Maire-Clare Killen, Liam McEntee, Mohan Emmanuel, Prasad Karpe and Rajiv Limaye describe the use of arthroplasty to treat a degenerative condition of the first metatarsophalangeal joint (MTP joint)
Hallux rigidus is a degenerative condition of the first metatarsophalangeal (MTP) joint of the great toe. It is characterised by progressive loss of motion, particularly dorsiflexion. This, along with osteophyte formation, results in pain and stiffness. The condition tends to affect patients in the fourth and fifth decades and, when severe, can result in significant disability [1].
Plain radiographs are the investigation of choice, along with clinical examination to establish the diagnosis. Radiological appearances are varied: dorsal osteophytes are primarily the sole finding in early stage disease, with progression to significant joint space narrowing, periarticular cystic changes and involvement of sesamoids as the disease progresses (Figure 1). A classification system described by Coughlin and Shurnas in 2003 uses a combination of clinical and radiological findings and is a commonly used tool for grading the severity of disease (Table1) [2].
In addition to the stage of disease, the extent of any associated deformity, and patients’ age and activity level are also considered when deciding on surgical treatment. Traditionally, mild to moderate disease has been treated with cheilectomy or osteotomy, with more severe cases being treated with arthrodesis [3]. More recently, treatment using joint replacement, either by means of hemiarthroplasty or total arthroplasty of the MTP joint, is becoming an increasingly popular option for patients with advanced disease.
There are numerous implants available for use in hallux rigidus with varying designs, including hemiarthroplasty and total arthroplasty. The aim of this article is to provide an overview of the use of arthroplasty for hallux rigidus and the various prostheses available.
Arthroplasty for hallux rigidus
Arthroplasty of the first MTP joint was initially developed in the 1950s as an alternative surgical option to arthrodesis. Initial optimism for this new surgery led to its increased use, without adequate understanding of implant designs or choice of materials, and lack of appreciation for the importance of patient selection [4].
Initial outcomes of these early prosthesis designs were promising; however, as time progressed it became apparent that the complex mechanical demands of the first MTP joint resulted in certain implant materials or designs having poor medium-