Mid-term results of arthrodesis of the 1st metatarsophalangeal joint and resection of the heads of the small metatarsals in comparison with joint-preserving surgery on the forefoot in patients with rheumatoid arthritis and osteoarthritis

The aim of the study – to compare the mid-term results of joint-preserving surgery on the forefoot and arthrodesis of the 1st metatarsophalangeal joint in combination with resection of the heads of the small metatarsals in patients with rheumatoid arthritis (RA) and osteoarthritis (OA).

Materials and methods. The patients were divided into 2 groups depending on the diagnosis. The main group included 143 patients with rheumatoid arthritis, and the control group included 57 patients with osteoarthritis. Arthrodesis of the 1st metatarsophalangeal joint with resection of the small ray heads and joint-preserving surgery were performed in both groups. To evaluate the results, changes in pain intensity on a visual analog scale, the functional status of the foot on the AOFAS (American Orthopaedic Foot and Ankle Society) scale (for 1st and 2–5th toes) before surgery, 3 months, 1 year, and 3 years after surgery, as well as disease activity (in the case of patients with rheumatoid arthritis) were studied.

Results. In group 1 (RA), 3 years after surgery, there was a decrease in pain intensity according to VAS in 134 (93.71%) patients <40 mm, in 6 (4.2%) – from 41 to 70 mm, and in 3 (2.1%) ≥71 mm; on the AOFAS scale (for 1st and 2–5th toes), the results were as follows: excellent – 33 (23.08%) and 40 (27.97%) , good – 88 (61.54%) and 84 (58.74%), satisfactory – 20 (13.99%) and 16 (11.19%), unsatisfactory – 2 (1.4%) and 2 (1.4%), respectively. In group 2 (OA), 3 years after surgery, VAS pain intensity decreased in 56 (98.25%) patients <40 mm and in 1 (1.75%) – from 41 to 70 mm; on the AOFAS scale (for 1st and 2–5th toes): excellent – 19 (33.33%) and 21 (36.84%), good – 37 (64.91%) and 34 (59.65%), satisfactory – 1 (1.75%) and 1 (1.75%), unsatisfactory – 2 (1.4%) and 1 (1.75%), respectively. At the same time, the average value of DAS28 (Disease Activity Score 28) disease activity in patients with unsatisfactory results was 3.98±0.6 points.

Conclusions. Joint-preserving surgery in the group of patients with rheumatoid arthritis and osteoarthritis improve the functional status of the foot and reduce the intensity of pain in the medium-term postoperative period. Given the absence of statistically significant differences with the results after arthrodesis of the 1st metatarsophalangeal joint and resection of the small ray heads, these surgical techniques are recommended for patients with rheumatoid arthritis with an inflammatory activity level of the disease <3.98 according to DAS28.

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