Minimally Invasive Cheilectomy Surgery

Minimally invasive Procedure to Remove Bony Arthritis from Big Toe Joint.

Minimally invasive Cheilectomy

A minimally invasive cheilectomy procedure is used to remove arthritic bony prominence on the top of the big toe joint mostly that develops from osteoarthritis of the big toe joint.

Why is Cheilectomy Done

The cheilectomy procedure generally is used to be done using as an incision of approximately 4 to 6 cm on the top of the big toe joint. The body produces extra bone and bone spurs on top of the big toe joint which causes pain due to impingement and footwear irritation. This is usually a sign of osteoarthritis of the big toe joint. The big toe joint requires reasonable and pain-free movement to aid good foot function and appropriate propulsion during walking. The minimally invasive Cheilectomy procedures achieves this.

What are the different types of cheilectomy surgery?

Cheilectomy surgery is used to treat early or moderate osteoarthritis of the big toe joint known as hallux rigidus. There are X-ray findings of loss of joint space and cartilage thinning that causes extra bone formation around the joint.

Open cheilectomy

Surgery would involve opening the joint and the capsule using an incision which causes scarring.

Minimally invasive cheilectomy

Surgery only require a small 4 mm incision on the top of the joint through which the whole surgical procedure is performed and hence reduces the risk of scar tissue and a quicker recovery. There is less soft tissue damage and hence less risk of scarring, swelling and post operative pain.

Benefits of minimally invasive cheilectomy?

Minimally invasive cheilectomy allows quicker recovery with only three days of rest. The patients can then wear trainers and start to mobilise as the wound is very small and heals over 7 to 10 days. There is much less swelling and allows early range of motion exercises to maintain and achieve greater range of motion in the joint.

Potential risks and complications

All surgeries carry risks and complications and the main risk with cheilectomy procedure is local nerve irritation which is usually transient. It may well be that the arthritis in the joint progresses over time and it requires joint implant or fusion surgery of the big toe joint in 30% of cases. Other general risks of any surgery include but are not limited to infection, clots, delayed healing, scar irritation, joint stiffness, continued pain, nerve injury, complex regional pain syndrome. These risks are very small and often mitigated with the expertise to surgeon.

Week-on-week recovery after minimally invasive cheilectomy.

Postoperatively, you would expect that to rest for the three to five days with high elevation of the foot. You can walk no more than 10 minutes an hour. After three to five days the main dressing is removed and the waterproof plaster is maintained. You transition into a trainer and start to walk. You may use a trauma shoe for the first three to five days and week two you can start to push further and start to do some gentle exercises. Running would not possible for four to six weeks usually after minimally invasive cheilectomy. Swelling will typically subside over 8 to 10 weeks where a final result can be determined.

The cost of minimally invasive cheilectomy surgery

Minimally invasive surgery can be performed under local anaesthetic or sedation. The costs vary on the type of anaesthesia. Typically, minimally invasive cheilectomy surgery ranges in the price of £4000- £5000.

Is minimally invasive cheilectomy painful postoperatively?

The pain after minimally invasive surgery is very little. You may need to take painkillers for two to four days postoperatively to manage swelling. However, compare to open surgery your experience will be minimal pain.

What is the difference between cheilectomy and bunion surgery?

Cheilectomy surgery is performed for osteoarthritis whereas the bunion surgery involves cutting and resetting the bone with screw fixation within a healthy joint. During cheilectomy procedure an unhealthy joint is treated whereas with bunion surgery typically there is very little or no osteoarthritis. Also the bump treated with cheilectomy procedure is usually on top of the foot whereas the bunion deformities are mostly on the side of the foot.

How will you diagnosis the hallux rigidus and decide whether minimally invasive cheilectomy procedure is suitable?

Plain X-rays and clinical examination can determine whether there is some healthy cartilage that is still present within the joint. In such cases, a cheilectomy procedure can be very successful as the most of the cartilage remains to be healthy. Should this can also determined with the help of X-rays and should the arthritis be quite progressive in that you have very little or no cartilage then a fusion or joint implants are more appropriate choice of procedure.

How soon can I walk after minimally invasive cheilectomy?

You can walk straightaway for 10 to 15 minutes an hour after the procedure. However, for the first three to five days you should limit this ideally to no more than 15 minutes an hour.