LONG-TERM RESULTS OF FOREFOOT ARTHROPLASTY IN PATIENTS WITH RHEUMATOID-ARTHRITIS

Disabling forefoot deformity of rheumatoid origin frequently requires surgical intervention. Twenty-three patients (36 feet) who underwent e xcision of the metatarsal heads in our unit between 1980 and 1987 were assessed clinically and radiologically (n=12) and by questionnaire (n =11) at an average 10.5 years (range: 4 to 15) following surgery. Alth ough the procedure was initially successful at the time of review, the result was classified as unsatisfactory because of restriction of wal king ability due to pain in the forefoot area in 56% of patients, Recu rrence of the deformity-more frequently involving the great toe-had oc curred in 72% of patients, and painful callosities were present in 61% , In the patients examined clinically and radiologically, unsatisfacto ry results were due mainly to mal-alignment of the great toe and exten sor tendon tightness, Hindfoot deformity also significantly contribute d to pain in the forefoot area, Diminished arthroplasty space, irregul ar resection cascade, and development of bony spikes were frequently a ssociated with recurrence and callosities. The result of forefoot arth roplasty deteriorates with time. Failure to maintain a plantigrade gre at toe, intrinsic weakness, and hindfoot deformity were the main facto rs contributing to an unsatisfactory result.