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Sánchez-Del-Saz J, Puerto-Vázquez MG, Serrano-Mateo L, Tome-Delgado JL, Galeote-Rodríguez JE. [Long-term clinical and radiological results of metatarsophalangeal resection arthroplasty in patients with large forefoot deformities]. ACTA ORTOPEDICA MEXICANA 2024; 38:155-163. [PMID: 38862145 DOI: 10.35366/115810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
INTRODUCTION metatarsophalangeal resection arthroplasty is considered a salvage surgical procedure able to improve the quality of life of patients with major forefoot deformities. MATERIAL AND METHODS a retrospective observational study of 31 patients (36 feet) with major forefoot deformities operated at our institution was performed. Thirty two feet required additional surgery involving the first ray, most of them (72.2%) through MTP joint fusion. The mean follow-up period was 10.3 ± 4.6 years. Most patients were women (87.1%), the mean age was 74.2 ± 11.5 years. RESULTS at the final follow-up, mean AOFAS score was 77.9 ± 10.2 points and mean MOxFQ score was 18.3 ± 8.3 points. Visual analog scale (VAS) for pain improved significantly from 7.5 ± 1.2 points to 3.4 ± 2.1 points on average. Good clinical results were also reported on ability to put on shoes comfortably. The mean resection arthroplasty spaces at the end of the study were 1.3, 1.8, 2.5 and 4.4 mm, for second to fifth rays, respectively. The mean sizes of remodeling osteophytes at the end of the study were 1.6, 1.4, 1.1 and 0.7 mm, respectively. Significant improvement was also achieved in the hallux valgus angle (HVA) and intermetatarsal angle (IMA) at the end of the study. CONCLUSION in our experience, metatarsophalangeal resection arthroplasty continues to be a valid choice in patients with major forefoot deformities, with satisfactory long-term clinical and radiographic results.
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Affiliation(s)
- J Sánchez-Del-Saz
- Departamento de Cirugía Ortopédica y Traumatología, Unidad de Cirugía de Pie y Tobillo. Hospital Clínico San Carlos, Madrid, España
| | - M G Puerto-Vázquez
- Departamento de Cirugía Ortopédica y Traumatología, Unidad de Cirugía de Pie y Tobillo. Hospital Clínico San Carlos, Madrid, España
| | - L Serrano-Mateo
- Departamento de Cirugía Ortopédica y Traumatología, Unidad de Cirugía de Pie y Tobillo. Hospital Clínico San Carlos, Madrid, España
| | - J L Tome-Delgado
- Departamento de Cirugía Ortopédica y Traumatología, Unidad de Cirugía de Pie y Tobillo. Hospital Clínico San Carlos, Madrid, España
| | - J E Galeote-Rodríguez
- Departamento de Cirugía Ortopédica y Traumatología, Unidad de Cirugía de Pie y Tobillo. Hospital Clínico San Carlos, Madrid, España
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Tominaga A, Ikari K, Yamada A, Yano K, Okazaki K. Outcomes of Joint-Preserving Surgery for Forefoot Deformities in Patients With Rheumatoid Arthritis. Foot Ankle Int 2024; 45:261-271. [PMID: 38327241 DOI: 10.1177/10711007241226898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND With the advent of effective disease-modifying medications, the surgical treatment of forefoot deformities in patients with rheumatoid arthritis (RA) has evolved from joint-sacrificing to joint-preserving surgery. However, it is unclear whether joint-preserving surgery is effective for the full range of metatarsophalangeal joint involvement. Hence, this study investigated the postoperative outcomes of joint-preserving surgery for rheumatoid forefoot deformities with a wide range of joint destruction. METHODS This retrospective observational study included 68 feet from 68 patients with RA who underwent joint-preserving surgery for forefoot deformities between 2014 and 2020. The Larsen grade classification was used to assess the first metatarsophalangeal joint destruction and classify patients into 4 groups as follows: 0 and 1 (n = 14), 2 (n = 21), 3 (n = 19), and 4 and 5 (n = 14). The Self-Administered Foot and Ankle Evaluation Questionnaire (SAFE-Q) score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) were determined before surgery and at the last follow-up visit. RESULTS The median observation duration was 40 (range, 24-78) months. SAFE-Q scores of all groups significantly improved in all subscales at the last observation, with no significant differences among the study groups. Radiographic evaluations of all groups revealed significant improvements in HVA and IMA after surgery, with no significant differences among the groups. CONCLUSION In patients using the surgical approaches described in this study, joint-preserving surgery for rheumatoid forefoot deformities led to satisfactory clinical and radiographic improvements, regardless of the severity of joint destruction. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Ayako Tominaga
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University, Tokyo, Japan
| | - Akifumi Yamada
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Yano
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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3
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Chapman LS, Jones J, Redmond AC, Flurey CA, Richards P, Hofstetter C, Smith TO, Arnold JB, Hannan MT, Maxwell LJ, Menz HB, Shea B, Golightly YM, Tugwell P, Beaton D, Conaghan PG, Helliwell PS, Siddle HJ. Developing a core outcome set for foot and ankle disorders in rheumatic and musculoskeletal diseases: A scoping review and report from the OMERACT 2022 foot and ankle special interest group session. Semin Arthritis Rheum 2023; 61:152210. [PMID: 37156170 DOI: 10.1016/j.semarthrit.2023.152210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Foot and ankle involvement is common in rheumatic and musculoskeletal diseases, yet high-quality evidence assessing the effectiveness of treatments for these disorders is lacking. The Outcome Measures in Rheumatology (OMERACT) Foot and Ankle Working Group is developing a core outcome set for use in clinical trials and longitudinal observational studies in this area. METHODS A scoping review was performed to identify outcome domains in the existing literature. Clinical trials and observational studies comparing pharmacological, conservative or surgical interventions involving adult participants with any foot or ankle disorder in the following rheumatic and musculoskeletal diseases (RMDs) were eligible for inclusion: rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthropathies, crystal arthropathies and connective tissue diseases. Outcome domains were categorised according to the OMERACT Filter 2.1. RESULTS Outcome domains were extracted from 150 eligible studies. Most studies included participants with foot/ankle OA (63% of studies) or foot/ankle involvement in RA (29% of studies). Foot/ankle pain was the outcome domain most commonly measured (78% of studies), being the most frequently specified outcome domain across all RMDs. There was considerable heterogeneity in the other outcome domains measured, across core areas of manifestations (signs, symptoms, biomarkers), life impact, and societal/resource use. The group's progress to date, including findings from the scoping review, was presented and discussed during a virtual OMERACT Special Interest Group (SIG) in October 2022. During this meeting, feedback was sought amongst delegates regarding the scope of the core outcome set, and feedback was received on the next steps of the project, including focus group and Delphi methods. CONCLUSION Findings from the scoping review and feedback from the SIG will contribute to the development of a core outcome set for foot and ankle disorders in RMDs. The next steps are to determine which outcome domains are important to patients, followed by a Delphi exercise with key stakeholders to prioritise outcome domains.
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Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK
| | - Jennifer Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Caroline A Flurey
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | | | | | - John B Arnold
- Alliance for Research in Exercise, Nutrition & Activity (ARENA), Allied Health & Human Performance Unit, University of South Australia, Adelaide, Australia
| | - Marian T Hannan
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Beverley Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, NC, USA; College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Peter Tugwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dorcas Beaton
- Department of Occupational Science and Occupational Therapy, Institute for Work and Health, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK.
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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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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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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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7
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He Y, Shan F, Fan C, Zeng X, Yang G, Tang B. Effectiveness of the First Metatarsophalangeal Joint Arthrodesis Versus Arthroplasty for Rheumatoid Forefoot Deformity: A Systematic Review and Meta-Analysis of Comparative Studies. J Foot Ankle Surg 2021; 60:787-794. [PMID: 33775544 DOI: 10.1053/j.jfas.2020.06.031] [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: 06/03/2019] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 02/03/2023]
Abstract
To compare the clinical outcomes of resection arthroplasty of metatarsals 2-5 with either first metatarsophalangeal joint arthrodesis or arthroplasty for rheumatoid forefoot deformity treatment. Comparative studies on the clinical effects of resection arthroplasty of metatarsals 2-5 with either first metatarsophalangeal joint arthrodesis or arthroplasty for the treatment of rheumatoid forefoot deformity were systematically reviewed and a meta-analysis conducted. A total of 337 patients (459 feet) with rheumatoid forefoot deformity from 6 comparative studies were included, with the mean follow-up times ranging from 25 to 80 months in the arthrodesis group and 35 to 102 months in the arthroplasty group. Postoperative pain, satisfaction, hallux valgus angle, the 1st -2nd intermetatarsal angle, adverse events mainly including non-union and the reoperation rate, and pedobarographic data were reported. In the pooled analysis, there were no significant pain score differences between 1st metatarsophalangeal joint arthrodesis and arthroplasty groups (SMD = 0.04, p = .734; I2 = 43.7%, p = .149), but the hallux valgus angle and the 1st -2nd intermetatarsal angle showed significant differences between these 2 groups (For hallux valgus angle, SMD = -0.439, p = .002; I2 = 96.6%, p = .000; for 1st -2nd intermetatarsal angle, SMD = -0.569, p = .000; I2 = 98.2%, p = .000). The rate of non-union varied from 0% to 26% in the arthrodesis group. The reoperation rate varied from 3% to 9.6% in the arthrodesis group and from 4% to 11.6% in the arthroplasty group. A comparison of the procedures showed that first metatarsophalangeal joint arthrodesis with resection arthroplasty of the lesser rays produced similar postoperative pain relief and better maintenance of the hallux valgus angle and the 1st -2nd intermetatarsal angle for rheumatoid forefoot deformity. However, the results should be interpreted with caution due to the high heterogeneity and relatively low quality of the reviewed articles.
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Affiliation(s)
- Yuan He
- Associate Professor, Division of Orthopedics, First People's Hospital of Xining City, Xining, Qinghai, China
| | - Farong Shan
- Associate Professor, Division of Orthopedics, First People's Hospital of Xining City, Xining, Qinghai, China
| | - Cheng Fan
- Resident, Sports Medicine Center, First People's Hospital of Xining City, Xining, Qinghai, China
| | - Xuezhu Zeng
- Resident, Sports Medicine Center, First People's Hospital of Xining City, Xining, Qinghai, China
| | - Guolei Yang
- Resident, Sports Medicine Center, First People's Hospital of Xining City, Xining, Qinghai, China
| | - Bo Tang
- Foot and Ankle Surgeon, Sports Medicine Center, First People's Hospital of Xining City, Xining, Qinghai, China.
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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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9
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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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10
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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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11
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Tobimatsu H, Ikari K, Yano K, Okazaki K. Triple osteotomy for erosive first metatarsal in a patient with rheumatoid arthritis: a case report. Mod Rheumatol Case Rep 2020; 5:6-10. [PMID: 33269650 DOI: 10.1080/24725625.2020.1789303] [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
Recently, over the half of the patients with rheumatoid arthritis achieved clinical remission with beneficial effects of disease modifying anti-rheumatic drugs, including biological disease modifying anti-rheumatic drugs. Because the patients in remission should have no/reduced progression of joint damage, there is a trend towards joint-preserving surgery in the treatment of rheumatoid forefoot deformities. Here we report a 76-year-old woman with rheumatoid arthritis developed a severe forefoot deformity including a large bony erosion of the first metatarsal head. She showed near remission for rheumatoid arthritis without having clinically active synovitis in her MTP joints. To preserving her metatarsophalangeal joint, a double first metatarsal osteotomy was planned to remove the bony erosion and simultaneously correct the hallux valgus. Thirty-month follow-up demonstrated excellent radiographical and patient-reported outcomes. To the best of our knowledge, this is the first case of a double first metatarsal osteotomy to remove the bony erosion and simultaneously correct the hallux valgus in a patient with rheumatoid arthritis with a large erosion of the first metatarsal head.
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Affiliation(s)
- Haruki Tobimatsu
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Yano
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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12
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Ohta K, Fukushi JI, Ikemura S, Kamura S, Miyahara HA, Nakashima Y. Preoperative Japanese Society for the Surgery of the Foot Lesser toe score and erythrocyte sedimentation rate influence wound healing following rheumatoid forefoot surgery. Mod Rheumatol 2020; 31:380-385. [PMID: 32476570 DOI: 10.1080/14397595.2020.1775960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Delayed wound healing is one of the most common complications following forefoot surgery in patients with rheumatoid arthritis. We aimed to identify the risk factors for delayed wound healing following rheumatoid forefoot surgery. METHODS Consecutive patients who underwent primary rheumatoid forefoot surgery (86 feet; 53 patients) between April 2008 and February 2019 were retrospectively evaluated. Clinical data, including smoking history, duration of the disease, presence of diabetes mellitus, medication, white blood cell count, erythrocyte sedimentation rate (ESR), C-reactive protein, the surgical procedure performed, and the Japanese Society for Surgery of the Foot (JSSF) scores, were collected. RESULTS Delayed wound healing was identified in 20 of 86 (23.3%) feet. In univariate analysis, participants showing delayed healing were older at the time of surgery (p = .04), their ESR was higher (p = .0006), and their total (p = .019) and pain (p = .016) scores on the JSSF Lesser toe scale were lower than those showing normal healing. In multivariable analysis, both the total preoperative JSSF Lesser toe scale score (p = .0239) and ESR (p = .0126) remained significant risk factors for delayed wound healing. CONCLUSIONS After rheumatoid forefoot surgery, surgeons should pay more attention to wound care in patients with lower preoperative JSSF Lesser toe score and high ESR.
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Affiliation(s)
- Koji Ohta
- Department of Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-Ichi Fukushi
- Department of Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Satoshi Ikemura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Kamura
- Department of Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hisa-Aki Miyahara
- Department of Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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13
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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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14
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Yano K, Saito H, Ikari K, Okazaki K. Impact of joint-preserving surgery on plantar pressure among patients with rheumatoid arthritis. Mod Rheumatol 2019; 30:604-606. [DOI: 10.1080/14397595.2019.1627741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Koichiro Yano
- Department of Orthopedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Hiroharu Saito
- Department of Orthopedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
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15
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Kasai T, Nakamura T, Iwasawa M, Nagase Y, Juji T, Tanaka S, Matsumoto T. Factors affecting bone union after distal shortening oblique osteotomy of the lesser metatarsals. Mod Rheumatol 2019; 30:502-508. [PMID: 31154882 DOI: 10.1080/14397595.2019.1626972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: There have been few reports on factors affecting bone union after metatarsal osteotomies. The purpose of this study was to clarify the factors affecting bone union after distal shortening oblique osteotomy of the lesser metatarsals.Methods: Patients who underwent distal shortening oblique osteotomy of the lesser metatarsals were retrospectively investigated. Failure to achieve bone union at 6 months after surgery was defined as delayed union. Background characteristics and radiographic measurements were compared between patients with and those without delayed union, and factors affecting bone union were assessed using multivariate analysis.Results: Among 204 toes in 58 patients evaluated in this study, delayed union occurred in 28%. In multivariate analysis, corticosteroid use (odds ratio (OR), 3.68; 95% confidence interval (CI), 1.65-8.16; p< .01), larger preoperative overlap between the metatarsal and the proximal phalanx (OR, 1.11 (per 1 mm increase); 95% CI, 1.02-1.21; p= .02), and larger gap at the osteotomy site (OR, 3.02 (per 1 mm increase); 95% CI, 1.76-5.16; p< .01) were identified as independent risk factors of delayed union.Conclusion: The identified risk factors of delayed union after distal shortening metatarsal osteotomies were corticosteroid use, preoperative overlap between the metatarsal and the proximal phalanx, and a gap at the osteotomy site.
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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
| | - Takeomi Nakamura
- Department of Orthopaedic Surgery, National Hospital Organization, Sagamihara Hospital, Sagamihara, Japan
| | - Mitsuyasu Iwasawa
- Department of Orthopaedic Surgery, National Hospital Organization, Sagamihara Hospital, Sagamihara, Japan
| | - Yuichi Nagase
- Department of Rheumatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Takuo Juji
- Department of Rheumatology, JCHO Yugawara Hospital, Kanagawa, 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.,Department of Rheumatology, JCHO Yugawara Hospital, Kanagawa, Japan
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16
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Yano K, Ikari K, Nakayama M, Sakuma Y, Imamura H, Tobimatsu H, Shimazaki M. The impact of hindfoot deformities for the recurrence of hallux valgus after joint-preserving surgeries for rheumatoid forefoot deformities. Foot Ankle Surg 2019; 25:348-353. [PMID: 30321979 DOI: 10.1016/j.fas.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recurrence of hallux valgus (HV) is a common complication after forefoot surgery for rheumatoid forefoot deformities. The aim of this study is to evaluate the impact of hindfoot malalignment on recurrence. METHODS This was a retrospective observational study designed to analyze the radiographic outcomes of 87 feet in 64 patients with rheumatoid arthritis treated with a joint-preserving surgery for HV deformity. Differences in hindfoot alignment preoperatively between the recurrence and nonrecurrence groups was compared. RESULTS There were no significant differences in hindfoot alignment preoperatively between groups. To estimate the impact of technical problems, the HV and intermetatarsal angles measured from radiographs 3 months postoperatively were compared between groups. The HV angles in the recurrence group were significantly larger than those in the nonrecurrence group (p=0.02). CONCLUSIONS There were no significant differences between preoperative hindfoot malalignment and postoperative recurrence of HV in rheumatoid forefoot surgeries.
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Affiliation(s)
- Koichiro Yano
- Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University, 10-22, Kawada, Shinjuku, Tokyo 1620054, Japan.
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University, 10-22, Kawada, Shinjuku, Tokyo 1620054, Japan.
| | - Masanori Nakayama
- Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University, 10-22, Kawada, Shinjuku, Tokyo 1620054, Japan.
| | - Yu Sakuma
- Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University, 10-22, Kawada, Shinjuku, Tokyo 1620054, Japan.
| | - Hitoshi Imamura
- Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University, 10-22, Kawada, Shinjuku, Tokyo 1620054, Japan.
| | - Haruki Tobimatsu
- Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University, 10-22, Kawada, Shinjuku, Tokyo 1620054, Japan.
| | - Miwako Shimazaki
- Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University, 10-22, Kawada, Shinjuku, Tokyo 1620054, Japan.
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17
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Onodera T, Nakano H, Homan K, Kondo E, Iwasaki N. Preoperative radiographic and clinical factors associated with postoperative floating of the lesser toes after resection arthroplasty for rheumatoid forefoot deformity. BMC Musculoskelet Disord 2019; 20:87. [PMID: 30782150 PMCID: PMC6381651 DOI: 10.1186/s12891-019-2462-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/07/2019] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to clarify the characteristics associated with postoperative floating of the lesser toes, especially focusing on the medial and lateral lessor toes, after arthrodesis of the first metatarsophalangeal joint and resection arthroplasty of the lessor toes in rheumatoid forefoot deformity. Methods Fourty-seven feet of 43 people who underwent resection arthroplasty of the metatarsal head of the lesser toes for rheumatoid arthritis of the metatarsophalangeal joints were included. We retrospectively evaluated the preoperative radiographic findings and clinical characteristics of the patients, and the occurrence of postoperative floating of the lesser toes. The mean duration of follow-up was 36.5 (range 12 to 114) months. Results Preoperative dislocation grades of the second and third toes that demonstrated postoperative floating were significantly higher than those of toes that did not experience postoperative floating. The hallux valgus deformity before surgery was significantly more severe in toes with postoperative floating of the second and third lessor toes than those with no floating (p < 0.05). In addition, the Japanese Society for Surgery of the Foot (JSSF) hallux scale scores before surgery in toes with postoperative floating of the fourth and fifth lessor toes were significantly worse than those in non-dislocating toes (p < 0.05). Conclusions The preoperative condition of the first metatarsophalangeal joint, including hallux valgus deformity, pain, range of motion, activity of daily living, and function is significantly different between postoperative floating of the lesser toes and non-floating of them after resection arthroplasty for rheumatoid forefoot deformity.
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Affiliation(s)
- Tomohiro Onodera
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Hiroaki Nakano
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Kentaro Homan
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Eiji Kondo
- Department of Advanced Therapeutic Research for Sports Medicine, Hokkaido University School of Medicine, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
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18
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Schrier JC, Keijsers NL, Matricali GA, Verheyen CCPM, Louwerens JWK. Resection or preservation of the metatarsal heads in rheumatoid forefoot surgery? A randomised clinical trial. Foot Ankle Surg 2019; 25:37-46. [PMID: 29409260 DOI: 10.1016/j.fas.2017.07.1126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/28/2017] [Accepted: 07/28/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite impressive results of the pharmacological management of rheumatoid arthritis, still certain patients suffer from rheumatoid forefoot problems. Surgical treatment of these forefoot deformities can be an option. In literature no high-quality studies on this topic can be found. The goal of present study is to compare the results of a metatarsal head (MTH) resecting technique with a MTH preserving technique in the operative treatment of severe rheumatoid forefoot deformity. METHODS Patients suffering from well-defined rheumatoid forefoot deformity were prospectively enrolled in three institutions. This non-blinded study had a randomised clinical design and eligible patients were randomly assigned to undergo either resection of preservation of the MTH. The primary outcome measure consisted of the AOFAS score. Secondary outcome measures were: the FFI, the VAS for pain and the SF-36. RESULTS Twenty-three patients (10 in MTH preservation group) were included and analysed. After one year follow-up no significant differences in AOFAS score and additional outcome factors were found. A total of 10 complications in 23 patients were reported. CONCLUSIONS This randomised clinical study did not show significant clinical difference between a MTH resecting and a preserving procedure in patients suffering from rheumatoid forefoot deformity. Both procedures resulted in considerable improvement of pain and activity scores.
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Affiliation(s)
- Joost C Schrier
- Dept Orthopaedic Surgery, Medinova Clinics Breda, The Netherlands; Dept Orthopaedic Surgery, Sint Maartenskliniek Nijmegen, The Netherlands.
| | - Noel L Keijsers
- Dept Orthopaedic Surgery, Sint Maartenskliniek Nijmegen, The Netherlands
| | | | - Cees C P M Verheyen
- Dept Orthopaedic Surgery and Traumatology, Isala Hospital Zwolle, The Netherlands
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19
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Horita M, Nishida K, Hashizume K, Nasu Y, Saiga K, Nakahara R, Machida T, Ohashi H, Ozaki T. Outcomes of Resection and Joint-Preserving Arthroplasty for Forefoot Deformities for Rheumatoid Arthritis. Foot Ankle Int 2018; 39:292-299. [PMID: 29415557 DOI: 10.1177/1071100717743996] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We investigated the clinical outcomes of resection and joint-preserving arthroplasty for forefoot deformities in patients with rheumatoid arthritis. METHODS Sixteen feet of 14 women (average age, 67.1 years; range, 53-82) underwent resection arthroplasty of the metatarsal head (resection group), and 18 feet of 15 women (average age, 61.3 years; range, 40-73) underwent a metatarsophalangeal joint-preserving procedure with shortening oblique metatarsal osteotomies of the lesser toes (joint preservation group). The mean disease duration in the resection and joint preservation groups was 23.6 and 19.1 years, and the average follow-up period was 37.3 and 33.5 months, respectively. The classification of Larsen was used to assess the severity of destruction of the metatarsophalangeal (MTP) joint. Preoperative and postoperative clinical evaluation included Japanese Society for Surgery of the Foot (JSSF) score and postoperative complications. RESULTS The number of preoperative radiographic destruction of the MTP joints (Larsen grade II, III, IV, and V) was 0, 29, 39, and 12 joints in the resection group and 13, 67, 9, and 1 joints in the joint preservation group. The mean JSSF score improved significantly from 61.3 to 83.9 points in the resection group ( P < .001) and from 62.2 to 90.8 points in the joint preservation group ( P < .001). In the resection group, recurrence of callosities and claw toe deformity was observed in 6 and 3 feet, respectively. In the joint-preserving group, recurrence of callosities and hammer toe deformity was observed in 1 foot each. CONCLUSION The resection arthroplasty and joint-preserving procedure showed satisfactory clinical outcomes. However, whether both procedures can maintain the good clinical results without the recurrence of forefoot deformity will require longer follow-up. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Masahiro Horita
- 1 Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiichiro Nishida
- 1 Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenzo Hashizume
- 2 Department of Rehabilitation, Okayama Rosai Hospital, Okayama, Japan
| | - Yoshihisa Nasu
- 3 Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenta Saiga
- 1 Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryuichi Nakahara
- 4 Department of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takahiro Machida
- 1 Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hideki Ohashi
- 1 Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshifumi Ozaki
- 1 Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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20
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Ebina K, Hirao M, Hashimoto J, Nampei A, Shi K, Tomita T, Futai K, Kunugiza Y, Noguchi T, Yoshikawa H. Comparison of a self-administered foot evaluation questionnaire (SAFE-Q) between joint-preserving arthroplasty and resection-replacement arthroplasty in forefoot surgery for patients with rheumatoid arthritis. Mod Rheumatol 2016; 27:795-800. [DOI: 10.1080/14397595.2016.1259968] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kosuke Ebina
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan,
| | - Makoto Hirao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan,
| | - Jun Hashimoto
- Department of Rheumatology, National Hospital Organization, Osaka-Minami Medical Center, Kawachinagano-shi, Japan,
| | - Akihide Nampei
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka-Minami Medical Center, Kawachinagano-shi, Japan,
| | - Kenrin Shi
- Department of Rheumatology, Yukioka Hospital, Osaka, Japan,
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Japan, and
| | - Kazuma Futai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan,
| | - Yasuo Kunugiza
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization, Hoshigaoka Medical Center, Hirakata, Japan
| | - Takaaki Noguchi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan,
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan,
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