First ray resection arthroplasty versus arthrodesis in the treatment of the rheumatoid foot.

Abstract

Different options exist for the operative treatment of forefoot problems and deformities in rheumatoid arthritis (RA). The current study compared first ray and resection arthroplasty with respect to patient satisfaction, clinical and functional outcome. In a retrospective study 53 RA patients were investigated with a minimum followup of 2 years after corrective forefoot surgery. Two patient groups were distinguished: One group had been treated with arthrodesis of the first metatarsophalangeal (MTP) joint whereas the other group had been treated with a first ray resection arthroplasty. Both groups underwent resection arthroplasty at the lesser metatarsal heads. Our arthrodesis patients were significantly younger than patients with resection arthroplasty. Five patients had been treated bilaterally so that the results of 58 feet were analyzed. Patient satisfaction was lower in the arthrodesis group as compared to the resection arthroplasty patients. However, the arthrodesis patients revealed better functional results and showed a push-off from the hallux. No significant radiographic difference was seen in the mean hallux valgus angles. Younger patients revealed a higher disease activity and a worse general health status than older patients. Pedobarographic results demonstrated significant differences in selected foot regions, predominantly in the hallux. Peak pressures were significantly higher in the lateral midfoot and the hallux after arthrodesis as compared to the resection arthroplasty group. Patients with arthrodesis revealed better foot function during the dynamic roll-over process even though the resection arthroplasty patients were subjectively more satisfied.