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Horita M, Nishida K, Nasu Y, Nakahara R, Saiga K, Hamada M, Ozaki T. Outcome after resection arthroplasty or shortening oblique osteotomy of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal joint for severe rheumatoid forefoot deformities. J Orthop Surg (Hong Kong) 2022; 30:10225536221117903. [PMID: 35938600 DOI: 10.1177/10225536221117903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE We investigated objective and patient-reported outcomes after resection arthroplasty or shortening oblique osteotomy (SOO) of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal (MTP) joint for severe rheumatoid forefoot deformities. METHODS 17 feet from 14 women (mean age, 67.8 years) underwent resection arthroplasty of the lesser metatarsal heads (MTH resection group), while 13 feet from nine women and two men (mean age, 68.7 years) underwent SOO of the lesser metatarsals (MTH preservation group). Arthrodesis of the first MTP joint was performed in all cases. Mean follow-up in the MTH resection and preservation groups was 25.0 and 21.3 months, respectively. Preoperative and postoperative clinical evaluation included Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q) scores. RESULTS Mean total JSSF scale significantly improved from 53.4 to 76.4 in the MTH resection group (p < .001) and from 50.1 to 74.2 in the MTH preservation group (p = .002). Pain and pain-related and shoe-related SAFE-Q subscale scores significantly improved after surgery in both groups. In the MTH resection group, recurrence of painful callosities and claw toe deformity was observed in four and three feet, respectively. In the MTH preservation group, one patient experienced recurrence of painful callosities and one underwent revision surgery for IP joint dislocation. CONCLUSION Resection arthroplasty or SOO of the lesser metatarsals combined with arthrodesis of the first MTP joint achieved significant improvement with respect to pain relief, deformity correction, and footwear comfort.
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Affiliation(s)
- Masahiro Horita
- Department of Orthopaedic Surgery, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiichiro Nishida
- Department of Orthopaedic Surgery, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihisa Nasu
- Department of Orthopaedic Surgery, 92057Okayama University Hospital, Okayama, Japan
| | - Ryuichi Nakahara
- Department of Orthopaedic Surgery, 92057Okayama University Hospital, Okayama, Japan
| | - Kenta Saiga
- Department of Sports Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Masanori Hamada
- Department of Rehabilitation Medicine, 92057Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Etani Y, Hirao M, Ebina K, Tsuboi H, Noguchi T, Okamura G, Miyama A, Takami K, Nampei A, Tsuji S, Owaki H, Okada S, Hashimoto J. Modified Scarf Osteotomy with Medial Capsular Interposition Combined with Metatarsal Shortening Offset Osteotomy: A Comparison of Patients with Noninflammatory Arthritis and Rheumatoid Arthritis of the Foot. J Bone Joint Surg Am 2022; 104:1269-1280. [PMID: 35700087 DOI: 10.2106/jbjs.21.01486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients who have noninflammatory arthritis of the feet may develop destructive changes on the first metatarsal head and painful dislocation of the metatarsophalangeal (MTP) joint of 1 or more lesser toes. This aim of this study was to compare feet with noninflammatory arthritis and those with rheumatoid arthritis (RA) with respect to the clinical and radiographic outcomes after treatment of these destructive deformities with a modified Scarf osteotomy with medial capsular interposition into the newly formed first MTP joint, combined with metatarsal shortening offset osteotomy. METHODS A retrospective observational study of 93 feet (31 with noninflammatory arthritis and 62 with RA) was performed. Hallux and lesser-toe scores on the Japanese Society for Surgery of the Foot (JSSF) scoring system, a self-administered foot evaluation questionnaire (SAFE-Q), and preoperative and postoperative radiographic parameters were evaluated. RESULTS There were significant improvements at the time of the final follow-up in the mean scores on the hallux and lesser-toe scales of the JSSF system and in the SAFE-Q score. The postoperative JSSF lesser-toes function score was better for the feet with noninflammatory arthritis feet than the feet with RA. There was no significant difference in the hallux valgus angle (HVA) between 1 month postoperatively and the final follow-up for both groups. Furthermore, the HVA showed a strong correlation between the 1-month and final follow-up values. CONCLUSIONS The combination of the modified Scarf osteotomy with medial capsular interposition and shortening metatarsal offset osteotomy was useful and safe in feet with noninflammatory arthritis. The HVA at 1 month after surgery is useful to predict the HVA within 5 years after surgery. The postoperative clinical score for the lesser toes was better in the feet with noninflammatory arthritis. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yuki Etani
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Makoto Hirao
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kosuke Ebina
- Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hideki Tsuboi
- Department of Orthopaedics, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Takaaki Noguchi
- Department of Orthopaedics/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, Osaka, Japan
| | - Gensuke Okamura
- Department of Orthopaedics, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Akira Miyama
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka-Toneyama Medical Center, Toyonaka, Osaka, Japan
| | - Kenji Takami
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Akihide Nampei
- Nampei Orthopaedics and Rheumatology Clinic, Katsuragi, Nara, Japan
| | - Shigeyoshi Tsuji
- Department of Orthopaedics/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, Osaka, Japan
| | - Hajime Owaki
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO) Osaka Hospital, Osaka, Osaka, Japan
| | - Seiji Okada
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Jun Hashimoto
- Department of Orthopaedics/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, Osaka, Japan
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Janbazi L, Morovati H, Raissi GR, Forogh B, Bagherzadeh Cham M. Validity and reliability of the Persian version of self-administered foot evaluation questionnaire (SAFE-Q) in people with foot orthopedic problems. J Orthop Sci 2022:S0949-2658(22)00129-4. [PMID: 35691878 DOI: 10.1016/j.jos.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/03/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Foot problems are one of the main causes of seeing a doctor. According to the World Health Organization's definition of health, the healthcare system must consider patients' quality of life as an important entity. In this regard, many tools have been developed to evaluate patients' opinions about their health status. The purpose of the present study is to evaluate the validity and reliability of the Persian version of the Foot Self-Assessment Questionnaire (SAFE-Q) in patients with foot orthopedic problems. METHOD 215 people aged 17-60 years with orthopedic foot problems were included in this cross-sectional study. The Spearman correlation coefficient of SAFE-Q questionnaires versus Foot Function Index (FFI) questionnaire was evaluated for the convergent validity. Forty-three people randomly completed SAFE-Q again one week later. Intraclass correlation coefficient (ICC) and Cronbach's alpha was calculated to evaluate the test-retest reliability and internal consistency of the SAFE-Q, respectively. RESULTS A strong relationship was found between the SAFE-Q total score and other scales with FFI questionnaire (r = 0.52 to 0.87). ICC test-retest reliability and Cronbach's alpha were 0.981 and 0.98 for SAFE-Q, respectively. CONCLUSION The results indicate that the Persian version of the SAFE-Q questionnaire has acceptable validity and reliability and can be used to assess the health status and quality of life of Persian speakers with orthopedic foot problems.
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Affiliation(s)
- Lobaneh Janbazi
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Hazrat Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hawre Morovati
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Gholam Reza Raissi
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bijan Forogh
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Masumeh Bagherzadeh Cham
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Firoozgar General Hospital, Iran University of Medical Sciences, Tehran, Iran; Department of Orthotics & Prosthetics, Iran University of Medical Sciences, Tehran, Iran.
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Horita M, Nishida K, Kaneda D, Hashizume K, Nasu Y, Nakahara R, Saiga K, Ohashi H, Watanabe M, Ozaki T. Subjective and Objective Outcomes of Surgery for Rheumatoid Forefoot Deformities Under the Current Treatment Paradigm. J Foot Ankle Surg 2022; 61:53-59. [PMID: 34303577 DOI: 10.1053/j.jfas.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 12/16/2020] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
We investigated the clinical outcomes of surgical procedures for the treatment of forefoot deformities in patients with rheumatoid arthritis. Twenty feet in 16 women (mean age 62.1 years) underwent corrective osteotomy of the first metatarsal bone with shortening oblique osteotomy of the lesser metatarsophalangeal joints (joint-preservation group), while 13 feet in 12 women (mean age 67.4 years) underwent arthrodesis of the first metatarsophalangeal joint with resection arthroplasty of the lesser metatarsophalangeal joints (joint-sacrifice group); mean follow-up for each group was 25.8 and 23.8 months, respectively. The mean total Japanese Society for Surgery of the Foot (JSSF) scale improved significantly from 64.2 to 89.2 in the joint-preservation group (p < .001), and from 54.2 to 74.2 in the joint-sacrifice group (p = .003). In the joint-preservation group, the postoperative range of motion (ROM) of the joint, walking ability, and activities of daily living scores of the JSSF scale were significantly higher than those in the joint-sacrifice group (p = .001, p = .001, and p = .019, respectively). There were no differences in the subscale scores of the self-administered foot evaluation questionnaire between 2 groups either pre- or postoperatively. No differences in the postoperative complications were found between 2 groups. Although the joint-sacrificing procedure resulted in lower objective outcomes than the joint-preserving procedure regarding the ROM of the joint, the walking ability, and the level of activities of daily living, both procedures resulted in similar treatment outcomes when evaluated by the subjective measures.
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Affiliation(s)
- Masahiro Horita
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiichiro Nishida
- Associate Professor, Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Daisuke Kaneda
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenzo Hashizume
- Orthopaedic Surgeon, Department of Rehabilitation, Japan Labour Health and Welfare Organization, Okayama Rosai Hospital, Okayama, Japan
| | - Yoshihisa Nasu
- Assistant Professor, Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Ryuichi Nakahara
- Assistant Professor, Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Kenta Saiga
- Assistant Professor, Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Hideki Ohashi
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masahito Watanabe
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshifumi Ozaki
- Professor, Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Hishikawa N, Toyama S, Sawada K, Kawasaki T, Ohashi S, Ikoma K, Tokunaga D, Mikami Y. Effect of Foot Orthosis Treatment on Quality of Life in Secondary Sarcopenia Patients with Rheumatoid Arthritis-Related Foot Impairment. Prog Rehabil Med 2022; 7:20220047. [PMID: 36160028 PMCID: PMC9470498 DOI: 10.2490/prm.20220047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/23/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives: Patients with rheumatoid arthritis (RA)-related foot impairment have a high rate of sarcopenia. Treatment using a foot orthosis (FO) enables not only a reduction in pain while walking but also an increase in physical activity, helping to prevent further loss of muscle mass. However, the primary goal of treating RA is to maximize patients’ long-term quality of life (QOL). We investigated whether FO treatment both increases physical activity and improves QOL. Methods: Among 31 patients with RA-related foot impairment, 15 with sarcopenia were treated with an FO for 6 months. Foot-specific QOL (measuring using the Self-Administered Foot Evaluation Questionnaire), foot pain, activities of daily living, and physical activity (walking-intensity activity and moderate- to vigorous-intensity activity) were compared before treatment and after 6 months of treatment. Results: Ten patients who completed 6 months of follow-up were analyzed. Significant QOL improvements were found in the Pain and Pain-Related category and the Physical Functioning and Daily Living category (P = 0.02–0.04); however, no significant changes were found in the Social Functioning, General Health and Well-Being, or Shoe-Related categories (P = 0.09–0.21). Foot pain and activities of daily living significantly improved (P = 0.01–0.04). Physical activity significantly increased for walking-intensity activity (P = 0.04) but did not change for moderate- to vigorous-intensity activity (P = 1.00). Conclusions: FO treatment in patients with RA-related foot impairment and sarcopenia increased light-intensity physical activity such as walking and improved physical QOL.
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Affiliation(s)
- Norikazu Hishikawa
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koshiro Sawada
- Department of Development of Multidisciplinary Promotion for Physical Activity, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Kawasaki
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Suzuyo Ohashi
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daisaku Tokunaga
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Takakubo Y, Wanezaki Y, Oki H, Naganuma Y, Shibuya J, Honma R, Suzuki A, Satake H, Takagi M. Forefoot Deformities in Patients with Rheumatoid Arthritis: Mid- to Long-Term Result of Joint-Preserving Surgery in Comparison with Resection Arthroplasty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111257. [PMID: 34769775 PMCID: PMC8583379 DOI: 10.3390/ijerph182111257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Yuya Takakubo
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
- Department of Rehabilitation, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
- Correspondence:
| | - Yoshihiro Wanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
| | - Hiroharu Oki
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
- Faculty of Orthopaedic Surgery, Yamagata Saisei Hospital, Yamagata 990-9585, Japan
| | - Yasushi Naganuma
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
- Faculty of Orthopaedic Surgery, Yamagata Prefectural Central Hospital, Yamagata 990-2292, Japan
| | - Junichiro Shibuya
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
- Department of Orthopaedic Surgery, Izumi Orthopaedic Hospital, Sendai-shi 981-3121, Japan
| | - Ryusuke Honma
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
- Department of Rehabilitation, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Akemi Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
| | - Hiroshi Satake
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
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Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010667. [PMID: 34682415 PMCID: PMC8535323 DOI: 10.3390/ijerph182010667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/04/2021] [Accepted: 10/09/2021] [Indexed: 02/08/2023]
Abstract
Background. The effectiveness of scarf and Akin osteotomy with intra-articular lateral soft tissue release for the correction of hallux valgus (HV) in patients with rheumatoid arthritis (RA) has not been elucidated. Methods. A total of 36 feet in 28 patients with RA who had scarf and Akin osteotomy with intra-articular stepwise lateral soft tissue release between 2015 and 2020 at a single institute were investigated retrospectively, with a mean follow-up period of 32.0 ± 16.9 months. Radiographic evaluations including the HV angle, intermetatarsal angle, and sesamoid position were performed preoperatively and postoperatively. Clinical outcomes were assessed using the Japanese Society of Surgery of the Foot (JSSF) hallux scale and self-administered foot evaluation questionnaire (SAFE-Q). Results. The procedure resulted in significant HV correction, with a recurrence rate of 13.9%. The JSSF scale and all five SAFE-Q subscale scores significantly improved (p < 0.05), with no major complications. More than 90% of cases achieved adequate lateral soft tissue release without sacrificing the adductor tendon of the hallux. Conclusions. Intra-articular stepwise lateral soft tissue release in combination with scarf and Akin osteotomy provided satisfactory radiographic and patient-reported outcomes for the correction of HV in patients with RA with minimum lateral soft tissue release.
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Combination of Modified Scarf Osteotomy and Metatarsal Shortening Offset Osteotomy for Rheumatoid Forefoot Deformity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910473. [PMID: 34639772 PMCID: PMC8508223 DOI: 10.3390/ijerph181910473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/27/2021] [Accepted: 10/02/2021] [Indexed: 11/17/2022]
Abstract
With the progress of medical treatment for rheumatoid arthritis (RA), several joint-preserving forefoot surgical procedures have been established and performed. In this situation, we have been choosing the combined surgery: modified scarf osteotomy for the great toe and metatarsal shortening offset osteotomy for the lesser toes in RA cases. A retrospective observational study of 53 RA patients (mean follow-up period: 4.6 years) who underwent the surgery was completed. RA foot ankle scores were assessed, using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a self-administered foot evaluation questionnaire (SAFE-Q) was also checked to evaluate clinical outcomes. For radiological evaluations, deformity parameters were measured using radiographs of the feet with weight-bearing. JSSF hallux and lesser toes scores and the SAFE-Q score showed significant improvement in all indices. HVA, M1-M2A, M1-M5A, M2-M5A, and sesamoid position were significantly improved after surgery. At the final follow-up, the hallux valgus deformity had recurred in 4 feet (7.5%), and hallux varus deformity had developed in 8 feet (15.1%). No case of recurrent hallux valgus deformity required revision surgery. Recurrence of dorsal dislocation/subluxation of the lesser toe MTP joint was seen in 6 feet (11.3%) after surgery. A combination of modified scarf osteotomy for the great toe and modified metatarsal shortening offset osteotomy for the lesser toes is one of the novel surgical procedures for rheumatoid forefoot deformity. Preoperative disease activity of RA negatively affected the clinical score of the hallux. The spread of M2-M5A was a risk factor for resubluxation of the lesser toe MTP joint.
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Ohashi H, Nishida K, Nasu Y, Saiga K, Nakahara R, Horita M, Okita S, Ozaki T. A Novel Radiographic Measurement Method for the Evaluation of Metatarsophalangeal Joint Dislocation of the Lesser Toe in Patients with Rheumatoid Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147520. [PMID: 34299970 PMCID: PMC8303857 DOI: 10.3390/ijerph18147520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022]
Abstract
Dorsal dislocation of metatarsophalangeal (MTP) joints of the lesser toe frequently occurs in patients with rheumatoid arthritis (RA), and may cause painful and uncomfortable plantar callosities and ulceration. The current study examined the reliability and clinical relevance of a novel radiographic parameter (the MTP overlap distance [MOD]) in evaluating the severity of MTP joint dislocation. The subjects of the current study were 147 RA patients (276 feet; 1104 toes). MOD, defined as the overlap distance of the metatarsal head and the proximal end of the phalanx, was measured on plain radiographs. The relationship between the MOD and clinical complaints (forefoot pain and/or callosity formation) was analyzed to create a severity grading system. As a result, toes with callosities had a significantly larger MOD. ROC analysis revealed that the MOD had a high AUC for predicting an asymptomatic foot (−0.70) and callosities (0.89). MOD grades were defined as follows: grade 1, 0 ≤ MOD < 5 mm; grade 2, 5 ≤ MOD < 10 mm; and grade 3, MOD ≥ 10 mm. The intra- and inter-observer reliability of the MOD grade had high reproducibility. Furthermore, the MOD and MOD grade improved significantly after joint-preserving surgeries for lesser toe deformities. Our results suggest that MOD and MOD grade might be useful tools for the evaluation of deformities of the lesser toe and the effect of surgical intervention for MTP joints in patients with RA.
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Affiliation(s)
- Hideki Ohashi
- Department of Orthopaedic Surgery, Takahashi Central Hospital, Okayama 716-0033, Japan;
| | - Keiichiro Nishida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (M.H.); (T.O.)
- Correspondence: ; Tel.: +81-86-235-7273
| | - Yoshihisa Nasu
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan; (Y.N.); (K.S.); (R.N.)
| | - Kenta Saiga
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan; (Y.N.); (K.S.); (R.N.)
| | - Ryuichi Nakahara
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan; (Y.N.); (K.S.); (R.N.)
| | - Masahiro Horita
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (M.H.); (T.O.)
| | - Shunji Okita
- Department of Orthopaedic Surgery, Okayama City Hospital, Okayama 700-0962, Japan;
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (M.H.); (T.O.)
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Joint-Preserving Surgery for Forefoot Deformities in Patients with Rheumatoid Arthritis: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084093. [PMID: 33924481 PMCID: PMC8068870 DOI: 10.3390/ijerph18084093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022]
Abstract
The combination of first metatarsophalangeal joint arthrodesis and resection arthroplasty of all lesser metatarsal heads has been historically considered the golden standard treatment for rheumatoid forefoot deformities. However, as recent improved management of rheumatoid arthritis have reduced progression of joint destruction, the surgical treatments for rheumatoid forefoot deformities have gradually changed from joint-sacrificing surgery, such as arthrodesis and resection arthroplasty, to joint-preserving surgery. The aim of this literature review was to provide current evidence for joint-preserving surgery for rheumatoid forefoot deformities. We focused on the indications, specific outcomes, and postsurgical complications of joint-preserving surgery in this review.
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Yano K, Ikari K, Tobimatsu H, Okazaki K. Patient-Reported and Radiographic Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformities: A Retrospective Case Series with Mean Follow-up of 6 Years. J Bone Joint Surg Am 2021; 103:506-516. [PMID: 33475311 DOI: 10.2106/jbjs.20.01144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an autoimmune disorder and a chronic inflammatory disease that can damage joints throughout the body. As dramatic improvements in medical treatment have contributed to reduced progression of joint destruction, surgical methods for the treatment of RA-related forefoot deformities have gradually changed from joint-sacrificing to joint-preserving. The aim of this study was to assess the long-term outcomes, including patient-reported outcomes, of joint-preserving surgery for forefoot deformities associated with RA. METHODS This retrospective study included 105 feet in 89 patients with RA who were treated during the period of January 2012 to May 2015 and had a minimum of 5 years of follow-up (mean, 6.0 ± 0.9 years). The patient-reported outcome measure used was the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), which was completed preoperatively and at the latest follow-up (n = 53 feet). The hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the position of the medial sesamoid were measured preoperatively, at 3 months postoperatively, and at the latest follow-up. Cases of delayed wound-healing, hallux valgus recurrence, nonunion at the osteotomy sites, and reoperation were recorded. Kaplan-Meier survival curves were used to determine the estimated survivorship, with reoperation as the end point. RESULTS Scores of all 5 subscales of the SAFE-Q demonstrated significant improvement at the latest follow-up. The average HVA and IMA decreased significantly 3 months postoperatively, and these measurements remained significantly lower than the preoperative values (p < 0.01). The position of the medial sesamoid at the latest follow-up improved significantly (p < 0.01). Delayed wound-healing was found at the site of surgery in 21 (20.0%) of the 105 feet. Recurrence of hallux valgus was observed in 11 (10.5%) of the feet. There was no case of nonunion at any osteotomy site. Eleven (10.5%) of the feet required reoperation. The estimated survivorship of the studied joint-preserving surgery at 7 years, with reoperation as the end point, was 89.5%. CONCLUSIONS Satisfactory long-term patient-reported and radiographic outcomes after joint-preserving surgery for forefoot deformities associated with RA can be achieved. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Koichiro Yano
- Department of Orthopedic Surgery (K.Y., K.I., H.T., and K.O.) and Institute of Rheumatology (K.Y., K.I., and H.T.), Tokyo Women's Medical University, Tokyo, Japan
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Shimomura K, Yasui T, Teramoto A, Ozasa Y, Yamashita T, Iwasawa M. Time Course of Quality of Life Improvement Between Resection Arthroplasty and Metatarsophalangeal Joint-Preserving Forefoot Arthroplasty for Rheumatoid Arthritis. Foot Ankle Int 2021; 42:166-175. [PMID: 33155486 DOI: 10.1177/1071100720962096] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Resection arthroplasty has long been a major treatment option for forefoot deformity caused by rheumatoid arthritis (RA). However, metatarsophalangeal (MTP) joint-preserving surgery is now surpassing classic resection arthroplasty. This study was performed to compare the postoperative results of these 2 operative methods. METHODS Fifty-one toes of 40 patients with RA who underwent resection arthroplasty (resection group) or MTP joint-preserving arthroplasty (preservation group) from 2014 to 2017 for forefoot deformity were followed up for >1 year and were retrospectively analyzed. In the preservation group, open reduction of joint dislocation was performed if needed, and the deformity was corrected by metatarsal shortening osteotomy. The mean follow-up period was 21 months. The Japanese Society for Surgery of the Foot (JSSF) scales (objective outcome measures), the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) (subjective outcome measure), and radiographic indices were compared between the groups. The resection group and preservation group comprised 15 toes of 11 patients and 36 toes of 29 patients, respectively. RESULTS There were no significant differences in the preoperative radiographic indices, JSSF scales, or SAFE-Q results between the 2 groups. The preservation group showed better JSSF scores at the last follow-up (median hallux scale, 89 vs 74; median lesser scale, 87 vs 79). In the preservation group, the SAFE-Q scores gradually improved with time until 12 months postoperatively. In the resection group, the scores decreased 3 months postoperatively and then improved and reached a plateau 6 months postoperatively. At 12 months postoperatively, there was no significant difference in the SAFE-Q scores between the 2 groups. CONCLUSIONS MTP joint-preserving arthroplasty resulted in superior objective scores to resection arthroplasty in patients with RA forefoot deformity. Although the subjective scores did not differ between the groups at the last follow-up, the time course of postoperative quality of life improvement was different between the 2 surgeries. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Kota Shimomura
- Department of Orthopaedic Surgery, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.,Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Tetsuro Yasui
- Department of Orthopaedic Surgery, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Yasuhiro Ozasa
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Mitsuyasu Iwasawa
- Department of Orthopaedic Surgery, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
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Kasai T, Momoyama G, Nagase Y, Yasui T, Tanaka S, Matsumoto T. Disease activity affects the recurrent deformities of the lesser toes after resection arthroplasty for rheumatoid forefoot deformity. Mod Rheumatol 2020; 31:365-372. [PMID: 32552188 DOI: 10.1080/14397595.2020.1783164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The purpose of this study was to clarify the effect of disease activity on recurrent deformities after resection arthroplasty for forefoot deformities in patients with rheumatoid arthritis (RA). METHODS This study included 83 feet in 58 patients with RA who underwent resection arthroplasty of all metatarsal heads, with a minimum follow-up of 2 years. The patients' demographic characteristics, preoperative radiographic findings, and RA disease activity evaluated using the 28-joint disease activity score based on the erythrocyte sedimentation rate (determined preoperatively and at the final follow-up) were compared between feet with and without postoperative recurrent deformities of the toes. Recurrent deformities were assessed separately for the hallux and lesser toes. RESULTS Recurrence in the hallux and lesser toes occurred in 23 feet (27.7%) and 13 feet (15.7%), respectively. With respect to recurrent hallux deformity, only the preoperative severity of hallux deformity was associated with recurrence. On the other hand, postoperative deformity of the lesser toes was positively associated with disease activity alone and not with other preoperative factors. CONCLUSION Postoperative control of RA disease activity was associated with recurrent deformity of the lesser toes but not that of the hallux after resection arthroplasty of all metatarsals for rheumatoid forefoot deformities.
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Affiliation(s)
- Taro Kasai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Rheumatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Gen Momoyama
- Department of Rheumatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Department of Orthopaedic Surgery, Itakura Hospital, Chiba, Japan
| | - Yuichi Nagase
- Department of Rheumatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tetsuro Yasui
- Department of Orthopaedic Surgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takumi Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Ortega-Avila AB, Moreno-Velasco A, Cervera-Garvi P, Martinez-Rico M, Chicharro-Luna E, Gijon-Noqueron G. Surgical Treatment for the Ankle and Foot in Patients with Rheumatoid Arthritis: A Systematic Review. J Clin Med 2019; 9:E42. [PMID: 31878151 PMCID: PMC7019508 DOI: 10.3390/jcm9010042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/11/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022] Open
Abstract
The aim was to identify effective surgical treatments for patients with rheumatoid arthritis in the foot and/or ankle. A systematic review of the literature was conducted via a data search of the PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PROSPERO databases, from their inception until June 2019. Only non-randomized controlled trials and cohort studies were included in this review. Two of the present authors independently assessed the quality of each study and extracted the relevant data. A quality assessment of all articles was performed using the methodological index for non-randomized studies criteria. In addition, the Newcastle Ottawa scale was used for cohort studies. Thirteen studies met the inclusion criteria (five cohort studies and eight NRCTs). The total population considered was 923 patients (570 patients had RA), with a mean age of 58.8 years. Regarding the risk of bias, both the NRCTs and the cohort studies had a moderate level of quality. Despite the relatively low quality of these studies, surgical treatment for the foot and/or ankle is shown to reduce pain and improve functionality in patients with RA, in the short term (6-12 months).
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Affiliation(s)
- Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
| | - Antonio Moreno-Velasco
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
| | - Pablo Cervera-Garvi
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
| | - Magdalena Martinez-Rico
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
| | - Esther Chicharro-Luna
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, San Juan de Alicante, 03550 Alicante, Spain;
| | - Gabriel Gijon-Noqueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
- Biomedical Research Institute (IBIMA), 29010 Malaga, Spain
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Hirao M, Tsuboi H, Tazaki N, Kushimoto K, Ebina K, Yoshikawa H, Hashimoto J. Effects of range of motion exercise of the metatarsophalangeal joint from 2-weeks after joint-preserving rheumatoid forefoot surgery. Mod Rheumatol 2019; 30:305-312. [PMID: 30924699 DOI: 10.1080/14397595.2019.1601853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives: Joint-preserving rheumatoid forefoot surgery improves clinical outcomes, but postoperative range of motion (ROM) of the metatarsophalangeal (MTP) joint remains an issue. The objective of this study was to evaluate the effect of ROM exercise from the early period after lesser toe MTP joint-preserving surgery.Methods: A retrospective, observational study of 22 rheumatoid arthritis patients who underwent modified metatarsal shortening offset osteotomy was completed. Lesser toe scales were administered using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and the maximum distance of continuous walking was checked to evaluate clinical outcomes. Maximum passive ROM of the lesser toe MTP joints and the extension angle of the 2nd MTP joint at the terminal stance phase during gait were measured and evaluated.Results: Pain scores and ROM-related indices of the JSSF lesser toe scale improved significantly in the exercise group. The extension angle of the 2nd MTP joint at the terminal stance phase during gait was increased, and the maximum distance of continuous walking seemed longer.Conclusion: Passive/active ROM exercise from 2-weeks after surgery can improve a patient's activity and forefoot function through increasing ROM of the MTP joint at the terminal stance phase.
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Affiliation(s)
- Makoto Hirao
- Department of Rheumatology/Orthopaedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.,Department of Orthopaedics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Tsuboi
- Department of Rheumatology/Orthopaedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan.,Department of Orthopaedics, Osaka Rosai Hospital, Osaka, Japan
| | - Naotaka Tazaki
- Department of Rehabilitation, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan
| | - Kohei Kushimoto
- Department of Rehabilitation, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan
| | - Kosuke Ebina
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Hashimoto
- Department of Rheumatology/Orthopaedics, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan
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Ebina K, Hirao M, Takagi K, Ueno S, Morimoto T, Matsuoka H, Kitaguchi K, Iwahashi T, Hashimoto J, Yoshikawa H. Comparison of the effects of forefoot joint-preserving arthroplasty and resection-replacement arthroplasty on walking plantar pressure distribution and patient-based outcomes in patients with rheumatoid arthritis. PLoS One 2017; 12:e0183805. [PMID: 28850582 PMCID: PMC5574579 DOI: 10.1371/journal.pone.0183805] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/13/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this retrospective study is to clarify the difference in plantar pressure distribution during walking and related patient-based outcomes between forefoot joint-preserving arthroplasty and resection-replacement arthroplasty in patients with rheumatoid arthritis (RA). Methods Four groups of patients were recruited. Group1 included 22 feet of 11 healthy controls (age 48.6 years), Group2 included 36 feet of 28 RA patients with deformed non-operated feet (age 64.8 years, Disease activity score assessing 28 joints with CRP [DAS28-CRP] 2.3), Group3 included 27 feet of 20 RA patients with metatarsal head resection-replacement arthroplasty (age 60.7 years, post-operative duration 5.6 years, DAS28-CRP 2.4), and Group4 included 34 feet of 29 RA patients with metatarsophalangeal (MTP) joint-preserving arthroplasty (age 64.6 years, post-operative duration 3.2 years, DAS28-CRP 2.3). Patients were cross-sectionally examined by F-SCAN II to evaluate walking plantar pressure, and the self-administered foot evaluation questionnaire (SAFE-Q). Twenty joint-preserving arthroplasty feet were longitudinally examined at both pre- and post-operation. Results In the 1st MTP joint, Group4 showed higher pressure distribution (13.7%) than Group2 (8.0%) and Group3 (6.7%) (P<0.001). In the 2nd-3rd MTP joint, Group4 showed lower pressure distribution (9.0%) than Group2 (14.5%) (P<0.001) and Group3 (11.5%) (P<0.05). On longitudinal analysis, Group4 showed increased 1st MTP joint pressure (8.5% vs. 14.7%; P<0.001) and decreased 2nd-3rd MTP joint pressure (15.2% vs. 10.7%; P<0.01) distribution. In the SAFE-Q subscale scores, Group4 showed higher scores than Group3 in pain and pain-related scores (84.1 vs. 71.7; P<0.01) and in shoe-related scores (62.5 vs. 43.1; P<0.01). Conclusions Joint-preserving arthroplasty resulted in higher 1st MTP joint and lower 2nd-3rd MTP joint pressures than resection-replacement arthroplasty, which were associated with better patient-based outcomes.
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Affiliation(s)
- Kosuke Ebina
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- * E-mail:
| | - Makoto Hirao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keishi Takagi
- Department of Rehabilitation, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Sachi Ueno
- Department of Rehabilitation, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tokimitsu Morimoto
- Department of Orthopaedic Surgery, Suita Municipal Hospital, Suita, Osaka, Japan
| | - Hozo Matsuoka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuma Kitaguchi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toru Iwahashi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Jun Hashimoto
- Department of Rheumatology, National Hospital Organization, Osaka-Minami Medical Center, Kawachinagano, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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