Resection arthroplasty of the metatarsophalangeal joints in rheumatoid arthritis. A follow-up study of 100 patients.

Abstract

The follow-up results 1 to 11 years (mean 5 years) after resection arthroplasty of the forefoot or arthrodesis of the first metatarsophalangeal (MTP) joint performed on 100 patients (179 feet) with classical or definite rheumatoid arthritis are presented and analysed. The main indication for surgery was pain in the damaged and more or less luxated MTP joint. Resection arthroplasty of MTP joints II-V was performed from the plantar approach in 167 feet. The Keller or Mayo operation was performed on the first MTP joint in 129 feet. Arthrodesis of the first MTP joint was done in 17 feet. The proximal joint of the hallux was not treated in 33 feet. According to the subjective assessment, results after surgery were considered good by 49 patients (91 feet, 51%), fair by 44 (76 feet, 42%), and poor by 7 (12 feet, 7%). These 7 patients complained of persistent pain or a disabling deformity of the toes, or both. Although these results were generally satisfactory, the objective results were not good. At follow-up more than 50% of the patients had recidivistic callosities, a hallux valgus deformity, a dorsal dislocation and lateral deviation of the lesser toes, or radiologically observable bony proliferations of the distal ends of the metatarsals--or a combination of these. All patients in whom a proximal or interphalangeal joint of the hallux was surgically or spontaneously fused were satisfied: the stiff joint was painless on walking. When destruction of the first MTP joint is severe and painful, arthrodesis is recommended.