J Rheum Dis.  2024 Jan;31(1):33-40. 10.4078/jrd.2023.0044.

Preoperative patient’s expectations and clinical outcomes after rheumatoid forefoot deformity reconstruction by joint sacrificing surgery

• Kim SJ
• Gil YW
• Sung IH

• KMID: 2549634
• DOI: http://doi.org/10.4078/jrd.2023.0044

Abstract

Objective
To study the clinical and radiologic factors related with overall patient satisfaction of joint scarifying reconstruction on severe rheumatoid forefoot deformity (RFD).
Methods
Forty cases of RFD were retrospectively enrolled. A questionnaire on the factors for patient’s expectations and satisfactions of the greater and lesser toes was administered, including repression of relapse in deformity (D), pain reduction (P), improvement in shoe wearing (S), barefoot activity (B), and appearance (A). Overall satisfaction were assessed using the 5-digitscale. Hallux valgus angle, 1, 2 intermetatarsal angle, and other radiologic parameters were measured. Pearson’s correlation and multiple linear regression analyses were used to evaluate the relationships between these factors and overall satisfaction.
Results
Overall satisfaction was 4.0±0.82. Postoperative radiologic parameters were corrected in adequate range. Visual analog scale (VAS) was reduced from 7.2±2.1 to 2.2±1.8. For the greater toe, patient’s expectations (D, P, S, B, and A) were 4.2, 4.1, 3.0, 2.5, 2.7 and satisfactions were 4.2, 4.0, 3.4, 3.5, 3.3, respectively. For the lesser toes, patient’s expectations (D, P, S, B, and A) were 3.9, 4.1, 3.4, 3.0, 2.8, and satisfactions were 3.4, 4.0, 3.4, 3.6, 2.9, respectively. Satisfactions with P and B, and reduction amounts of VAS were significantly correlated with overall satisfaction.
Conclusion
Although forefoot reconstruction with a joint sacrificing procedure is non-physiological, it could be a good surgical option for severe RFD. Each patient’s expectations and satisfactions with this procedure could vary. Thus, it seems important to inform patients preoperatively that expectation could be fulfilled well or less.

Keyword

Human forefoot; Rheumatoid arthritis; Surgical treatment; Patient’s expectations and satisfaction

Figure

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  Figure 1 Preoperative radiographs of a patient with severe rheumatoid forefoot deformity. HVA, 1-2 IMA are 56.25°, 22.73° (A). Postoperative radiographs of a patient after modified Dwyer procedure. HVA, 1-2 IMA are 27.5°, 23.25° (B). HVA: hallux valgus angle, IMA: intermetatarsal angle.

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