Comparing the Clinical Outcomes of Percutaneous Cheilectomy to Open Cheilectomy with Moberg Osteotomy for the Treatment of Hallux Rigidus

Abstract

Category: Midfoot/Forefoot; Other Introduction/ Purpose: Cheilectomy of the first metatarsophalangeal joint (MTP) is employed as an early treatment option to alleviate pain and restore some motion in patients with hallux rigidus. A dorsal closing wedge osteotomy of the proximal phalanx (Moberg) is often added to the cheilectomy to theoretically increase functional range of motion of the MTP joint. While cheilectomy with Moberg (OCM) has traditionally been performed through an open dorsal incision exposing the entire joint, percutaneous cheilectomy (PC) has become increasingly popular due to smaller incisions, minimal pain, and quicker recovery; however, few studies have compared the PC to commonly practiced open techniques to determine if the PC could deliver similar outcomes. Therefore, we aimed to compare the patient reported outcomes of PC to open cheilectomy with Moberg osteotomy. Methods: This retrospective cohort study included 119 patients who underwent PC or OCM for a diagnosis of hallux rigidus. Patients were included if they were over 18 years old and had preoperative and minimum 1-year postoperative PROMIS scores. Patients were excluded if they had prior cheilectomy or any concomitant procedures on the ipsilateral forefoot. Patients were divided into two groups based on their procedures. Forty-eight patients were classified into the “percutaneous cheilectomy” group (mean age: 60 years) while 71 patients belonged to the “open cheilectomy with Moberg” group (mean age 54.2 years). Preoperative, minimum 1-year postoperative, and preoperative to postoperative change in PROMIS physical function, pain interference, pain intensity, global physical health, global mental health, and depression domains were analyzed between groups. Complications were also noted and compared. Results: Preoperatively, the OCM group demonstrated worse physical function, pain interference, pain intensity, and global physical health compared to the PC group. There were no significant differences in mental health-related domains. Postoperatively, there were no significant differences in any PROMIS domain between groups (Table 1). Length of follow-up was 20.3 months in the PC group and 13.8 months for the OCM group (p <.001). While both groups experienced significant preoperative to postoperative improvement in physical function, pain interference, and pain intensity, in addition to global physical health for the OCM group, the degree of preoperative to postoperative improvement for the OCM group was significantly greater. There were no significant differences in complications between groups. Conclusion: While we found a greater degree of improvement in function and pain in the OCM group, postoperative scores were not different from the PC group. This implies that patients undergoing OCM had greater preoperative deficits in pain and function, and thus demonstrated greater improvements to end up with similar postoperative outcomes as the PC group. Therefore, since the percutaneous cheilectomy resulted in similar postoperative function and pain levels, it appears to deliver an adequate surgical treatment when compared to open cheilectomy with Moberg.