Characteristics of complications after surgical treatment of deformities of the forefoot in patients with rheumatoid arthritis

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Abstract

Aim – to evaluate and analyze postoperative complications that occurred after joint-preserving operations and arthrodesis of the 1st metatarsophalangeal joint in combination with resection of the small ray heads on the forefoot in patients with rheumatoid arthritis.

Material and methods. Patients with rheumatoid arthritis (n-143) were divided into 2 groups depending on the surgical technique. 63 patients were included in group 1 (main group), 80 patients were included in group 2 (control group). Joint-preserving surgical techniques were used in group 1, and arthrodesis of the 1st metatarsophalangeal joint and resection of small rays were performed in the second group. The number of postoperative complications and their types in both groups were assessed, as well as the parameters influencing the occurrence of complications.

Results. There were 25 cases of complications in both groups, 13 cases (20.58%) in group 1, 12 cases (15%) in group 2. The distribution in groups 1 and 2 was as follows: recurrence of deformities of 1 finger (9.52% and 0%), recurrence of deformities of 2-5 fingers (3.17% and 5%), pain in VAS ≥ 60 mm (4.76% and 5%), formation of pseudoarthrosis (0% and 1.25%), instability of metal structures (3.17% and 2.50%), trophic disorders (0% and 1.25%), respectively. A correlation was found between the activity of rheumatoid arthritis ≥ 3.98 points on the DAS28 scale and an increased incidence of postoperative complications.

Conclusion. The results obtained in both groups indicate that joint-preserving techniques for surgical correction of deformities of the forefoot in patients with rheumatoid arthritis, as well as standard ones, are recommended for use in compliance with indications and contraindications.

About the authors

Daniil V. Kapitonov

V.A. Nasonova Research Institute of Rheumatology

Author for correspondence.
Email: ortho_surg@mail.ru
ORCID iD: 0000-0002-0454-0974

postgraduate student, traumatologist-orthopedist

Russian Federation, Moscow

Evgenii I. Byalik

V.A. Nasonova Research Institute of Rheumatology

Email: sklifbialik@yandex.ru
ORCID iD: 0000-0001-7938-1536

MD, Dr. Sci. (Medicine), Professor, leading researcher of the laboratory of rheumatoid orthopedics and rehabilitation, traumatologist-orthopedist

Russian Federation, Moscow

Lyudmila I. Alekseeva

V.A. Nasonova Research Institute of Rheumatology

Email: dr.alekseeva@gmail.com
ORCID iD: 0000-0001-7017-0898

MD, Dr. Sci. (Medicine), Head of the Department of Metabolic Diseases of Bones and Joints, Head of the Osteoarthritis Laboratory

Russian Federation, Moscow

Sergei A. Makarov

V.A. Nasonova Research Institute of Rheumatology

Email: smakarov59@rambler.ru
ORCID iD: 0000-0001-8563-0631

MD, Cand. Sci. (Medicine), Head of the Department of Traumatology and Orthopedics

Russian Federation, Moscow

Valerii E. Byalik

V.A. Nasonova Research Institute of Rheumatology

Email: DoctorBjalik@yandex.ru
ORCID iD: 0000-0002-3745-0924

MD, Cand. Sci. (Medicine), traumatologist-orthopedist

Russian Federation, Moscow

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Supplementary files

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1. JATS XML
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2. Figure 1. X-ray image before the JPS; immediately after the deformity was eliminated; 3 months after the JPS (recurrence of the deformity); the appearance of the foot 3 months after the operation.

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3. Figure 2. A – postoperative X-ray; B – X-ray 8 weeks after GRS (false joint 1 MTP).

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4. Figure 3. A – X-ray immediately after JPS (Scarf, Akin, Weil osteotomy); B – X-ray 6 months after JPS (aseptic necrosis of the head of the 2nd MB, instability of the Herbert screw, recurrence of the hallux valgus deformity of the 1st finger).

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Copyright (c) 2025 Kapitonov D.V., Byalik E.I., Alekseeva L.I., Makarov S.A., Byalik V.E.

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