J Korean Foot Ankle Soc.  2018 Dec;22(4):156-160. 10.14193/jkfas.2018.22.4.156.

Surgical Treatment of Chronic Tophaceous Gout in the 1st Metatarso-Phalangeal Joint

Affiliations
  • 1Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Pohang, Korea. nammd60@hanmail.net

Abstract

PURPOSE
Chronic tophaceous gout is a painful and disabling inflammatory disease. Surgical treatment for chronic tophaceous gout is very difficult with many complications. This study evaluated the efficacy of shortening scarf osteotomy on the treatment of chronic tophaceous gout in the 1st metatarso-phalangeal (MTP) joint.
MATERIALS AND METHODS
From January 2006 to December 2015, 14 patients (19 cases) who underwent axial shortening scarf osteotomy for chronic tophaceous gout were reviewed. All patients were male. The average age at the time of surgery was 59.6 years (42~66 years). The minimum follow-up was 24 months. Total removal of the tophi mass with the adhered medial capsule of the 1st MTP joint was attempted. Axial shortening scarf osteotomy was done on the 1st metatarsal shaft. The visual analogue scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was assessed preoperatively and postoperatively. The range of motion (ROM) of the 1st MTP joint was also compared pre- and postoperatively.
RESULTS
The average size of the extracted tophaceous mass was 32 mm. The mean amount of the length of metatarsal shortening was 4.9 mm. The mean ROM of the 1st MTP joint was improved from 30.4° to 62.3°. The mean AOFAS forefoot score improved from 51.4 to 86.6 points. The mean VAS for pain improved from 4.6 to 0.3 points.
CONCLUSION
The axial shortening scarf osteotomy used on chronic tophaceous gout could reconstruct the 1st MTP joint with an improved ROM and was free of pain. Axial shortening scarf osteotomy is suggested as a useful and effective method for the treatment of chronic tophaceous gout.

Keyword

Tophaceous gout; Scarf osteotomy; Shortening

MeSH Terms

Ankle
Follow-Up Studies
Foot
Gout*
Humans
Joints*
Male
Metatarsal Bones
Methods
Osteotomy
Range of Motion, Articular
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