Foot & Ankle International - September 2020 - 1033

Chrea et al	

1033

Figure 1.  Graph demonstrating the number of cheilectomy and Moberg with (PVACM) and without (CM) a polyvinyl alcohol implant
cases over the course of the study collection period.

orthopedic foot and ankle fellowship-trained surgeons.
Each represented surgeon performed a statistically similar
proportion of PVACM and CM cases, with the exception of
1 surgeon, who performed significantly more CM procedures (29%) than PVACM procedures (12%; P = .018). No
surgeon performed more than 50% of cases in either group.

Study Population
Preoperatively, each patient underwent standing anteroposterior (AP), oblique, and lateral plain radiographs as well as
clinical evaluation. The severity of hallux rigidus was
assessed using the Coughlin and Shurnas6 classification
system. Our cohort consisted of patients with severity of
grade II, III, or IV based on combined radiologic and clinical examination. Many of these patients were candidates for
first MTP arthrodesis but desired preservation of joint
motion and had at least 20 degrees of first MTP joint dorsiflexion preoperatively.
Chart review was performed to collect demographic
information and to record any postoperative complications.
The average age for all patients was 56 (range, 25-75)
years, with an average of 57 (range, 26-75) years for the
PVACM group and 54 (range, 25-73) years for the CM
group (P = .10). The average body mass index (BMI) for
all patients was 25.7 (range, 18.2-42.3) kg/m2, with an
average of 26.6 (range, 18.2-42.3) kg/m2 for the PVACM

group and 24.9 (range, 18.2-35.4) kg/m2 for the CM group
(P = .05). Ninety-seven out of 133 total patients (72.9%)
were female, 44 of 60 patients (73.3%) in the PVACM
group and 53 of 73 patients (72.6%) in the CM group (P =
.91). The average time from surgery to clinical follow-up
was 27.7 (range, 16.0-46.4) months for PVACM patients
and 36.6 (range, 18.6-47.8) months for CM patients. The
CM group has had a longer follow-up period as we have
been performing this procedure for a longer period of time
compared with the PVACM procedure, which was introduced with the more recent Food and Drug Administration
(FDA) approval of the PVA implant. A graph showing the
number of PVACM and CM cases performed over the
course of the study collection period is provided (Figure 1).

Survey Outcomes
Patient-reported outcomes were assessed using PatientReported Outcomes Measurement Information System
(PROMIS) scores, which has been validated in various foot
and ankle surgeries.2,14,15 PROMIS is a computerized adaptive test (CAT) used to assess functional outcomes in
multiple domains. The following PROMIS domains were
evaluated: Physical Function, Pain Interference, Pain
Intensity, Global Physical Health, Global Mental Health,
and Depression. Scores have a standardized mean of 50, the
reference population average, with a standard deviation
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