Forefoot reconstruction in rheumatoid arthritis patients: Keller-Lelievre-Hoffmann versus arthrodesis MTP1-Hoffmann

The aim of this study was to compare the subjective, clinical end pedodynog raphic results of two large groups of patients operated on in our departmen t. From January 1987 to December 1992, 38 rheumatoid patients (59 feet) underw ent a Keller-Lelievre arthroplasty of the first metatarsophalangeal (MTP1) joint and a Hoffmann resection of the lesser metatarsal heads. The mean fol low-up was 35 months. From June 1992 to August 1997 48 patients (62 feet) with rheumatoid arthrit is underwent an arthrodesis of the MTP1 joint and Hoffmann resection of the lesser metatarsal heads. The mean follow-up was 25 months. In 10 feet the arthrodesis was performed as a revision procedure of a failed Keller-Leliev re arthroplasty. The patients of both series were assessed in the same way: personal intervi ew, clinical examination, radiographs, bilateral footprints, and pedodynogr aphic measurements. Static and dynamic pedodynographic measurements were ta ken with a 64-sensor matrix insole in a standard shoe. Six of our patients had an arthrodesis-Hoffmann procedure performed on one foot and a Keller-Le lievre-Hoffmann procedure on the contralateral side. Although there is better loadbearing of the first ray with relative unloadi ng of the central metatarsal heads in the arthrodesis MTP1-Hoffmann group, subjective evaluation of the procedure was slightly better in the Keller-Le lievre-Hoffmann group. Ninety-three percent of the patients in the Keller g roup were satisfied or satisfied with minor reservations versus 87 percent in the arthrodesis group. This difference is not statistically significant. Recurrent deformity was not more prominent in the Keller-Lelievre-Hoffmann group; however, it may be that with a longer follow-up, the feet in the art hrodesis-Hoffmann group hold up better over time. The arthrodesis MTP1-Hoffmann procedure can be used as a revision procedure for a failed Keller-Hoffmann operation, although these procedures were mor e difficult and needed a longer recovery time than the primary MTP1 arthrod esis.