Outcomes of Joint-Preserving Surgery for Forefoot Deformities in Patients With Rheumatoid Arthritis

Area of Science:

• Orthopedic Surgery
• Rheumatology
• Foot and Ankle Surgery

Background:

• Rheumatoid arthritis (RA) treatment has shifted towards joint-preserving surgery for forefoot deformities.
• The efficacy of joint-preserving surgery across the spectrum of metatarsophalangeal joint involvement in RA remains under investigation.

Purpose of the Study:

• To evaluate the postoperative outcomes of joint-preserving surgery for rheumatoid forefoot deformities.
• To assess the effectiveness of these procedures in patients with varying degrees of joint destruction.

Main Methods:

• Retrospective observational study of 68 feet from 68 RA patients undergoing joint-preserving surgery (2014-2020).
• Patients classified into four groups based on Larsen grade of first metatarsophalangeal joint destruction.
• Clinical (SAFE-Q scores) and radiographic (HVA, IMA) outcomes assessed pre- and post-surgery.

Main Results:

• Significant improvements in SAFE-Q scores across all subscales were noted in all patient groups.
• Radiographic assessment showed significant improvements in hallux valgus angle (HVA) and intermetatarsal angle (IMA) post-surgery.
• No significant differences in clinical or radiographic improvements were observed among the different severity groups.

Conclusions:

• Joint-preserving surgery provides satisfactory clinical and radiographic outcomes for rheumatoid forefoot deformities.
• The effectiveness of these surgical approaches is consistent, irrespective of the extent of joint destruction in rheumatoid arthritis patients.