NATIONAL HARBOR, Md. (EGMN) –Joint-sparing surgical techniques can reduce pain, increase function, and improve the appearance of lesser metatarsophalangeal joint deformities in patients with severe rheumatoid arthritis, a small retrospective study has shown.
In a survey of 11 patients with RA undergoing joint-sparing surgery, 83% reported improved callosities and shoe wear. Half of them reported improved cosmesis, and almost all said they had less pain at rest and less weight-bearing pain after the surgery, Brockford D. Herring, D.O., said at the annual meeting of the American Orthopaedic Foot and Ankle Society.
The researchers retrospectively studied preoperative x-rays for dislocations and postoperative x-rays for recurrent dislocations from forefoot RA cases. They identified 11 patients with 30 lesser toe reconstructions and 10 metatarsal shortenings with an average follow-up of 4.7 years.
Among these patients, 60% of lesser toes were dislocated on preoperative x-ray and 30% were re-dislocated on postoperative x-ray. The fourth and fifth toes accounted for two-thirds of re-dislocations. Of the 10 metatarsal shortenings, only one was re-dislocated on postoperative x-ray.
The joint-sparing procedure involves metatarsophalangeal capsule release, extensor digitorum longus to extensor digitorum brevis tendon transfer, proximal phalangeal head resection, flexor digitorum longus to extensor tendon transfer through a drill hole in the proximal phalanx, and metatarsal shortening (on occasion).
Two-thirds of patients said their results were excellent, but no one reported changes in gait stability. All patients said that they would recommend the procedure to individuals with RA.
As the disease progresses, these techniques maintain bone stock for later salvage procedures, said Dr. Herring, an orthopedic surgeon in Sarasota, Fla.