LATE RESULTS AFTER FOREFOOT SURGERY IN RH EUMATOID-ARTHRITIS AND FAILURE ANALYSIS

Rheumatoid arthritis as a systemic disease frequently involves the for efoot. Hallux valgus with degeneration of the first metatarsophalangea l joint and dorsal subluxation or dislocation of the lateral four meta tarsophalangeal joints are classic findings. Lateral drifting of the t oes is also a late sequela. 330 deformed forefeet were treated surgica lly between 1984 and 1989 at the orthopaedic department of the univers ity of Jena. 286 feet (86,6%) could be followed up for a mean of 7.4 y ears (range 5.1-10.4 years) using clinical, radiological and footprint evaluation. For the exposure of the four lateral metatarsophalangeal joints we used a transverse plantar approach at the level of the metat arsal necks. The resection of the metatarsal heads was done by using a n oscillating saw. Treating the hallux valgus deformity we choosed a s light resection of the first metatarsal head (48,2%), Keller's excisio n arthroplasty (40,0%) or an arthrodesis of the first metatarsophalang eal joint (11,8%). 35% of the reviewed patients suffered from adverse symptoms including pain in the big toe or the forefoot, problems with footwear and restriction of their walking ability. The lateral metatar salgia was caused by a bad alignement of the lateral four metatarsals or plantar spurs at the level of the metatarsal stumps. In combination with the resection of the lateral four metatarsal heads arthrodesis o f the first metatarsaophalangeal joint provided the best results. Slig ht resection and modelling of the first metatarsal head provided accep table results. Keller's excision arthroplasty caused the worst outcome and can no longer be recommended for rheumatoid arthritis forefeet.