Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis
Abstract
:1. Introduction
2. Patients and Methods
2.1. Patients
2.2. Radiographic and Clinical Assessments
2.3. Surgical Technique
2.4. Postoperative Care
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Procedures | Second Toe | Third Toe | Fourth Toe | Fifth Toe |
---|---|---|---|---|
Oblique osteotomy for shortening of the metatarsal | 32 | 27 | 23 | 11 |
PIP joint arthrodesis * | 12 | 6 | 6 | 0 |
Shortening osteotomy of the proximal phalanx | 3 | 1 | 0 | 0 |
Abduction osteotomy of the metatarsal | 1 | 1 | 0 | 0 |
Weil osteotomy | 0 | 4 | 0 | 0 |
Medial translation of the metatarsal head | 0 | 0 | 0 | 13 |
Items | Total (n = 36) | Recurrent Deformity (n = 5) | No Recurrent Deformity (n = 31) | p Value | |
---|---|---|---|---|---|
Age, years | 64.8 ± 9.2 | 64.2 ± 8.2 | 64.9 ± 0.5 | 0.8712 | |
Duration of disease, years | 18.5 ± 12.0 | 10.8 ± 5.2 | 19.7 ± 12.4 | 0.1266 | |
Follow-up period, months | 30.9 ± 16.2 | 36.2 ± 22.0 | 30.1 ± 15.4 | 0.4420 | |
Methotrexate, mg/week | 5.1 ± 4.5 | 9.0 ± 6.0 | 4.5 ± 4.0 | 0.0344 * | |
Prednisolone, mg/day | 1.4 ± 2.0 | 2.6 ± 2.5 | 1.2 ± 1.9 | 0.1595 | |
Use of bDMARDs, n (%) | 12 (33) | 2 (40) | 10 (32) | 0.8053 | |
DAS28-ESR | 2.8 ± 0.9 | 3.2 ± 1.2 | 2.7 ± 0.9 | 0.2930 | |
Body mass index, kg/m2 | 20.8 ± 2.7 | 22.0 ± 2.5 | 20.7 ± 2.7 | 0.2956 | |
Radiographic parameters | |||||
Preoperative | HVA, ° | 45.5 ± 9.6 | 54.2 ± 7.2 | 44.0 ± 9.2 | 0.0257 * |
IMA, ° | 17.5 ±3.7 | 18.8 ± 3.3 | 17.3 ± 3.8 | 0.4000 | |
Sesamoid position | 0:1:35:0 | 0:0:0:5 | 0:0:1:30 | >0.999 | |
1 month postoperative | HVA, ° | 7.9 ±6.8 | 19.6 ± 6.0 | 6.0 ± 4.7 | <0.0001 * |
IMA, ° | 6.5 ± 4.3 | 10.1 ± 4.4 | 5.9 ± 4.0 | 0.0383 * | |
Sesamoid position | 16:13:7:0 | 0:4:1:0 | 16:9:6:0 | 0.0585 | |
3 months postoperative | HVA, ° | 10.2 ± 6.8 | 21.0 ± 6.0 | 8.4 ± 5.1 | <0.0001 * |
IMA, ° | 7.9 ± 3.9 | 10.1 ± 6.4 | 7.6 ± 3.4 | 0.0886 | |
Sesamoid position | 11:17:5:3 | 0:3:1:1 | 10:14:4:2 | 0.4160 | |
6 months postoperative | HVA, ° | 9.7 ± 7.7 | 20.1 ± 6.3 | 8.0 ± 6.6 | 0.0005 * |
IMA, ° | 7.1 ± 4.2 | 9.8 ± 5.2 | 6.7 ± 3.9 | 0.1331 | |
Sesamoid position | 11:13:10:2 | 0:1:4:0 | 11:12:6:2 | 0.0418 * | |
Latest follow-up | HVA, ° | 10.3 ± 11.2 | 29.2 ±7.6 | 7.2 ± 8.4 | <0.0001 * |
IMA, ° | 7.0 ± 4.1 | 10.0 ±5.2 | 6.5 ± 3.8 | 0.0801 | |
Sesamoid position | 11:8:10:7 | 0:1:2:2 | 11:7:8:5 | 0.2036 |
Scores | Preoperative | Latest Follow-Up | p Value |
---|---|---|---|
JSSF hallux scale score | |||
Pain (40 points) | 22.3 ± 9.1 | 37.9 ± 4.2 | <0.0001 * |
Function (45 points) | 22.7 ± 7.9 | 38.9 ± 6.7 | <0.0001 * |
Alignment (15 points) | 0.7 ± 2.8 | 14.0 ± 2.6 | <0.0001 * |
Total (100 points) | 45.1 ± 14.6 | 90.7 ± 10.8 | <0.0001 * |
SAFE-Q score | |||
Pain and pain-related | 67.1 ± 18.8 | 84.6 ± 15.7 | <0.0001 * |
Physical functioning and daily living | 67.6 ± 22.3 | 79.1 ± 19.3 | 0.0053 * |
Social functioning | 66.8 ± 26.9 | 84.0 ± 22.7 | 0.0019 * |
Shoe-related | 39.7 ± 19.5 | 61.6 ± 18.0 | <0.0001 * |
General health and well-being | 62.0 ± 27.8 | 85.5 ± 17.8 | <0.0001 * |
Study | Procedures for Correcting HV | Addition of Akin Osteotomy | No. of Feet | Mean FU Period, Months | Approach for Lateral Release | Extent of Lateral Release | Preoperative HVA, ° | HVA at the Latest FU, ° | Cases with Recurrent HV, % | Cases with Iatrogenic Hallux Varus, % | Clinical Outcomes |
---|---|---|---|---|---|---|---|---|---|---|---|
Berg et al. [9] | scarf osteotomy | if necessary, 30% | 20 | 65 | dorsal | NR | 41 | 28 | 40% (no definition of recurrent HV) | 0% | Patient satisfaction rate: 79% |
Barouk et al. [10] | scarf osteotomy | routine, 100% | 55 | 75 | NR | NR | NR | NR | 5% (no definition of recurrent HV) | some | none |
Bhavikatti et al. [11] | scarf osteotomy | 0% | 66 | 51 | dorsal | NR | 32 | 14 | 5% (HVA >18° and IMA >11°) | NR | AOFAS score: 39.8 ⇒ 88.7, Subjective report: excellent 74%, good 13.5%, fair 10.5%; poor 1% |
Kushioka et al. [13] | scarf osteotomy with medial capsule interposition | if necessary, 4% | 76 | 35 | dorsal | routine fashion: adductor tendon insertion into the PP, DTML, and capsule between the first metatarsal and the lateral sesamoid | 50.8 | 12.8 | 16% (HVA >20°) | 9% | JSSF RA foot and ankle scale score: 52.2 ⇒ 76.9, JSSF hallux scale score: 38.2 ⇒ 74.5, SAFE-Q score: no preoperative data ⇒ 78.8/71.3/70.2/83.1/60.4 |
Our study | scarf osteotomy | if necessary, 100% | 36 | 32 | intra- articular | stepwise fashion: suspensory ligament, lateral capsule, and adductor tendon insertion into the PP | 45.5 | 10.3 | 14% (HVA >20°) | 11% | JSSF hallux scale score: 45.1 ⇒ 90.7, SAFE-Q score: 67.1/67.6/66.8/39.7/62.0 ⇒ 84.6/79.1/84.0/61.6/85.5 |
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Matsumoto, T.; Maenohara, Y.; Chang, S.H.; Ono, K.; Omata, Y.; Hirose, J.; Tanaka, S. Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis. Int. J. Environ. Res. Public Health 2021, 18, 10667. https://doi.org/10.3390/ijerph182010667
Matsumoto T, Maenohara Y, Chang SH, Ono K, Omata Y, Hirose J, Tanaka S. Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis. International Journal of Environmental Research and Public Health. 2021; 18(20):10667. https://doi.org/10.3390/ijerph182010667
Chicago/Turabian StyleMatsumoto, Takumi, Yuji Maenohara, Song Ho Chang, Kumiko Ono, Yasunori Omata, Jun Hirose, and Sakae Tanaka. 2021. "Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis" International Journal of Environmental Research and Public Health 18, no. 20: 10667. https://doi.org/10.3390/ijerph182010667
APA StyleMatsumoto, T., Maenohara, Y., Chang, S. H., Ono, K., Omata, Y., Hirose, J., & Tanaka, S. (2021). Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis. International Journal of Environmental Research and Public Health, 18(20), 10667. https://doi.org/10.3390/ijerph182010667