The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis

Ra, Fuhrmann; Jo, Anders

doi:10.1007/s002640100264

Cited by 41 publications

(28 citation statements)

References 23 publications

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“…Other types of resection arthroplasty have also been described focusing on the 1st MTPJ by Hueter [38], Mayo [39], and Keller [40]. Resection arthroplasty was first popularized for the management of RA in 1963 by Clayton [41]. In 2001, Fuhrmnn et al presented their retrospective series on the results of resection arthroplasty of the 1st MTPJ in RA patients [42].…”

Section: Surgical Managementmentioning

confidence: 99%

The rheumatoid forefoot

Brooks

Hariharan

2013

Curr Rev Musculoskelet Med

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Rheumatoid arthritis (RA) manifests itself in a variety of ways, with its effect being seen in around 90 % of sufferers' feet. The foot has been found to be the most common reason for incapacity in patients with RA, with the forefoot the most common area. The foot is second, behind only the hand, as the most common place for manifestation of RA. Pain in the foot is commonly the most debilitating condition, which causes the patient to seek specialist help. As well as pain, foot deformities such as hallux valgus and claw toes are common complaints. These symptoms often arise as a result of continued walking on an unstable foot, leading to painful callosities and dislocation of the metatarsophalangeal joints. Other conditions, such as pannus formation and Morton's neuroma, can be related to RA. This review sets out what we believe to be a successful approach to the rheumatoid forefoot, which aims at the relief of pain and the preservation of ambulation. Key to a successful outcome is appropriate medical control with a multidisciplinary approach that enables close liaison between orthopaedic surgeons, orthotists, and rheumatologists. Combined clinics provide this multidisciplinary care. Those treating RA need to be aware of the high incidence of foot involvement and how early intervention may benefit the patient. The aim of this article is to present current evidence to enable people to develop a treatment algorithm for this condition.

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Section: Surgical Managementmentioning

confidence: 99%

The rheumatoid forefoot

Brooks

Hariharan

2013

Curr Rev Musculoskelet Med

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“…Walking ability was reduced in only 1 study (35) and not improved in another (37). Improvements in walking ability ranged from 67% to 80% in the remaining 4 studies (36,40).…”

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confidence: 99%

“…Overall outcome varied from excellent or good in 60 -85% (32,34), good in 75% (38), good or satisfactory in 88% (39), and fair or good in 93% (41) of cases. Satisfaction with the operative procedure varied between 25% and 67% (36,37,43). Pain relief ranged from 33% to 100% (35,37,(41)(42)(43).…”

mentioning

confidence: 99%

“…Satisfaction with the operative procedure varied between 25% and 67% (36,37,43). Pain relief ranged from 33% to 100% (35,37,(41)(42)(43).…”

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confidence: 99%

“…There were 12 retrospective observational surgical studies (Table 4) involving Ͼ50 patients, the number required by our inclusion criteria; all of these studies evaluated forefoot arthroplasties. The studies could be divided into 2 groups: in 1 group of 6 studies, surgery invariably involved the great toe (32)(33)(34)(35)(36)(37); in the other group of 6 studies, not all patients had surgery to the great toe (38 -43). Of the 6 studies that always involved the great toe, 3 studies evaluated identical great toe procedures and 3 evaluated different great toe interventions.…”

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confidence: 99%

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Interventions for foot disease in rheumatoid arthritis: A systematic review

2005

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Objective. To systematically review medical and surgical foot intervention studies in rheumatoid arthritis (RA), focusing on clinical efficacy, study quality, and risk of harm. Methods. We searched appropriate databases using a combination of the terms "rheumatoid arthritis" and "foot" against terms indicating treatment; we also hand-searched references. We selected articles in English (1968 -2003) comprising randomized controlled trials (RCTs), controlled clinical trials (CCTs), prospective observational studies, and large retrospective observational surgical studies (>50 cases). RCT quality was examined using Jadad scoring; other designs were assessed qualitatively. Results. Inclusion criteria were met by 33 of 894 identified studies, comprising 5 RCTs and 1 CCT (all nonsurgical), 15 prospective observational studies (8 nonsurgical, 7 surgical), and 12 large retrospective studies (all surgical). Functional, custom-designed and semirigid orthoses and extra-depth shoes were effective in single RCTs of variable quality; no comparative studies have been conducted. This finding was supported by a CCT and prospective observational studies. There was no evidence of harm. There were no controlled trials of surgery. Prospective observational studies suggest that forefoot arthroplasty and first metatarsophalangeal joint implants, but not plantar callous debridement, are effective. Comparative retrospective analyses suggest that some procedure variants may be better, and surgery may relieve pain better than orthoses. Infection was the main risk. Conclusion. RCT evidence shows that orthoses and special shoes are likely to be beneficial in patients with RA. The only evidence of benefit from surgery comes from observational studies, because no RCTs have been conducted. Further RCT evidence is needed, although well-designed observational studies may be helpful.

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