title: A comparative study on the results of the modified Ludloff osteotomy for hallux valgus deformities with minimal erosion of the metatarsophalangeal joints in rheumatoid patients versus non-rheumatoid patients.
abstract: OBJECTIVE
  We aimed to compare the outcomes of joint-preserving surgery for hallux valgus deformities with minimal erosion of the metatarsophalangeal joint in rheumatoid patients with non-rheumatoid controls, and to determine the prognostic factors of recurrence in rheumatoid patients.
  
  
  METHODS
  A total of 18 rheumatoid patients (20 feet, Group I) and 35 non-rheumatoid patients (39 feet, Group II) were included. The mean follow-up was 29.6 months. Radiographic and clinical outcomes were compared. To identify the prognostic factors for recurrences in rheumatoid patients, subgroup analyses were done in Group I.
  
  
  RESULTS
  Most of the outcomes showed favorable results in both groups. However, Group II had better results in hallux valgus angle (HVA) (15.9° vs. 7.9°, p < 0.001), and in sesamoid position (p = 0.040) at final follow-up. Group I showed higher recurrence rate (50% vs. 0%). The final American Orthopaedic Foot and Ankle Society score was better in Group II (82.1 vs. 90.7, p = 0.014). The large preoperative HVA, non-performance of Akin osteotomy, and insufficient reduction of sesamoid position were related to recurrence in rheumatoid patients.
  
  
  CONCLUSIONS
  Joint-preserving surgery for hallux valgus deformities in rheumatoid forefoot deformity showed favorable results in mid-term follow-up; however, it should be warned of possible recurrent deformities.
authors.affiliation: a Department of Orthopaedic Surgery , Hanyang University College of Medicine , Seoul , South Korea.
authors.forename: Il-Hoon
authors.initials: IH
authors.lastname: Sung
authors.forename: Yoon-Kyoung
authors.initials: YK
authors.lastname: Sung
authors.forename: Dong-Ryul
authors.initials: DR
authors.lastname: Huh
authors.forename: Sung-Jae
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006215:Hallux Valgus / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012008:Recurrence; D016896:Treatment Outcome
keywords: Hallux valgus deformity; Joint-preserving surgery; Ludloff osteotomy; Recurrence; Rheumatoid forefoot deformity