Distal Oblique Osteotomy vs Arthrodesis for Advanced Hallux Rigidus: A Matched Cohort Study

Background: Arthrodesis is regarded as the gold standard for advanced hallux rigidus, providing reliable pain relief but at the cost of first metatarsophalangeal (MTP) joint motion and implant-related complications. Distal oblique osteotomy (DOO) is a joint-preserving alternative that addresses dorsal impingement and altered biomechanics, but direct comparisons with arthrodesis in advanced disease remain limited. Methods: This study retrospectively reviewed prospectively collected registry data from a single tertiary orthopaedic centre. Patients with advanced hallux rigidus who underwent first MTP joint arthrodesis or DOO after failing conservative management were included. Cohorts were matched for age, sex, body mass index, radiographic severity, and hallux valgus angle; however, residual differences remained between cohorts. Clinical outcomes assessed at a minimum of 24 months included patient satisfaction, complications, revision surgery rates, visual analogue scale (VAS) pain, American Orthopaedic Foot & Ankle Society (AOFAS), and range of motion (ROM) scores. Results: Fifty-nine patients were included (arthrodesis = 28; DOO = 31). Both groups showed improvements in pain and function postoperatively. Patient satisfaction rates (arthrodesis = 25 [89.3%] vs DOO = 28 [90.3%], P > .05) and satisfaction score (arthrodesis = 2.14 [1.04] vs DOO = 1.84 [1.07], P > .05) were similarly high. The overall complication rate was lower ( P = .025) in the DOO group (3.2%) compared with the arthrodesis group (28.6%), although complication profiles differed between procedures. Revision surgery rates were lower following DOO, although this difference was not statistically significant. AOFAS scores were higher in the DOO group, whereas the ROM was expectedly greater following DOO ( P < .05), whereas postoperative VAS pain scores were comparable between groups. Conclusion: DOO may represent a motion-preserving surgical option for selected patients with advanced hallux rigidus. In this study, DOO was associated with comparable patient satisfaction and pain relief to arthrodesis, with preservation of joint motion and lower observed complication rates. These findings suggest that DOO may be considered as an alternative in appropriate patients, although further prospective studies are required. Level of Evidence: Level III, retrospective cohort study.