Effectiveness of the First Metatarsophalangeal Joint Arthroplasty versus Arthrodesis for Rheumatoid Forefoot Deformity: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 CHEN Gang ¹ , LI Bingbing ¹ , CHEN Fengming ¹ , REN Peng ¹ , LIU Yu ²

1. Department of Microsurgical Repair, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;2. Evidence-Based Medicine Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

CHEN Gang, Email: cggwwhyt@sohu.com

Keywords：

Arthroplasty; Arthrodesis; Rheumatoid forefoot deformity; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20130040

Video：

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Objective 　To evaluate the clinical effectiveness of the first metatarsophalangeal (MTP) joint arthroplasty versus arthrodesis for rheumatoid forefoot deformity.
Methods 　The randomized controlled trials (RCTs) about the first MTP joint arthroplasty vs. arthrodesis for rheumatoid forefoot deformity published by February 2012 were searched in the databases such as CNKI, Ovid, MEDLINE, CBM, EMbase, WanFang Data, The Cochrane Library (Issue 1, 2012), and KJEBM. Two reviewers independently screened studies, extracted data, and evaluated the methodological quality according to the inclusion and exclusion criteria. Then meta-analysis was conducted using RevMan 5.1 software.
Results 　A total of 4 RCTs were included. Among total 206 (269 feet) patients involved in, 98 (130 feet) were in the arthroplasty group, while the other 108 (139 feet) were in the arthrodesis group. The results of meta-analysis showed that the arthrodesis group was superior to the arthroplasty group in the footwear (MD=−0.88, 95%CI −1.55 to −0.22, P=0.01), and the alignment (MD=−5.04, 95%CI −8.94 to −1.14, P lt;0.000 01) with significant differences. But there were no significant differences between the two groups in patient satisfaction, metastatic lesions, pain, activity and weight-bearing of Hallux.
Conclusion 　Based on the current studies, arthrodesis is superior to arthroplasty in treating rheumatoid forefoot deformity. For the quality restrictions and possible publication bias of the included studies, more double blind, high quality RCTs are required to further evaluate the effects.

Citation： CHEN Gang,LI Bingbing,CHEN Fengming,REN Peng,LIU Yu. Effectiveness of the First Metatarsophalangeal Joint Arthroplasty versus Arthrodesis for Rheumatoid Forefoot Deformity: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(2): 236-241. doi: 10.7507/1672-2531.20130040 Copy

1.	Lui TH. Technical tips: Modified resection arthroplasty for correction of rheumatoid forefoot deformity. Foot Ankle Surg, 2010, 16(2): 74-77.
2.	Grondal L, Brostrom E, Wretenberg P, et al. Arthrodesis versus Mayo resection:the management of the first metatarsophalangeal joint in reconstruction of the roeumatoid forefoot. J Bone Joint Surg Br, 2006, 88(7): 914-919.
3.	Amin A, Cullen N, Singh D. rheumatoid forefoot reconstruction. Acta Orthop Belg, 2010, 76(3): 289-297.
4.	Hamalainen M, Raunio P. Long-term follow up of rheumatoid forefoot surgery. Clin Orthop Relat Res, 1997, 340: 34-38.
5.	Mann RA, Schakel ME 2nd. Surgical correction of rheumatoid forefoot deformities. Foot Ankle Int, 1995, 16(1): 1-6.
6.	Mulcahy D, Daniels TR, Lau JT, et al. Rheumatoid forefoot deformities: a comparison study of 2 functional methods of reconstruction. J Rheumatol, 2003, 30(7): 1440-1450.
7.	Rosenbaum D, Timte B, Schmiegel A, et al. First ray resection arthroplasty versus arthrodesis in the treatment of the rheumatoid foot. Foot Ankle Int, 2011, 32(6): 589-594.
8.	Torikai E, Kageyama Y, Suzuki M, et al. Comparison between resection arthroplasty alone and resection arthroplasty with arthrodesis of the first MTP joint for rheumatoid forefoot deformities. Mod Rheumatol, 2008, 18(5): 486-491.
9.	Vandeputte G, Steenwerckx A, Mulier T, et al. Forefoot reconstruction in rheumatoid arthritis patients:Keller-Lelievre-Hoffmann versus arthrodesis MTP1-Hoffmann. Foot Ankle Int, 1999, 20(7): 438-443.
10.	Coughlin MJ. Rheumatoid forefoot reconstruction. A long-term follow-up study. J Bone Joint Surg Am, 2000, 82(3): 322-341.
11.	Kitaoka HB, Alexander LJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
12.	Jadad AR, Moore RA, Corral D. Assessing the quality of the reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
13.	Popelka S, Hromadka R, Bartak V. Bilateral arthrodesis of the medial foot joints in a patient with rheumatoid arthritis. Acta Chir Orthop Traumatol Cech, 2012, 79(1): 74-79.
14.	Turner DE, Helliwell PS, Emery P. The impact of rheumatoid arthritis on foot function in the early stages of disease: a clinical case series. BMC Musculoskelet Disord, 2006, 7N: 102.
15.	Suckel A, Wulker N. Arthrodesis of the first metatarsophalangeal joint. Orthopade, 2006, 35(4): 443-449.
16.	Lombardi CM, Silhanek AD, Connolly FG, et al. The effect of first metatarsophalangeal joint arthrodesis on the first ray and the medial longitudinal arch:a radiographic study. J Foot Ankle Surg, 2002, 41(2): 96-103.
17.	Hoffman P. An operation for severe grades of contracted or clawed toes. Am J Orthop Surg, 1912, s2-9(3): 441.
18.	Burra G, Katchis SD. Rhenmatoid arthritis of the forefoot. Rheum Dis Clin North Am, 1998, 24(1): 173-180.
19.	Bolland BJ, Sauve PS, Taylor GR. Rheumatoid forefoot reconstruction: first metatarsophalangeal joint fusion combined with Weil’s metatarsal osteotomies of the lesser rays. J Foot Ankle Surg, 2008, 47(2): 80-88.
20.	Fuhrmann RA. The treatment of rheumatoid foot deformities. Orthopade, 2002, 31(12): 1187-1197.
21.	Reize P, Leichtle CI, Leichtle UG. Long-term results after metatarsal head resection in the treatment of rheumatoid arthritis. Foot Ankle Int, 2006, 27(8): 586-590.
22.	Fuhrmann RA, Anders JO. The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis. Int Orthop, 2001, 25(5): 312-316.
23.	Hattori H, Mibe J, Nohara A, et al. Course of damage to the hallux over 5 years after forefoot resection arthroplasty in rheumatoid arthritis patients. Int Orthop, 2007, 31(4): 477-481.

1. Lui TH. Technical tips: Modified resection arthroplasty for correction of rheumatoid forefoot deformity. Foot Ankle Surg, 2010, 16(2): 74-77.
2. Grondal L, Brostrom E, Wretenberg P, et al. Arthrodesis versus Mayo resection:the management of the first metatarsophalangeal joint in reconstruction of the roeumatoid forefoot. J Bone Joint Surg Br, 2006, 88(7): 914-919.
3. Amin A, Cullen N, Singh D. rheumatoid forefoot reconstruction. Acta Orthop Belg, 2010, 76(3): 289-297.
4. Hamalainen M, Raunio P. Long-term follow up of rheumatoid forefoot surgery. Clin Orthop Relat Res, 1997, 340: 34-38.
5. Mann RA, Schakel ME 2nd. Surgical correction of rheumatoid forefoot deformities. Foot Ankle Int, 1995, 16(1): 1-6.
6. Mulcahy D, Daniels TR, Lau JT, et al. Rheumatoid forefoot deformities: a comparison study of 2 functional methods of reconstruction. J Rheumatol, 2003, 30(7): 1440-1450.
7. Rosenbaum D, Timte B, Schmiegel A, et al. First ray resection arthroplasty versus arthrodesis in the treatment of the rheumatoid foot. Foot Ankle Int, 2011, 32(6): 589-594.
8. Torikai E, Kageyama Y, Suzuki M, et al. Comparison between resection arthroplasty alone and resection arthroplasty with arthrodesis of the first MTP joint for rheumatoid forefoot deformities. Mod Rheumatol, 2008, 18(5): 486-491.
9. Vandeputte G, Steenwerckx A, Mulier T, et al. Forefoot reconstruction in rheumatoid arthritis patients:Keller-Lelievre-Hoffmann versus arthrodesis MTP1-Hoffmann. Foot Ankle Int, 1999, 20(7): 438-443.
10. Coughlin MJ. Rheumatoid forefoot reconstruction. A long-term follow-up study. J Bone Joint Surg Am, 2000, 82(3): 322-341.
11. Kitaoka HB, Alexander LJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
12. Jadad AR, Moore RA, Corral D. Assessing the quality of the reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
13. Popelka S, Hromadka R, Bartak V. Bilateral arthrodesis of the medial foot joints in a patient with rheumatoid arthritis. Acta Chir Orthop Traumatol Cech, 2012, 79(1): 74-79.
14. Turner DE, Helliwell PS, Emery P. The impact of rheumatoid arthritis on foot function in the early stages of disease: a clinical case series. BMC Musculoskelet Disord, 2006, 7N: 102.
15. Suckel A, Wulker N. Arthrodesis of the first metatarsophalangeal joint. Orthopade, 2006, 35(4): 443-449.
16. Lombardi CM, Silhanek AD, Connolly FG, et al. The effect of first metatarsophalangeal joint arthrodesis on the first ray and the medial longitudinal arch:a radiographic study. J Foot Ankle Surg, 2002, 41(2): 96-103.
17. Hoffman P. An operation for severe grades of contracted or clawed toes. Am J Orthop Surg, 1912, s2-9(3): 441.
18. Burra G, Katchis SD. Rhenmatoid arthritis of the forefoot. Rheum Dis Clin North Am, 1998, 24(1): 173-180.
19. Bolland BJ, Sauve PS, Taylor GR. Rheumatoid forefoot reconstruction: first metatarsophalangeal joint fusion combined with Weil’s metatarsal osteotomies of the lesser rays. J Foot Ankle Surg, 2008, 47(2): 80-88.
20. Fuhrmann RA. The treatment of rheumatoid foot deformities. Orthopade, 2002, 31(12): 1187-1197.
21. Reize P, Leichtle CI, Leichtle UG. Long-term results after metatarsal head resection in the treatment of rheumatoid arthritis. Foot Ankle Int, 2006, 27(8): 586-590.
22. Fuhrmann RA, Anders JO. The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis. Int Orthop, 2001, 25(5): 312-316.
23. Hattori H, Mibe J, Nohara A, et al. Course of damage to the hallux over 5 years after forefoot resection arthroplasty in rheumatoid arthritis patients. Int Orthop, 2007, 31(4): 477-481.

Chinese Journal of Evidence-Based Medicine

Effectiveness of the First Metatarsophalangeal Joint Arthroplasty versus Arthrodesis for Rheumatoid Forefoot Deformity: A Meta-Analysis

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