Abstract
A retrospective study of 34 feet from 20 consecutive patients with rheumatoid arthritis was performed to investigate the development of damage to the hallux over 5 years after forefoot resection arthroplasty. Radiographically we analysed changes in two valgus angles and the interphalangeal joint (IP) damage of the hallux. These parameters were measured preoperatively, 12 months postoperatively, and at the latest follow-up. Although the average HVA (between the first metatarsal and the proximal phalanx) significantly decreased from 38.7° preoperatively to 8.66° postoperatively, the angle increased to 23.0° during the first 12 months following surgery. Further deterioration of the angle at the last follow-up was not detected (25.3°; P=0.252). The average IPV (between the proximal phalanx and the distal phalanx) angle significantly increased from 6.65° preoperatively to 12.1° 12 months postoperatively and thereafter slightly increased to 13.3° at the latest follow-up. The average of the Sharp/van der Heijde score of the IP joint significantly increased from 5.71 preoperatively to 8.58 12 months postoperatively and thereafter slightly increased to 9.65 at the latest follow-up. The deterioration and destruction process of the hallux after resection arthroplasty occurred soon after surgery, and the progression of the deformity was temporary.
Résumé
L’étude rétrospective a porté sur 34 pieds chez 20 patients consécutifs présentant une arthrite rhumatoïde de façon à étudier l’évolution de la déformation du gros orteil, 5 ans après une résection arthroplastique de l’avant pied. Nous avons analysé de façon clinique et radiographique les angles des articulations du gros orteil. Ces paramètres ont été mesurés en préopératoire et en post-opératoire après 12 mois de suivi. L’angle métatarso phalangien était significativement amélioré passant de 38.7 en préopératoire à 8.66 en post-opératoire avec une amélioration de 23° durant les 12 mois suivant l’intervention chirurgicale. Il n’y a pas eu d’aggravation de cet angle au plus long recul. La moyenne de l’angle inter phalangien a été significativement augmenté de 6.65 en préopératoire à 12.1 en postopératoire. Le score moyen de Sharp et Van Der Heijde relatif à l’inter phalangienne a été significativement augmenté passant de 5.71 en préopératoire à 8.58 en post-opératoire. La destruction de l’articulation du gros orteil après résection arthroplastique survient précocement après la chirurgie et la progression de la déformation est très temporaire.
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Hattori, H., Mibe, J., Nohara, A. et al. Course of damage to the hallux over 5 years after forefoot resection arthroplasty in rheumatoid arthritis patients. International Orthopaedics (SICO 31, 477–481 (2007). https://doi.org/10.1007/s00264-006-0221-9
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DOI: https://doi.org/10.1007/s00264-006-0221-9