Outcomes of modified metatarsal shortening offset osteotomy for forefoot deformity in patients with rheumatoid arthritis: Short to mid-term follow-up

Hirao, Makoto; Ebina, Kosuke; Tsuboi, Hideki; Nampei, Akihide; Kushioka, Junichi; Noguchi, Takaaki; Tsuji, Shigeyoshi; Owaki, Hajime; Hashimoto, Jun; Yoshikawa, Hideki

doi:10.1080/14397595.2016.1276512

Cited by 33 publications

(37 citation statements)

References 18 publications

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“…This combination of techniques was most commonly used in the studies considered and achieved the best results, both in relieving pain and in enhancing functionality (p < 0.001) [19,20,40,43]. However, there is no evidence that this is more effective than arthroplasty in all the metatarsal heads (or the fist metatarsal), because according to the papers included in our analysis, the only related research conducted were case studies [18,45,46], which are considered to present low methodological quality. Moreover, these papers do not address the specific object of our investigation.…”

Section: Discussionmentioning

confidence: 98%

Surgical Treatment for the Ankle and Foot in Patients with Rheumatoid Arthritis: A Systematic Review

Ortega-Ávila

Moreno-Velasco

Cervera‐Garvi

et al. 2019

JCM

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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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Section: Discussionmentioning

confidence: 98%

Surgical Treatment for the Ankle and Foot in Patients with Rheumatoid Arthritis: A Systematic Review

Ortega-Ávila

Moreno-Velasco

Cervera‐Garvi

et al. 2019

JCM

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“…Shortening oblique osteotomy (SOO) is a useful procedure to improve the weight-bearing distribution of the foot in patients with RA. Several types of metatarsal shortening osteotomies with MTP joint preservation have been described [ 7 – 12 ]. Hirao et al reported that the alignment score for the 2 nd through 5 th digits on the Japanese Society for Surgery of the Foot scale significantly improved by modified metatarsal shortening offset osteotomy from 1.2 ± 2.9 preoperatively to 11.8 ± 3.6 postoperatively in patients with RA foot [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several types of metatarsal shortening osteotomies with MTP joint preservation have been described [ 7 – 12 ]. Hirao et al reported that the alignment score for the 2 nd through 5 th digits on the Japanese Society for Surgery of the Foot scale significantly improved by modified metatarsal shortening offset osteotomy from 1.2 ± 2.9 preoperatively to 11.8 ± 3.6 postoperatively in patients with RA foot [ 7 ]. Nishida et al demonstrated that the deformity score for JSSF RA ankle and foot scale significantly improved from 13.8 to 21.1 [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of an Intractable Forefoot Ulcer Using Realignment Osteotomy in a Patient with Rheumatoid Arthritis

Imai

Kondo

Kumazaki

et al. 2020

Case Reports in Orthopedics

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Forefoot deformities are common among patients with rheumatoid arthritis (RA). Herein, we describe a case of intractable ulceration on the dorsomedial aspect of the right 5th digit, secondary to forefoot deformity, in a 76-year-old woman with a 35-year history of RA. The ulcer was due to a persistent subcutaneous infection. Although the infection was controllable with antibiotics, there was concern of relapse because of the abnormal pressure on the skin due to an overlap of the 4th and 5th digits. We proceeded with surgical correction of the forefoot alignment, including shortening oblique osteotomy of metatarsals 2 through 5, rather than amputation of the 5th digit. Following surgery, targeted antibiotic treatment was provided. The postoperative course was unremarkable, and the patient recovered weight-bearing function without recurrence of pain or ulceration. Forefoot realignment is a feasible option that should be considered for treating intractable foot pain and ulceration secondary to long-lasting RA.

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“…As for the joint-preserving arthroplasty, most patients (85.3%; n = 29/34) were treated by the combination of modified Scarf osteotomy of the hallux with the medial longitudinal approach [ 23 ] and off-set shortening osteotomy of the lesser toes with a dorsal longitudinal approach between the second and third toe MTP joint, and between the fourth and fifth toe MTP joint, as previously described [ 24 ]. The hallux was internally fixed with AcuTwist Acutrak 2.0-mm headless compression screws (Acumed USA, Hillsboro, OR) or 2.0–3.0-mm cannulated cortical screws.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2017

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PurposeThe 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).MethodsFour 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.ResultsIn 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).ConclusionsJoint-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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Outcomes of modified metatarsal shortening offset osteotomy for forefoot deformity in patients with rheumatoid arthritis: Short to mid-term follow-up

Cited by 33 publications

References 18 publications

Surgical Treatment for the Ankle and Foot in Patients with Rheumatoid Arthritis: A Systematic Review

Surgical Treatment for the Ankle and Foot in Patients with Rheumatoid Arthritis: A Systematic Review

Treatment of an Intractable Forefoot Ulcer Using Realignment Osteotomy in a Patient with Rheumatoid Arthritis

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

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