Foot & Ankle Orthopaedics最新文献

{"title":"Minimally Invasive Cartilage Resection of the Subtalar Joint: An Anatomical Study.","authors":"Sebastian Schilde, Dariusch Arbab, Maria Felsberg, Heike Kielstein, Karl-Stefan Delank, Natalia Gutteck","doi":"10.1177/24730114251315666","DOIUrl":"10.1177/24730114251315666","url":null,"abstract":"<p><strong>Background: </strong>Subtalar arthrodesis is a commonly performed procedure for the treatment of posttraumatic or primary osteoarthritis and several hindfoot deformities. The primary objective of this study is to evaluate the efficacy and safety of a minimally invasive technique for cartilage removal of the subtalar joint using a modified sinus tarsi approach.</p><p><strong>Methods: </strong>An anatomical study was performed on 8 pairs of fresh frozen cadaveric feet. A modified 2.5-cm sinus tarsi approach was used to access the subtalar joint. Cartilage removal was performed in 2 groups using either a 13-mm Shannon burr (GB) or a curette (GC) with subsequent systematic dissection. Standardized scaled photographs of the resected articular surfaces were analyzed in ImageJ software to quantify cartilage removal. Nearby vulnerable anatomical structures such as the intermediate and lateral dorsal cutaneous nerves, peroneal, tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons were assessed for injury.</p><p><strong>Results: </strong>The area of completely removed cartilage in GC was median 79.7% talar and 76.6% calcaneal. In GB, median 67.8% of the talar cartilage and 76.8% of the calcaneal cartilage was removed. The overall mean of cartilage resection was 73% (±7.7). There was no statistically significant difference between the groups. Anatomical structures at risk were not inadvertently injured.</p><p><strong>Conclusion: </strong>Subtalar cartilage resection can be performed safely using a minimally invasive modified sinus tarsi approach and either a Shannon burr or curettes. The amount of cartilage resection is less than that reported in the literature for open cartilage resection, but may be beneficial in select patient populations at increased risk for wound healing compromise and infection.</p><p><strong>Level of evidence: </strong>Level III, comparative cadaver study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251315666"},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications and Early-Term Radiographic Analysis of a Novel Active Compression Tibiotalocalcaneal Arthrodesis Nail With a Proximal Flexible Coil.","authors":"Albert T Anastasio, Kevin A Wu, Emily J Luo, Cesar De Cesar Netto, Mark E Easley","doi":"10.1177/24730114251323895","DOIUrl":"10.1177/24730114251323895","url":null,"abstract":"<p><strong>Background: </strong>Tibiotalocalcaneal (TTC) arthrodesis is used among other methods as a salvage procedure for complex foot/ankle deformity. Fixation is usually achieved through plate/screw constructs or intramedullary (IM) nailing. Although IM nailing uses smaller incisions, fusion rates are variable and complications rates ranging from 25% to 55.7% have been reported. The Phantom ActivCore (AC) nail could serve as a viable alternative to traditional IM nailing by allowing for increased compression capacity and a potentially lower risk of stress fracture. However, no studies have described the early outcomes of TTC arthrodesis using the AC nail. The primary objective of this study was to determine the rates of early-term complications and radiographic union of the AC nail.</p><p><strong>Methods: </strong>Inclusion criteria consisted of patients who had undergone a tibiocalcaneal or TTC arthrodesis using the Phantom Hindfoot TTC Nail System with at least 6 months of follow-up. Radiographic analysis evaluated for successful union and flexibility of the flex coil. Patients were monitored for postoperative complications and additional secondary procedures.</p><p><strong>Results: </strong>Twenty-one patients were included and had an average follow-up of 9.4 ±4.7 months (range, 4.3-19 months). No intraoperative complications were reported. Seven patients experienced at least 1 adverse event, which included device migration, asymptomatic nonunion, symptomatic nonunion, bone stress reaction, device prominence, and screw breakage. There were no events of perioperative fractures or device breakage. Two patients required secondary surgical interventions. The 5 remaining patients were managed conservatively. An average nail coil flexion angle of 2.6 ± 3.1 degrees and 0.8 ± 1.59 degrees was found on lateral and anteroposterior radiographs, respectively. The overall union rate at a mean follow-up of 9.4 months was 90.4% (95% CI 69.6%, 98.8%).</p><p><strong>Conclusion: </strong>TTC arthrodesis via the AC nail demonstrated similar union rates and outcomes at short-term follow-up compared with rates generally reported in the literature for other IM nail constructs. The AC nail was able to function as designed and allow for motion at the proximal bone-implant interface.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251323895"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Hallux Valgus Surgical Planning Survey Using WBCT-based 3D Printing.","authors":"François Lintz, Enrico Pozzessere, Wolfram Grün, Antoine Acker, Erik Jesús Huánuco Casas, Eric Ferkel, Cesar de Cesar Netto","doi":"10.1177/24730114251325854","DOIUrl":"10.1177/24730114251325854","url":null,"abstract":"<p><strong>Background: </strong>Recent literature highlights the importance of treating hallux valgus (HV) as a 3-dimensional (3D) deformity. Although 3D printing may enhance visualization of the multiplanar aspects of HV, its influence on surgical planning remains unclear. This study assessed changes in surgical plans when surgeons sequentially reviewed 2D radiographs, 3D weightbearing computed tomography (WBCT), and 3D-printed models, hypothesizing that 3D printing would have the greatest impact.</p><p><strong>Methods: </strong>A single HV case (a 40-year-old woman, intermetatarsal angle [IMA] 21 degrees, HV angle [HVA] 47 degrees) was evaluated by 30 surgeons in a masked, stepwise manner. Surgical plans were recorded at each stage. Surgeons rated the influence of WBCT and 3D printing using a 5-point Likert scale. A follow-up survey examined the effect of these technologies on correction amplitudes.</p><p><strong>Results: </strong>The participants were mostly early career surgeons (median age 35.5 years, 2 years in practice). WBCT was accessible to 43.3% and used in 30% of HV cases, whereas 3D printing was accessible to 23.3% and used in 6.6%. Changes in the treatment algorithm occurred in 30% of cases after WBCT and in 43.3% after 3D printing. Significant differences (<i>P</i> < .05) were observed for the Lapicotton procedure between radiography and WBCT, and between WBCT and 3D printing. Surgeons performing <50 HV cases annually or with >70% Foot and Ankle specialization were more influenced by WBCT. Follow-up data (n = 23) indicated that WBCT and 3D printing influenced correction amplitudes, particularly for pronation and distal metatarsal articular angle (DMAA), more than for the IMA.</p><p><strong>Discussion: </strong>Both WBCT and 3D printing influenced surgical planning, mostly explained by changes in first ray tarsometatarsal procedures. The rotational components (pronation and DMAA) were perceived as the most significantly affected. Future studies should explore cost-effectiveness, patient outcomes, and the utility of combining WBCT and 3D printing in other deformities requiring multiplanar corrections.<b>Level of Evidence:</b> Level IV, cross-sectional survey.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251325854"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors and Complications in Tibiotalocalcaneal (TTC) Arthrodesis: A Nationwide Database Comparison Between Traumatic Ankle Fracture and Osteoarthritis.","authors":"Abhiram Dawar, Gnaneswar Chundi, David B Ahn, Avani A Chopra, Jonathan Lopez, Matthew Montani, Sheldon S Lin, Tuckerman Jones","doi":"10.1177/24730114251325851","DOIUrl":"10.1177/24730114251325851","url":null,"abstract":"<p><strong>Background: </strong>Tibiotalocalcaneal (TTC) arthrodesis is an established treatment for osteoarthritis (OA), offering stabilization and earlier weightbearing. However, its role in managing traumatic fractures (TFs) remains controversial because of higher risks of complications. This study aimed to compare complication rates, readmissions, and predictors of adverse outcomes in TTC arthrodesis performed for OA vs TF using a national database.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the Nationwide Readmissions Database (2016-2021). Patients undergoing TTC arthrodesis were identified via <i>International Classification of Diseases, Tenth Revision</i> (<i>ICD-10</i>) codes and stratified by indication (OA or TF). Primary outcomes included complication rates, 30- and 90-day readmissions, and revision surgeries. Multivariable logistic regression identified independent predictors of complications. Propensity score matching (PSM) was performed to account for baseline differences.</p><p><strong>Results: </strong>TF cases exhibited significantly higher complication rates (54.5% vs 16.0%, <i>P</i> < .001), including malunion (11% vs 2%, <i>P</i> < .001) and cellulitis (5% vs 1%, <i>P</i> < .001). Readmission rates were also elevated in TF patients at 30 days (17% vs 3%, <i>P</i> < .001) and 31-90 days (14% vs 4.8%, <i>P</i> < .001). Logistic regression identified chronic kidney disease, diabetes, and obesity as independent predictors of complications. PSM confirmed these findings, demonstrating significantly higher rates of complications and readmissions in TF patients.</p><p><strong>Discussion: </strong>Findings indicate that TTC arthrodesis for TF is associated with higher risks of complications and readmissions compared with OA, attributable to acute injury characteristics and surgical complexity. Chronic comorbidities further exacerbate these risks. Optimizing perioperative management and timing of surgery in TF patients may mitigate complications. This study highlights the need for individualized care strategies to improve outcomes in TTC arthrodesis for trauma.</p><p><strong>Level of evidence: </strong>Level III, therapeutic: case-control study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251325851"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"President and Program Chairs' Introduction.","authors":"David B Thordarson, Samuel B Adams, Tonya L Dixon","doi":"10.1177/24730114251322570","DOIUrl":"https://doi.org/10.1177/24730114251322570","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251322570"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Timing of Hindfoot Reconstruction Before or After Primary Total Knee Arthroplasty Impact Reoperation Rates?","authors":"Nicolas M Dohse, Joseph A Larwa, Alex M Moses, Cole Herbel, Ramiro Lopez, Cameron K Ledford, Edward T Haupt","doi":"10.1177/24730114251318735","DOIUrl":"10.1177/24730114251318735","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) and hindfoot reconstruction (HFR) are often used to treat osteoarthritis and deformities of the knee and hindfoot. Despite the proven clinical effectiveness of these treatments, postoperative patient dissatisfaction is high. The knee and ankle are adjacent joints in the lower extremity, and angular deformity of either joint is known to affect positioning of the anatomical and mechanical axes of the entire limb. Although it is understood this relationship exists, there are limited studies evaluating outcomes of ipsilateral procedures on patients with pathologies of both knee and hindfoot. This article aims to evaluate whether TKA or TAA/HFR sequencing influences postoperative outcome. The study hypothesis is that TKA prior to TAA/HFR results in lower reoperation.</p><p><strong>Methods: </strong>A retrospective chart review using <i>Current Procedural Terminology</i> (<i>CPT</i>) codes was performed encompassing all patients who underwent TKA in conjunction with a variety of hindfoot procedures. All procedures were performed at a single academic medical site between 2000 and 2022. Exclusion criteria included those patients not having both ipsilateral TKA and hindfoot procedures or those lacking conclusive postoperative data. The primary outcome of this study was to identify significant reoperations such as adjacent joint arthrodeses, hardware removal, or unrelated ipsilateral limb surgery. Secondary outcomes included identification of revision procedures including revision TKA or revision HFR and other postoperative complication data.</p><p><strong>Results: </strong>This study included 158 patients, with 79 patients in each group. In the TKA-first group, the mean follow-up time was 10.24 years (range, 1.10-22.42 years) and the mean time to HFR was 5.94 years. In the HFR-first group, the mean follow-up time was 9.01 years (range, 1.01-23.55 years) and the mean time to TKA was 5.51 years.In patients who underwent TKA first, the mean reoperation rate was not significantly different from those who underwent HFR/TAA first, 30.4% vs 19.0% (<i>P</i> = .12). In patients who underwent TKA first, the rate of HFR reoperations (22.78%) was greater than TKA reoperations (7.59%) (<i>P</i> < .01). The revision rate was higher in the TKA-first group (17.7%) when compared to the HFR-first group (6.3%) (<i>P</i> = .03). Additionally, there were more revision HFR procedures in the TKA-first group (9/79) compared with the HFR-first group (1/79) (<i>P</i> <i>=</i> .009).</p><p><strong>Conclusion: </strong>In contrast to the study hypothesis that TKA first would result in less reoperation, our study found that TAA or HFR performed before TKA had an overall lower complication rate. However, these findings should be interpreted cautiously as the sample size was limited.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251318735"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2B or not 2B, should this not be the question? Comparison of 3D Surface Rendering CT to Plain Radiographs for Characterization of Posterior Malleolar Fracture Morphology.","authors":"Laura-Ann Lambert, Howard Stringer, Lizzy Weigelt, Lois Duncan, Jake Cowen, Lyndon Mason","doi":"10.1177/24730114241311879","DOIUrl":"https://doi.org/10.1177/24730114241311879","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to compare plain lateral radiographs and 3D surface rendering (SR) CT imaging, in the characterization of posterior malleolar fracture (PMF) morphology using the Mason and Molloy classification. The null hypothesis was that there was no difference in characterization of morphology between plain radiographs and 3D SR CT.</p><p><strong>Methods: </strong>Morphology of the PMF was categorized initially by the CT scan as classified by Mason and Molloy on 180 trimalleolar ankle fractures. PM fracture fragment size on the lateral radiograph were compared to their respective 3D surface rendering CT reconstructions, by two independent observers. Morphology of the PMF was assessed using all preoperative radiographs as compared to 3D SR CT.</p><p><strong>Results: </strong>On comparison of fracture fragment morphology, all fractures had poor categorization by plain radiographs although rotational pilon fractures (type 2A and 2B fractures) had the worse sensitivity and specificity (below 33% and below 50%, respectively). Radiographs underestimated joint involvement in type 2B fracture patterns because of the underappreciation of the posteromedial fragment.</p><p><strong>Conclusion: </strong>This study shows that the use of plain radiographs to categorize morphology of PMFs is poor. The study adds to the ever-growing body of evidence on the inaccuracy of using plain radiographs in PMFs to plan treatment. Additional CT imaging is imperative to allow for appropriate treatment planning in the management of PMF. Smaller fracture fragments are more susceptible to inaccuracies, especially the rotational pilon subtypes (2A and 2B) because of the obliquity of the posteromedial fragment to the plane of the X-ray source.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114241311879"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severity of Achilles Tendinopathy on Preoperative MRI and Short-term Functional Outcomes After Minimally Invasive Zadek Osteotomy.","authors":"SarahRose Hall, Thomas Lewis, Jonathan R M Kaplan, Oliver N Schipper, Ettore Vulcano, A Holly Johnson, Peter Lam, J Benjamin Jackson, Tyler Gonzalez","doi":"10.1177/24730114251322775","DOIUrl":"10.1177/24730114251322775","url":null,"abstract":"<p><strong>Background: </strong>Limited literature is available to guide surgeons on which patients with insertional Achilles tendinopathy (IAT) may be the best candidates for minimally invasive dorsal closing wedge calcaneal Zadek osteotomy (MIS ZO). We hypothesized that the severity of IAT on preoperative magnetic resonance image (MRI) may correlate with post-operative functional outcomes and help guide patient selection for treatment with MIS ZO.</p><p><strong>Methods: </strong>Patients who underwent MIS ZO for IAT ± Haglund deformity were identified and retrospectively analyzed. IAT severity was graded on preoperative MRI. Patient Reported Outcome Measurement Information System (PROMIS) scores, complications, and revisions were recorded. Continuous data were compared by analysis of variance with Bonferroni post hoc analysis.</p><p><strong>Results: </strong>Seventeen patients treated with MIS ZO, with follow-up >6 months, and preoperative MRI met our inclusion criteria. PROMIS pain scores significantly improved in patients with IAT grades 1-3, with 5, 5, and 7 patients, respectively, in each subgroup. In this small series we only identified statistically significant improvements in PROMIS function (<i>P</i> = .031), and mobility (<i>P</i> = .009) scores were only observed in patients with grade 2 pathology. Sixteen of 17 patients (94.2%) were very satisfied with their procedure and would undergo it again.</p><p><strong>Conclusion: </strong>In this pilot study, we did not find preoperative MRI findings to correlate well with patient-reported outcome scores following MIS ZO.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251322775"},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weightbearing Computed Tomography Measurements in Progressive Collapsing Foot Deformity: A Contemporary Review.","authors":"Aly Maher Fayed, Matthew Jones, Kepler Alencar Mendes de Carvalho, Nacime Salomão Barbachan Mansur, Cesar de Cesar Netto","doi":"10.1177/24730114251316547","DOIUrl":"10.1177/24730114251316547","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251316547"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Metatarsophalangeal Joint-Preserving Surgery Is Effective for Forefoot Deformity With Moderate to Severe Joint Destruction in Rheumatoid Arthritis.","authors":"Soichiro Sakai, Toshifumi Fujiwara, Ryosuke Yamaguchi, Nobuhiko Yokoyama, Daisuke Hara, Yukio Akasaki, Yasuharu Nakashima","doi":"10.1177/24730114251322790","DOIUrl":"10.1177/24730114251322790","url":null,"abstract":"<p><strong>Background: </strong>The study compares the clinical outcomes of first metatarsophalangeal (MTP) joint fusion vs joint-preserving surgery in rheumatoid arthritis (RA) patients with severe forefoot deformities.</p><p><strong>Methods: </strong>This single-center retrospective study at Kyushu University Hospital reviewed RA patients who underwent either first MTP joint arthrodesis or joint-preserving surgery for hallux valgus (HV) deformity between January 2008 and December 2022. A total of 103 feet (73 cases) were analyzed, with 75 feet (58 cases) showing radiographic bone destruction of Larsen grade 3 or higher. One foot underwent resection arthroplasty, so ultimately 74 feet in 57 cases were evaluated. Surgical procedures included joint-preserving biplane osteotomy or arthrodesis with crossed screws. Clinical outcomes were measured using the Japanese Society for Surgery of the Foot (JSSF) Hallux scale, whereas radiographic assessments included HV angle (HVA). Propensity score matching was used to minimize bias when comparing postoperative outcomes between the arthrodesis and joint-preserving surgery groups.</p><p><strong>Results: </strong>This study analyzed 74 feet undergoing either arthrodesis (27 feet) or joint-preserving surgery (47 feet) for HV. Patients in the 2 groups showed similar demographic and clinical characteristics except with respect to length of follow-up, which was greater in the arthrodesis group (5.1 ± 2.6 years vs 2.4 ± 2.0 years, <i>P</i> < .01) than the joint-preserving group. In the arthrodesis group, all patients underwent resection arthroplasty on the second to fifth toes. The joint-preserving group included first MTP joint surgery alone (n = 5) and first MTP joint and lesser MTP joint surgeries (resection arthroplasty, n = 29; joint-preserving surgery, n = 13). Functional scores significantly improved in both groups, with first metatarsophalangeal joint-preserving surgery yielding better postoperative outcomes. In cases of deformity recurrence, the recurrent cases exhibited greater immediate postsurgical HVA, but other foot function outcomes remained similar at the end of follow-up.</p><p><strong>Conclusion: </strong>Joint-preserving surgery for advanced rheumatoid forefoot deformity showed better functional improvement than arthrodesis using the propensity score matching and comparable clinical outcomes, highlighting it as a potential treatment option for severe joint destruction.</p><p><strong>Level of evidence: </strong>Level Ⅳ, retrospective study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 1","pages":"24730114251322790"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}