ＲＡ前足部変形に対する切除関節形成術の治療成績―５年以上の経過観察例―

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  • Resection Arthroplasty for Rheumatoid Forefoot Deformity-A 5-year Follow-up Study-

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The results of resection arthroplasty for forefoot deformity with rheumatoid arthritis (RA) in 22 feet of 14 patients, after follow-up of more than 5 years, were evaluated clinically and radiologically. Recurrence of callosities or toe deformities had occurred in 31.8% of feet. These complications were associated with the lack of length of the resected lesser metatarsal heads, especially the second. This study analyzed radiographic changes of the hallux valgus angle (HVA) and two intermetatarsal angles, one between the first and second (M1M2) and the other between the first and fifth (M1M5) . They were measured before the surgery, 3 weeks and 6 months after the surgery, and at the last follow-up at more than 5 years. The average HVA significantly decreased from 40.6° preoperatively to 9.41° postoperatively and increased again to 21.1° at 6 months after surgery. However, no deterioration of HVA was detected from 6 months after the surgery to the last follow-up at more than 5 years. The average M1M2 and M1M5 angles also decreased significantly postoperatively (from 13.1° to 11.5° and from 34.3° to 28.4°, respectively), and increased again at 6 months after the surgery (13.2° and 32.1°, respectively) . Again no deterioration of M1M2 and M1M5 angles was detected from 6 months after the surgery to the last follow-up at more than 5 years. In the present study, forefoot resection arthroplasty was a stable procedure for the patient with RA in the long term. The authors have recognized problems with recur-rence of callosities or toe deformities associated with poor alignment and length of the resected lesser metatarsal heads, and especially resection of the first and second metatarsal heads should be done with skepticism and caution.

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