The main surgical options for hallux rigidus include dorsal cheilectomy, arthroplasty and fusion. Compared to other surgical procedures dorsal cheilectomy involves relatively less bone loss, maintains joint motion and still leaves the potential for a further salvage procedure such as arthrodesis. The Manchester – Oxford Foot and Ankle Questionnaire (MOXFQ) has been endorsed by the British Foot and Ankle Society and recommended as a tool to measure surgical outcome. The aim of this study was to prospectively follow-up patients following dorsal cheilectomy for hallux rigidus using the patient-reported outcome measure, the MOXFQ. Patients were deemed suitable for dorsal cheilectomy if they had symptoms of dorsal impingement (painful restriction of terminal dorsiflexion of the hallux), with absence of pain in the mid-range of passive movement (indicative of end stage arthritis), and dorsal osteophytes on radiographs. Twenty five patients with a mean age of 62 years (range: 39 – 80 years) and comprising 17 females underwent dorsal cheilectomy for hallux rigidus. At a mean follow-up of 17 months (range 9–27 months), the mean MOXFQ score improved from 33/64 (95% CI: 27 – 38) pre-operatively to 9/64 (95% CI: 6 – 13) post-operatively. Eighty-four percent of patients had a clinically significant improvement in their walking domain, 68% in the social domain, and 59% in the pain domain of the MOXFQ. Four patients were deemed failures: three patients underwent subsequent arthrodesis for persisting pain, and one patient had no improvement in any domain of the MOXFQ. In conclusion, this study has provided further evidence of the success of dorsal cheilectomy as a reliable treatment option for hallux rigidus. It has also demonstrated the sensitivity of the patient focused reporting instrument the MOXFQ in assessing surgical outcomes in foot surgery.
Shoulder rotator cuff tears can be very debilitating and painful. Whilst massive tears may defy attempts at surgical repair due to the size of the defect, various biological materials have been proposed to reinforce tenuous repairs; initial results have been promising. It has been suggested that these materials may be used to bridge defects in the rotator cuff as a ‘patch’ or ‘interposition implant’ to provide pain relief and even offer some hope of functional recovery. A porcine dermal collagen implant (Permacol ©) has been engineered and introduced for the repair and reconstruction of soft tissues in the human body. In orthopaedics, it has been successfully used in the reinforcement and augmentation of rotator cuff repairs by suturing it over the repaired tendon. Proper et al reported good short term results in using this implant to bridge defects in massive rotator cuff tears and suggested it was good solution for this group of patients, reporting improvement in all aspects of the Constant Score. We have used Permacol © to reinforce cuff repairs with satisfactory results and thus considered its use as a salvage procedure to bridge massive rotator cuff defects, both of traumatic and degenerate origins. Unfortunately, we have seen with great concern that our results have been less than satisfactory. In a cohort of 20 patients who underwent Permacol © interposition / rotator cuff repair, 4 of these have failed, despite a promising initial recovery phase with good pain relief. We believe that use of this and similar implants to bridge a defect in the cuff is not indicated; MRI and dynamic ultrasound examination showed an inflammatory response in the shoulder, and resulting weakness/failure of the implant. We present clinical, radiographic, and histological findings of our experience and a discussion as to the probable cause for the failure of this implant in this particular group of patients.
