title: Fusion of the First Metatarsophalangeal Joint and Second to Fifth Metatarsal Head Resection for Rheumatoid Forefoot Deformity.
abstract: The goals of the present study were to evaluate the mid-term results of first metatarsophalangeal joint fusion combined with second to fifth metatarsal head resection in rheumatoid forefoot deformity and identify the prognostic factors. The inclusion criteria were 2010 American College of Rheumatology and/or European League Against Rheumatism criteria for rheumatoid arthritis; symptomatic forefoot deformity; first metatarsophalangeal joint fusion and second to fifth metatarsal head resection; and a minimum of 4 years of follow-up data available. The patients were evaluated using the Disease Activity Score 28 for rheumatoid arthritis, Health Assessment Questionnaire for Rheumatoid Arthritis, Foot Function Index, forefoot American Orthopaedic Foot and Ankle Society scale, and weightbearing radiographs. Different pre-, intra-, and postoperative variables were investigated to identify the prognostic factors. Sixty-two patients (89 feet) with a mean age of 60.8°± 9.4 years and 85.5°± 22.4 months of follow-up data were included. The preoperative American Orthopaedic Foot and Ankle Society scale score was 33.4 ± 16 points and improved significantly (p < .001) after surgery (mean 82.9 ± 11.7 points). The mean Foot Function Index improved significantly (p < .001) from 131.6 ± 37.4 to 77.4 ± 46.3 points at the last follow-up visit. Only the revision surgery variable was significantly (p = .02) related to poor outcomes. Revision was necessary in 8 feet (9%). This procedure produced satisfactory results. Poor outcomes were significantly related to the necessity for revision surgery for nonunion, malunion, inadequate metatarsal resection, and painful hardware.
authors.affiliation: Orthopedics Surgeon, First Department of Orthopaedics and Traumatology, University of Torino, CTO Hospital, Torino, Italy.
authors.forename: Pierfranco
authors.initials: P
authors.lastname: Triolo
authors.affiliation: Professor of Orthopedic Surgery, Department of Orthopaedics and Traumatology, University of Torino, AO Ordine Mauriziano Hospital, Torino, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Rosso
authors.affiliation: Orthopedic Surgeon, Department of Orthopaedics and Traumatology, University of Torino, AO Ordine Mauriziano Hospital, Torino, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rossi
authors.affiliation: Orthopedics Surgeon, First Department of Orthopaedics and Traumatology, University of Torino, CTO Hospital, Torino, Italy.
authors.forename: Raul
authors.initials: R
authors.lastname: Cerlon
authors.affiliation: Orthopedic Surgeon, Department of Orthopaedics and Traumatology, University of Torino, AO Ordine Mauriziano Hospital, Torino, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Cottino
authors.affiliation: Orthopedic Surgeon, Department of Orthopaedics and Traumatology, University of Torino, AO Ordine Mauriziano Hospital, Torino, Italy. Electronic address: davidebonasia@virgilio.it.
authors.forename: Davide Edoardo
authors.initials: DE
authors.lastname: Bonasia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000601:surgery*; D001174:Arthrodesis; D005260:Female; D005500:Follow-Up Studies; D005531:Foot Deformities, Acquired / Q000000981:diagnostic imaging / Q000601:surgery*; D005545:Forefoot, Human / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012086:Reoperation; D012720:Severity of Illness Index
keywords: fusion; metatarsal head resection; reconstruction; rheumatoid arthritis; rheumatoid forefoot deformity