Resection or preservation of the metatarsal heads in rheumatoid forefoot surgery? A randomised clinical trial

Schrier, Joost C.M.; Keijsers, Noël L.W.; Matricali, Giovanni; Verheyen, Cees C. P. M.; Louwerens, Jan Willem K.

doi:10.1016/j.fas.2017.07.1126

Cited by 11 publications

(7 citation statements)

References 51 publications

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“…A previous study has also reported good clinical outcomes for a joint-preserving lesser toes procedure and resection arthroplasty combined with arthrodesis of the first MTP joint; however, radiographic assessments were not conducted. 23…”

Section: Discussionmentioning

confidence: 99%

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

Horita

Nishida

Nasu

et al. 2022

J Orthop Surg (Hong Kong)

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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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Section: Discussionmentioning

confidence: 99%

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

Horita

Nishida

Nasu

et al. 2022

J Orthop Surg (Hong Kong)

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“…Other groups recently demonstrated good outcomes for joint-preserving arthroplasties similar to resection techniques, but likewise, long-term follow-ups are lacking. 14,25,34 Nevertheless, HV and the lesser toes have to be properly addressed and positioned with each operative procedure in order to achieve long-term satisfactory outcomes.…”

Section: Discussionmentioning

confidence: 99%

Forefoot Reconstruction Following Metatarsal Head Resection Arthroplasty With a Plantar Approach—A 20-Year Follow-Up

et al. 2019

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Background: Rheumatoid arthritis (RA) can cause significant forefoot disorders. If forefoot deformity and pain are severe, surgical treatment can be considered. The aim of this study was to analyze the long-term outcomes of surgical forefoot correction per Tillmann, which involves resection of the metatarsal heads through a transverse plantar approach for the lesser toes and a dorsomedial approach to the great toe. Methods: This retrospective study used patient-based questionnaires to analyze the revision rate, pain, use of orthoses, walking ability, forefoot function, and patient satisfaction of patients with RA who had undergone a complete forefoot correction of metatarsophalangeal (MTP) I to V. The study only included participants with RA before the era of biological agents and who were at least 20 years postoperatively. A total of 60 patients who had undergone 100 complete forefoot operations according to Tillmann 24.6 ± 3.5 years ago were included in this study. Results: The data collected showed that 35 reoperations were performed on 26 of the patients. Deformity relapses were often documented for the hallux valgus. More than 60% of the patients were able to wear conventional shoes. The distances the participants were able to walk were significantly increased by wearing shoes when compared with walking barefoot ( P < .01). Conclusion: While forefoot function remained difficult to assess, the majority of patients were able to use conventional shoes. This long-term follow-up study of patient-reported questionnaires completed more than 20 years after the Tillmann procedure showed that more than 80% of the patients remained satisfied with the outcome. Level of Evidence: Level IV, retrospective cohort study.

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“…Unter einer engmaschige Kontrolle der Krankheitsaktivität können an den Metatarsalegelenken II-V unter Remission auch gelenkerhaltende Eingriffe durchgeführt werden sofern 2/3 des Gelenkknorpels intakt sind. Eine Reihe an Studien zeigen in mittelfristigen Nachuntersuchungszeiträumen gleichwertige Ergebnisse für die Durchführung gelenkerhaltender subkapitaler Osteotomien im Vergleich zur Resektion [28].…”

Section: Yano Et Al Konnten Für Eine Closing Wedgeunclassified

Unterschiede in der Therapie entzündlich rheumatischer und degenerativer Füße. Die Vorfußchirurgie

Hassel

2022

Aktuelle Rheumatologie

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ZusammenfassungDer Unterschied zwischen rheumatischen und degenerativen Veränderungen am Fuß liegt in der fortschreitenden Destruktion der Gelenke bei persistierender Synovialitis der rheumatoiden Arthritis (RA). Unter der heute wirksameren immunsuppressiven Therapie und eines frühen und aggressiven Beginns zeigen sich mildere Verlaufsformen. So können zunehmend auch gelenkerhaltende Verfahren der Vorfußchirurgie Anwendung finden. Entscheidend ist hier jedoch die Remission mit sicherer Krankheitskontrolle für den gelenkerhaltenden Eingriff. Dennoch ist das Rezidiv- und Fehlstellungsrisiko aufgrund wiederkehrender arthritischer Phasen höher. Rheumaorthopädische Standardverfahren, wie die Arthrodese des Großzehengrundgelenkes mit Resektion der Metatarsaleköpfchen haben aber Ihren Stellenwert beim Vollbild des erosiven rheumatischen Vorfußes nicht verloren. Ein standardisiertes Vorgehen fehlt. Umso wichtiger ist es, mit jedem Patienten individuell die richtigen Maßnahmen zu festzulegen.

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Resection or preservation of the metatarsal heads in rheumatoid forefoot surgery? A randomised clinical trial

Cited by 11 publications

References 51 publications

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

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

Forefoot Reconstruction Following Metatarsal Head Resection Arthroplasty With a Plantar Approach—A 20-Year Follow-Up

Unterschiede in der Therapie entzündlich rheumatischer und degenerativer Füße. Die Vorfußchirurgie

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