Introduction. Studies have compared outcomes of first metatarsophalangeal joint (MTPJ1) implant hemiarthroplasty and arthrodesis, but there is a paucity of data on the influence of patient factors on outcomes. We evaluated data from a prospective, RCT of MTPJ1 implant hemiarthroplasty (Cartiva) and arthrodesis to determine the association between patient factors and clinical outcomes. Methods. Patients ≥18 years with Coughlin hallux rigidus grade 2, 3, or 4 were treated with implant MTPJ1 hemiarthroplasty or arthrodesis. Pain VAS, Foot and Ankle Ability Measure (FAAM) Sports and ADL, and SF-36 PF scores were obtained preoperatively, and at 2, 6, 12, 24, 52 and 104 weeks postoperatively. Final outcomes, MTPJ1 active peak dorsiflexion, secondary procedures, radiographs and safety parameters were evaluated for 129 implant hemiarthroplasties and 47 arthrodeses. Composite primary endpoint criteria for clinical success included pain reduction ≥30%, maintenance/improvement in function, and no radiographic complications or secondary surgical intervention at 24 months. Predictor variables included: grade; gender; age; BMI; symptom duration; prior MTPJ1 surgery; preoperative hallux valgus angle, ROM, and pain. Two-sided Fisher's Exact test was used (p< 0.05). Results. Patient demographics and baseline outcome measures were similar. Success rates between implant MTPJ1 hemiarthroplasty and arthrodesis were similar when stratified by hallux rigidus grade, gender, age, BMI, symptom duration, prior MTPJ1 surgery status, and preoperative VAS pain, hallux valgus and ROM (p0.05). Conclusion. Synthetic cartilage implant hemiarthroplasty (Cartiva) is an appropriate treatment for patients with hallux rigidus grade 2, 3 or 4 and is a reasonable choice in hallux rigidus in patients with < 20 degrees HVA, with a high degree of preoperative stiffness, irrespective of gender, age, BMI, hallux rigidus grade, preoperative pain, or duration of symptoms, in contrast to what might have been expected

Introduction. Scar sensitivity is a recognised complication of foot surgery. However there is very little published about it. This study looks at the incidence and natural history of scar sensitivity following hallux valgus surgery. Materials and Methods. Patients who had open hallux valgus surgery from December 2008 to December 2009, with a minimum follow up of 12 months, were contacted. Data regarding scar symptoms, their duration, severity at their worst and interventions undertaken were collected. Patients also completed a Roles and Maudsley patient satisfaction score. Results. 125 patients were contacted with response rate of 84%. 30% of patients had experienced scar symptoms following surgery. Of these, 20% had undertaken some form of nonsurgical intervention. The mean duration of symptoms was 16 weeks, and 95% of patients experienced resolution of symptoms. 99% of patients would opt to have the surgery again. Roles and Maudsley score ranged from 1 to 2. Discussion. Nearly one third of patients experienced scar symptoms, however nearly all resolved completely with or without simple treatments. Symptoms were not severe and did not affect satisfaction, function or the decision to have the surgery again. Educating patients preoperatively about scar sensitivity can relieve anxiety and improve the patient experience and they can be advised on simple and effective strategies should this common side effect occur. The results of this study provide the surgeon with valuable information in the consent and education of patients. Also, the fact that nearly all symptom settled within 16 weeks brings into question one of the purported advantages of minimally invasive surgery. Conclusion. Scar symptoms following hallux valgus surgery are common, but mild and almost all resolve in time