6.97. At mean follow-up of 5.3 years, the mean MOXFQ was 12.7 (0-57), the mean EQ5D Index was 0.851 (-0.02-1) and the mean VAS was 1.67 (0-8). The mean range of motion was 35° (30° dorsiflexion and 5° plantarflexion). The overall satisfaction rate was 90.2%. The implant survival rate was 97.6%.
Conclusions: The silastic big toe arthroplasty offers excellent clinical mid term survival and functional outcomes and could be considered as an attractive alternative to traditional fusion for end stage hallux rigidus.
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