Forefoot Deformities in Patients with Rheumatoid Arthritis: Mid- to Long-Term Result of Joint-Preserving Surgery in Comparison with Resection Arthroplasty.

Yuya Takakubo,Ryusuke Honma,Hiroshi Satake,Akemi Suzuki,Junichiro Shibuya,Yoshihiro Wanezaki,Michiaki Takagi,Yasushi Naganuma,Hiroharu Oki

doi:10.3390/ijerph182111257

Abstract

Background: Joint-preserving surgery for the forefoot has been increasingly performed for rheumatoid arthritis (RA). We compared joint-preserving surgeries with resection arthroplasty for RA in the forefoot. Methods: Forefoot surgeries were performed on 62 toes in 42 patients with RA (men: 2; women: 40) between 2002 and 2018. Three groups were compared: PP—31 toes treated with joint-preserving surgery involving the modified Mann method for the big toe and offset osteotomy for lesser toes, PR—15 toes treated with joint-preserving surgery for the big toe and resection arthroplasty for lesser toes, and RR—16 toes treated with resection arthroplasty for all the toes. Results: The PP group had significantly higher mean scores on a scale for RA in the foot and ankle at the latest follow-up than the RR group (86 vs. 75 points; p < 0.05). Hallux valgus (angle > 20°) of the big toe at the latest follow-up recurred in 10 (32%), 9 (60%), and 16 (100%) patients in the PP, PR, and RR groups, respectively. A revision surgery was performed in one patient each in the PP and PR groups. Conclusions: Joint-preserving surgery is superior to resection arthroplasty in preventing function loss and the recurrence of hallux valgus.

Highlights

Forefoot deformities have been reported to occur in approximately 90% of the patients with rheumatoid arthritis (RA) [1,2]
Resection arthroplasty and arthrodesis of the MTP joint have been the standard interventions for foot deformity due to RA [1,4,5]
Biologic treatment with methotrexate has been used in Japan since 2003 to prevent inflammatory joint destruction in RA [8,9]

Summary

Introduction

Forefoot deformities have been reported to occur in approximately 90% of the patients with rheumatoid arthritis (RA) [1,2]. Forefoot surgery for severe foot deformity due to RA has already been performed in 25–40% of such patients [3,4,5]. Representative surgical procedures include metatarsophalangeal (MTP) joint-preserving surgery, resection arthroplasty, arthrodesis, and artificial arthroplasty of MTP joint deformity for hallux valgus deformity and deformity of lesser toes. Resection arthroplasty and arthrodesis of the MTP joint have been the standard interventions for foot deformity due to RA [1,4,5]. Joint-preserving surgery for the forefoot has been increasingly performed for rheumatoid arthritis (RA). We compared joint-preserving surgeries with resection arthroplasty for RA in the forefoot. Hallux valgus (angle > 20◦ ) of the big toe at the latest follow-up recurred in 10 (32%), 9 (60%), and 16 (100%) patients in the PP, PR, and RR groups, respectively. A revision surgery was performed in one patient each in the PP and PR groups

Objectives

Methods

Results

Discussion

Conclusion