前足部免荷装具を併用したリウマチ性前足部矯正術の短中期成績

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  • Middle-term Result of Arthroplasty for Rheumatoid Forefoot Deformities with Non-weight-bearing Orthosis
  • ゼンソクブ メンカ ソウグ オ ヘイヨウシタ リウマチセイ ゼンソクブ キョウセイジュツ ノ タンチュウキ セイセキ

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Objective: It is well known that rheumatoid patients often suffered severe joint destruction of forefoot. We reported middle-term result of forefoot arthroplasty in rheumatoid patients, who were able to stand and walk soon after surgery with non-weight bearing orthosis of forefoot to prevent disuse atrophy.<BR>Methods : Eighteen feet of 12 patients were operated. Eleven patients were suffered from rheumatoid arthritis (RA), and one was due to systemic lupus erythematosus. Eleven were women and one was man. Mean age at surgery was 68 years (49-79) . Mean duration of affected disease was 195 months (48-360), and follow-up period was 18 months (12-79) . Modified Mitchell method was applied for 6 toes, modified Mann method for 9 toes, resection arthroplasty of metatarsophalangeal (MTP) joint for two and arthrodesis of MTP joint for one, respectively. For lesser toes, metatarsal bone offset osteotomy with preservation MTP joint was applied for 4 feet, and resection arthroplasty of MTP joint for 14 feet. We surveyed radiographic measurements during follow-up.<BR>Results : The patients were able to walk one or two days after surgery with non-weight bearing orthosis of forefoot. After 3 weeks, the patients were allowed to walk by full weight bearing with arch support. No patients showed disuse muscle and bone atrophy. Japanese society for surgery of the foot RA foot ankle scale was improved from 43.3 (21-68) to 65.3 (42-91) in average. Mean hallux valgus angle was improved from 38.8 (21-54) degree to 20.4 (12-48) degree, M1M2 angle to 9.2 (3-16) from 14.2 (10-20), and M1M5 to 25.5 (18-33) from 31.0 (20-37), respectively. However, the correction of hallux valgus angle decreased at latest follow-up compared to that at post-surgery. Recurrence of deformity was formed in four cases of modified Mitchell method, two of modified Mann method, and one of arthrodesis at latest follow-up, though they have few complains clinically.<BR>Conclusion : The forefoot arthroplasty in RA patients with non-weight bearing orthosis of forefoot was useful to prevent disuse atrophy, because they were able to stand and walk soon after surgery. It is necessary to improve this method to prevent recurrence of deformity even though the patients do not seem to have significant clinical problems.

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