ARTHRODESIS OF THE FIRST METATARSOPHALANGEAL JOINT IN PATIENTS WITH RHEUMATOID ARTHRITIS AND HALLUX VALGUS: CHOICE OF TECHNIQUE OF ARTHRODESIS FIXATION, COMPLICATIONS AND LONG-TERM RESULTS

Objective: to study results of arthrodesis of the first metatarsophalangeal joint (I MPT joint) in patients with rheumatoid
arthritis (RA) and hallux valgus, assess methods of arthrodesis fixation, reveal complications and analyze longterm results.

Subjects and methods. Authors observed 86 patients with RA, female : male ratio 3.2:1, mean age was 53.8±9.5 years (from 18 to 75 years); 80 from them had seropositive and 6 – seronegative RA. 72 patients had low, and 14 –moderate activity of the disease. II stage of RA was revealed in 31.4%, III – in 62.8%, IV – in 5.8%; 52.3% of  patients had I and 47.7% – II functional class. All patients  ad hallux valgus as a component of typical deformation of the forefoot – digitis V rheumaticus (DVR). Standard global reconstructive operation (SGRO) and its modification (MGRO) were used. Both techniques included arthrodesis of the I MTP joint where fusion of bones was fixed with Kirschner wire and compression clamps in groups A and B respectively. Results of surgical treatment
were assessed separately for I and II–V toes. The present work provides solely the results of the I MTP joint arthrodesis.

Results. Assessment of the I MTP joint with hallux valgus before and 2.3±1.5 years after operation based on AOFAS comprised 35.51±8.16/82.32±6.09 in the group A and 39.93±6.65/82.26±5,59 in the group B. Inefficiency of arthrodesis of the I MTP joint was observed in 3 patients from the group B (2.15%). Before operation, 3 from 141 feet had hallux valgus of the II stage (21–40°); III (41–60°) and IV (>60°) stages of hallux valgus were recorded in 90 and
48 feet respectively. Following 2.3 years after arthrodesis normal I MTP joints (10–11°) were observed in 131 feet whereas, that of the II stage of hallux valgus (12–20°) – in 10 feet.

Conclusion. High efficacy of arthrodesis of the I MTP joint in patients with RA and hallux valgus and, subsequently, low failure rate (2.15%) were achieved as a result of appropriate techniques of arthrodesis fixation. Positive long-term results (according to AOFAS questionnaire) in 2.3 years after the operation were recorded in 97.8% of cases.

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