AB0200 SHORT AND MID-TERM OUTCOME OF FOREFOOT SURGERY FOR PATIENTS WITH RHEUMATOID ARTHRITIS

Background:Patients with rheumatoid arthritis (RA) have frequently painful foot deformities. These deformities including hallux valgus, dorsal dislocation of the metatarsophalangeal (MTP) joints and hammer toe deformity of the lesser toes are associated with disability in daily activities.Objectives:The aim of this study is to investigate short and mid-term outcome of forefoot surgery for patients with RA.Methods:We investigated 28 patients with 39 foots who underwent forefoot surgery between January 2010 and December 2018 and followed for more than one year after surgery. Swanson implant arthroplasty or metatarsal osteotomy was performed for big toe, and shortening oblique osteotomy (SOO) was performed for the II-V toes. Examination items were as follows; plain X-ray changes in the angle of hallux valgus (HVA), the angle between the first and second metatarsal bones (M1/2), and the angle between the first and fifth metatarsal bones (M1/5) after surgery. The progress of painful hyperkeratosis and bunion, Japanese Society for Surgery of the foot standard rating system (JSSF scale), the recurrence of deformity and bone fusion, complications, and patient satisfaction were also examined.Results:The patients followed were 24 women with 34 feet and 4 men with 5 feet, and average age at the time of surgery was 66.1 years. HVA improved from average of 39.7 degrees to 20.2 degrees one month after surgery, but increased slightly to 23.5 degrees one year after surgery. Painful hyperkeratosis and bunion tended to disappear one month after surgery, and JSSF scale significantly improved at the final observation. One year after surgery, the bone fusion rate of big toe was 100%, but 7.8% of the metatarsal bone underwent SOO had non-union. The complications after surgery were one infection at the surgical site, one necrosis at the tip of the toe, and one infection of Swanson implant. Patient satisfaction at the final observation was highConclusion:Forefoot surgery for RA has problems such as recurrence, non-union, and infections, but it is considered to be a useful treatment because that pain by hyperkeratosis and bunion disappears and ADL improves.References:[1]Sung IH, Sung YK, Huh DR, Kim SJ. A comparative study on the results of the modified Ludloff osteotomy for hallux valgus deformities with minimal erosion of the metatarsophalangeal joints in rheumatoid patients versus non-rheumatoid patients.. Mod Rheumatol 2015; 25(5): 694-700.Disclosure of Interests:None declared

Metacarpophalangeal Joint Arthroplasty Using Flexible Hinge Toe Implant with Grommets for Boutonnière Deformity of Rheumatoid Thumb

Background: MP joint arthroplasty is one of the treatment options for the rheumatoid thumb with boutonniere deformity. The use of flexible hinge toe implant for MP joint reconstruction was introduced; however, the outcome of flexible toe implantation for the reconstruction of the MP joint has not as yet been reported in detail. Therefore, in this study, we retrospectively investigated the clinical outcome and radiological findings. Methods: We assessed 56 Swanson implant arthroplasties that used flexible hinge toe implants with grommets to address boutonnière deformity of the thumb MP joint. The minimum follow-up period was 6 months. Pain, the range of motion, grip strength, pinch strength, General health Visual analogue scale and DASH (Disabilities of Hand, Shoulder and Hand) were assessed. Results: For most of the patients, the procedure provided painless motion and stability to the thumb. In the radiological assessments, the preoperative flexion angles at the MP joint were 45° improved to 17°. The origin of arc was shifted toward the extended position and the average arc of motion was 21°, with a flexion arc from 23° to 44°. The severity of boutonniere deformity was improved in most cases. The average grip strength changed from 110 to 121 mmHg and the average side pinch power changed from 1.5 to 2.2 kgf. General health VAS improved from 40 to 29 (p = 0.019), and the DAS28-CRP decreased from 3.3 to 2.4 (p < 0.001). Infection occurred in one case, and there were no implant fractures. Conclusions: Swanson flexible hinge toe implant arthroplasty with grommets applied to the MP joint of the thumb was one of the recommended procedures for the reconstruction of boutonnière deformity of the thumb.

Correlation between range of motion and implant fracture: a 5 year follow-up of 72 joints in 18 patients in a randomized study comparing Swanson and Avanta/Sutter MCP silicone prosthesis

Eighteen out of 18 rheumatoid patients (at one centre of a two-centre 30 patient study previously reported) with a mean age of 56 years, and 72/72 operated joints were randomized to Avanta/Sutter or Swanson MCP prostheses and followed for 5 years. Both ulnar deviation and extension lag were improved already at 6 weeks and remained improved at 5 years. The Avanta prosthesis had a better range of motion (ROM) than the Swanson. Six of nine patients with Avanta/Sutter implants had at least one implant fracture compared to 1/9 patients with the Swanson implant ( P = 0.05) but fracture did not change the outcome subjectively. The ROM at 3 months correlated with the occurrence of an implant fracture at 5 years and a greater early ROM may be related to implant fracture. At 5 years patients remained satisfied and the deformities remained corrected.

Survivorship of the Neuflex Silicone Implant in MCP Joint Replacement

The Neuflex silicone metacarpophalangeal (MCP) joint replacement has previously been shown to provide improved movement, particularly flexion, when compared with the Swanson implant. In this study, we reviewed the outcome of 237 Neuflex implants in 66 patients with a follow-up of up to 7 years. Kaplan–Meier analysis using revision as the end stage revealed survival at 7 years to be 88%. If however an implant fracture, as seen radiographically, is taken as the end point, the survivorship drops to 68% at 7 years. These figures are comparable with a similar analysis for the Swanson implant. We conclude that the improved range of motion of the Neuflex implant demonstrated previously does not result in either a higher or a lower revision or implant fracture rate when compared with the Swanson implant.

REVISION METACARPOPHALANGEAL JOINT REPLACEMENT 30 YEARS AFTER PRIMARY SWANSON FLEXIBLE SILICONE IMPLANT ARTHROPLASTY IN A RHEUMATOID PATIENT: A CASE REPORT

We report a case of a patient with rheumatoid arthritis undergoing revision surgery 30 years after primary metacarpophalangeal joint arthroplasty using a Swanson implant. Removal and replacement of the implant were successfully performed, and the patient was satisfied with the revision surgery.

Grading of Radiographic Osteolytic Changes after Silastic Metacarpophalangeal Arthroplasty and a Prospective Trial of Osteolysis Following Use of Swanson and Sutter Prostheses

The purpose of this study was to compare the incidence of radiographic osteolysis following insertion of 89 Swanson and 126 Sutter metacarpophalangeal implants in rheumatoid arthritis patients. The mean follow-up time in the two groups of patients was 57 (40–80) and 55 (36–79) months, respectively. This paper proposes a new method of classifying radiographic osteolysis. The remarkable number of osteolytic changes seen in the bones adjacent to MCP prostheses in this study would suggest that silastic prostheses should only be used when other surgical alternatives cannot be used and that long-term control by radiography be maintained after implantation of silicone prostheses into the MCP joint. In all grades of our classification, osteolysis was more frequent in the Sutter than in the Swanson group in this study, suggesting that use of the Sutter rather than the Swanson implant is questionable.