AB0234 Patient’s expectations about surgery for the rheumatoid forefoot deformity
Authors: I. Sung, J. Lee, T. Kim, S. Kim
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Forefoot deformity has been a common problem in rheumatoid patients, often demanding surgery. Typical deformities include hallux valgus and deformity of lesser metatarsophalangeal joints (MTPJ) and toes. Patient's satisfaction has not been well dealt in the literature as most studies have focused on radiological and clinical parameters following surgical treatment. <h3>Objectives</h3> to assess preoperative patient's expectations and postoperative satisfaction, and also factors (e.g. fulfilment of expectations, radiological parameters, and clinical outcomes) that could affect on postoperative satisfaction following first MTPJ arthrodesis and lesser toe resection arthroplasty in patients with rheumatoid forefoot deformity <h3>Methods</h3> 40 patients who underwent first MTPJ arthrodesis on great toe and resection arthroplasty for all less toes were enrolled. Clinical and radiological outcomes were investigated retrospectively. Preoperative primary expectations for surgery were questioned and fulfilment of expectation was assessed by 5-point ordinal scale. Overall subjective satisfaction, radiological improvements, AOFAS forefoot score, and subjective Foot function index were also assessed. Correlation between overall satisfaction after surgery and above other factors was performed. Statistical analysis was done using SPSS and Spearman's rho rank correlation test was performed to analyse the correlation between factors. <h3>Results</h3> Mean follow-up was 38 months (range; 24~54). For preoperative expectations, 30 (75%) patients considered improvement in pain as the most important parameter and improvements in shoe wearable and gross appearance were expected in 7 (17.5%) and 3 (7.5%) patients, respectively. Fulfilment of expectations assessed showed very satisfied in 14 (35%), satisfied in 20 (50%), average in 5 (12.5%) and disappointed in 1 (2.5%) for great toe, and those regarding lesser toe showed very satisfied in 15 (37.5%), satisfied in 18 (45%), average in 6 (15%) and disappointed in 1 (2.5%), respectively. For overall postoperative satisfaction assessment, 16 patients (40%) were excellent while 16 (40%) were good, 6 (15%) fair, and 2 (5%) poor. AOFAS hallux and lesser toe score were 69.7±11.71 and 70.7±12.26, respectively. Foot function index was 20.5±12.07 at final follow-up. Preoperative and postoperative hallux valgus angle were 45.6°±10.55 and 17.4°±5.13, respectively. Those of 1–2 intermetatarsal angle were 14.2°±3.84 and 8.4°±3.72, respectively. Correlation analysis showed that significant factors that affected on overall satisfaction were fulfilment of expectation on the great toe (Spearman's rho=0.842, p&lt;0.001)and that of lesser toe, and AOFAS score. Radiological degree and improvement in HVA and IMA were not significantly associated with patient's satisfaction. <h3>Conclusions</h3> Expectations from surgery on rheumatoid forefoot deformity were improvement in pain as the most common parameter, improvements in shoe wearable and gross appearance. Fulfilment of patients' expectations on the great toe as well as on the lesser toe significantly affected on postoperative satisfaction. Careful counselling for patients' expectations and corresponding fulfilment should be performed before performing reconstructive surgery for rheumatoid forefoot deformity. <h3>Reference</h3> [1] Nash WJ, Al-Nammari S, Khan WS, Pengas IP. Surgical Management of the Forefoot in Patients with Rheumatoid Arthritis: A Review Article. Open Orthop J. 2015;9:78–83. <h3>Disclosure of Interest</h3> None declared