Foot & Ankle Surgery: Techniques, Reports & Cases (Jan 2023)
Comparison of short-term outcomes after distal metatarsal telescoping osteotomy and scarf osteotomy for hallux valgus in patients with rheumatoid arthritis
Abstract
Purpose: To compare the clinical and radiographic outcomes of distal metatarsal telescoping osteotomy (DMTO) and scarf osteotomy for hallux valgus (HV) in patients with rheumatoid arthritis (RA). Methods: Overall, 21 feet in 19 patients treated with DMTO and 26 feet in 26 patients treated with scarf osteotomy were retrospectively compared with significantly longer follow-up periods in the former procedure (51.0 months vs. 28.0 months, P < 0.0001). Radiographic measurements of HV-related parameters and the clinical outcomes which were compared using the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal joint score (AOFAS score) were obtained preoperatively and at the latest follow-up. A postoperative comparison of the patient-reported outcome measures was performed using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Results: Both the DMTO and scarf procedures improved the AOFAS score and HV-related parameters. The improvement in the AOFAS score and corrective amount of radiographic parameters showed no significant differences between the two groups. The pain and pain-related subscales of the SAFE-Q were significantly better in the DMTO group (86.7 vs. 70.0, P = 0.0009). The operative time for all toes was significantly shorter in the DMTO group (176.0 min vs. 210.0 min, P = 0.0002). No significant differences were observed in the incidence of post-operative complications. Conclusion: Both DMTO and scarf osteotomy demonstrated comparable outcomes for mild-to-severe HV deformities in patients with RA. The DMTO may be considered as an alternative surgical method for HV deformity in patients with RA with the advantages of being an easy technique and having a shorter operative time.
