Clinical and radiological outcomes including fixation stability of osteotomy site were compared in rheumatoid arthritis (RA) patients who underwent modified Ludloff osteotomy to correct hallux valgus with osteotomy site fixation using two screws versus those who underwent additional fixation using a plate.
The fixation technique performed with two screws was used to fix the osteotomy sites following modified Ludloff osteotomy in 15 patients (15 feet, Group S), while the augmented plate fixation technique was used in 14 patients (16 feet, Group P). Surgical outcomes were analysed using the American Orthopedic Foot and Ankle Society (AOFAS) scores, and radiologic parameters measured before surgery and during follow-up examinations. To evaluate the stability of each osteotomy site fixation technique, the 1–2 inter-metatarsal angle (IMA) and angle of the altered margin of the lateral cortex (AMLC) were measured immediately and 6 weeks after surgery, and variations in the angles were compared. In addition, bone mineral density (BMD) values were compared between patients with correction loss at the osteotomy site and those with no loss of correction.
No significant differences between groups were found for total AOFAS scores before surgery and at the final follow-up. However, significant differences were observed in the 1–2 IMA, beginning at 6 weeks postoperatively and continuing through the final follow-up. The 1–2 IMA and angle of AMLC measured immediately after and 6 weeks after surgery showed significantly greater variation in Group S than in Group P. In Group S, patients with correction loss (5 feet) at osteotomy site showed significantly lower BMD values than those with no loss of correction (10 feet). Despite the lower BMD values of patients in Group P than in Group S, a loss of correction did not occur in these patients.
Correction loss occurred at the osteotomy site within 6 weeks postoperatively in patients who underwent fixation using only the two-screw fixation technique following modified Ludloff osteotomy; such loss could be reduced using the augmented plate fixation technique even in patients with osteoporosis.
Bhavikatti M, Sewell MD, Al-Hadithy N, Awan S, Bawarish MA. Joint preserving surgery for rheumatoid forefoot deformities improves pain and corrects deformity at midterm follow-up. Foot (Edinb). 2012;22:81–4. CrossRef
Trnka HJ, Parks BG, Ivanic G, Chu IT, Easley ME, Schon LC, et al. Six first metatarsal shaft osteotomies: mechanical and immobilization comparisons. Clin Orthop Related Res. 2000;381:256–65. CrossRef
Lian GJ, Markolf K, Cracchiolo A, 3rd. Strength of fixation constructs for basilar osteotomies of the first metatarsal. Foot Ankle 1992;13:509–514.
Larsen A. How to apply Larsen score in evaluating radiographs of rheumatoid arthritis in long-term studies. J Rheumatol. 1995;22:1974–5. PubMed
Hardy RH, Clapham JC. Observations on hallux valgus; based on a controlled series. The J Bone Joint Surg Br. 1951;33-b:376–91.
Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. The shape of the lateral edge of the first metatarsal head as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2007;89:2163–72. PubMed
Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, van Zeben D, Kerstens PJ, Hazes JM, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): a randomized, controlled trial. Arthritis Rheum. 2008;58(2 Suppl):S126–35. PubMed
Bogoch ER, Moran EL. Bone abnormalities in the surgical treatment of patients with rheumatoid arthritis. Clin Orthop Relat Res. 1999;366:8–21. CrossRef
Anandarajah AP, El-Taha M. Peng C. Curr Rheumatol Rev: The Relationship between Focal and Generalized Bone Loss in Rheumatoid Arthritis; 2016.
Madsen O, Egsmose C, Hansen B, Sørensen O. Soft tissue composition, quadriceps strength, bone quality and bone mass in rheumatoid arthritis. Clin Exp Rheumatol. 1997;16:27–32.
Tanaka Y, Takakura Y, Takaoka T, Akiyama K, Fujii T, Tamai S. Radiographic analysis of hallux valgus in women on weightbearing and nonweightbearing. Clin Orthop Relat Res. 1997;336:186–94. CrossRef
- Comparison of outcomes according to fixation technique following the modified Ludloff osteotomy for hallux valgus in patients with rheumatoid arthritis
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II