Long-Term Results of the Modified Hoffman Procedure in the Rheumatoid Forefoot

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The Journal of Bone and Joint Surgery (American). 2005;87:748-752.

doi:10.2106/JBJS.C.01696

© 2005 The Journal of Bone and Joint Surgery, Inc.

Long-Term Results of the Modified Hoffman Procedure in the Rheumatoid

Forefoot

http://www.ejbjs.org/cgi/content/abstract/87/4/748

Investigation performed at the Department of Orthopaedic and Trauma Surgery,

Glasgow Royal Infirmary, Glasgow, United Kingdom

Background: Rheumatoid arthritis commonly affects the forefoot, causing

metatarsalgia, hallux valgus, and deformities of the lesser toes. Various

types of surgical correction have been described, including resection of the

lesser-toe metatarsal heads coupled with arthrodesis of the great toe,

resection arthroplasty of the proximal phalanx or metatarsal head, and

metatarsal osteotomy. We report the results at an average of five and a half

years following thirty-seven consecutive forefoot arthroplasties performed

in twenty patients by one surgeon using a technique involving resection of

all five metatarsal heads.

Methods: All patients were treated with the same technique of resection of

all five metatarsal heads through three dorsal incisions. All surviving

patients were asked to return for follow-up, which included subjective

assessment (with use of visual analogue pain scores, AOFAS [American

Orthopaedic Foot and Ankle Society] foot scores, and SF-12 [short Form-12]

mental and physical disability scores), physical examination, and

radiographic evaluation.

Results: All results were satisfactory to excellent in the short term (six

weeks postoperatively), and no patient sought additional surgical treatment

for the feet. A superficial infection subsequently developed in two feet,

and two feet had delayed wound-healing. At an average of 64.9 months

postoperatively, the average AOFAS forefoot score was 64.5 points and the

average hallux valgus angle was 22.3°. There were no reoperations.

Conclusions: Resection of all five metatarsal heads in patients with

metatarsalgia and hallux valgus associated with rheumatoid arthritis can be

a safe procedure that provides reasonable, if rarely complete, relief of

symptoms.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a

complete description of levels of evidence.

S. , MBChB, BSc, MRCS1, A.W.G. Kinninmonth, MB, FRCS(Ed)Orth2 and C.

Senthil Kumar, FRCS(Tr & Orth)3

1 Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee DD1 9SY,

United Kingdom. E-mail address for S. : simon_thomas97@...

2 Department of Orthopaedics, Golden Jubilee National Hospital, Beardmore

Street, Clydebank G81 4HX, United Kingdom

3 Department of Orthopaedic and Trauma Surgery, Glasgow Royal Infirmary,

Glasgow G4 0SF, United Kingdom

The authors did not receive grants or outside funding in support of their

research or preparation of this manuscript. They did not receive payments or

other benefits or a commitment or agreement to provide such benefits from a

commercial entity. No commercial entity paid or directed, or agreed to pay

or direct, any benefits to any research fund, foundation, educational

institution, or other charitable or nonprofit organization with which the

authors are affiliated or associated.