Isolated cheilectomy has been proposed for treatment of
hallux rigidus due to the perceived safety, efficacy, and ability to revise with repeat cheilectomy, implant or interpositional
arthroplasty, or
arthrodesis. A systematic review was undertaken to better understand the need for surgical revision after isolated cheilectomy for
hallux rigidus. Studies were eligible for inclusion only if they involved consecutively enrolled patients undergoing isolated cheilectomy or involved
revision surgery of the first metatarsophalangeal joint after isolated cheilectomy, evaluated patients at mean follow-up > or = 12 months' duration, and included details of complications. Twenty-three studies, describing 706 cheilectomies, met the inclusion criteria, with 62 (8.8%) undergoing surgical revision in the form of
arthrodesis (n = 23), no mention of revision procedure (n = 17), interpositional
arthroplasty (n = 13),
silicone implant
arthroplasty (n = 4), Keller resection
arthroplasty (n = 3), or repeat cheilectomy (n = 2). Twelve studies specified the grade of
hallux rigidus as: 103 (19.9%) grade 1, 210 (40.6%) grade II, 189 (36.6%) grade III, and 15 (2.9%) grade IV. Six studies indicated the number of cheilectomies that required
revision surgery as: 2 (20%) grade I, 8 (14.8%) grade II, 12 (9.1%) grade III, and 5 (55.6%) grade IV. These results make clear the low incidence of
revision surgery after cheilectomy for
hallux rigidus. Therefore, cheilectomy should be considered a first-line surgical treatment for
hallux rigidus. There remains a need for methodologically sound prospective cohort studies that focus on the use of cheilectomy for specific grades of
hallux rigidus.