Bipolar fresh osteochondral allograft for the treatment of hallux rigidus.

The term hallux rigidus is used to describe a condition characterized by pain and reduction of motion, especially in dorsiflexion, at the first metatarsophalangeal (1MTP) joint due to arthritis occurrence. The indication for surgery is pain combined with degenerative changes of the 1MTP joint. The surgical strategy has to be planned according to the degree of arthritis and is aimed to relieve pain, improve function, reduce the progression of arthritis, and correct any associated deformity. Although different surgical strategies have been proposed in order to spare the 1MTP joint, in the presence of end-stage arthritis, the most reliable solutions remain arthrodesis, interpositional arthroplasty, and prosthetic replacement. Arthrodesis provides satisfactory results for both patients and surgeons; nevertheless, it is not always well accepted by the patient. A possible alternative is a resorbable implant that during reabsorption forms fibrous tissue that maintains the stability and length of the toe. Prosthetic replacement of the 1MTP joint may represent an option but, despite a large number of different designs proposed over time, is prone to failure in the midterm and has a high rate of complications. Bipolar fresh osteochondral allograft (BFOA) was first used for the treatment of end-stage arthritis in the ankle joint and represents a fascinating option for biological joint reconstruction. The aim of this study was to describe 6 cases of total BFOA used for the treatment of hallux rigidus with endstage arthritis and to report the clinical and radiographic results obtained at a mean of 6 years of follow-up.