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

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.

The influence of medial cuneiform inclination on postoperative hallux valgus recurrence in rheumatoid arthritis patients: Insights from the KURAMA cohort study

“…3 Among the myriad afflictions RA imposes, foot deformities rank prominently, with an estimated 90% of RA patients experiencing some form of foot deformity and a notable 25%-40% undergoing surgery to address forefoot complications. 3 Previous studies demonstrated that the instability of the first tarsometatarsal (TMT) joint can be related to HV deformity, and the presence of the instability may be predictable by assessing the articular facet of the medial cuneiform in plain anteroposterior X-rays. [4][5][6][7][8][9][10][11] Surgical correction of HV includes various procedures, with joint-preserving techniques becoming more prevalent due to advancements in RA treatment.…”

“…18 The recurrence of HV was defined as hallux valgus angle (HVA) ≥20° after surgery. 3,19 The morphology of the TMT articular facet of the medial cuneiform was assessed by first TMT joint angle (1TMTJA) proposed by Brage et al (Figure S1). 9 The hindfoot deformity, reported as a risk factor for HV recurrence, 20,21 was assessed by talonavicular coverage angle (TNCA), lateral talocalcaneal angle (LTCA), calcaneal pitch angle (CPA), and talus-M1 angle (T1MTA).…”

“…Although there is no consensus on the definition of postoperative HV recurrence, the reported rate of HV recurrence in RA was 4.5%-60%. 3,19,30 the exact definition of recurrence as our study (HVA ≥20°). 3,19 Kushioka et al reported 16% recurrence in a mean follow-up of 35.3 months.…”

“…3,19,30 the exact definition of recurrence as our study (HVA ≥20°). 3,19 Kushioka et al reported 16% recurrence in a mean follow-up of 35.3 months. 19 Takakubo et al reported different HV recurrence rates based on the type of the concomitant surgery for the lesser toe; they observed 32% recurrence when joint-preserving surgery was conducted for the lesser toes, while they reported 60% recurrence when resection arthroplasty was performed for the lesser toes.…”

Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformity: An Editorial

“…Takakubo et al [ 6 ] compared joint-preserving surgery with joint-sacrificial surgery in patients with RA. In this study, joint-sacrificing surgery was performed if severe subluxation and dislocation of the MTP joint with contractures and stiffness were observed on the manipulation or stress radiographs.…”