Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
권호 표지
DOI QR코드

DOI QR Code

Surgical Treatment of Chronic Tophaceous Gout in the 1st Metatarso-Phalangeal Joint

족부 제 1중족 족지 관절에 발생한 만성 결절성 통풍의 수술적 치료

  • Lee, Tae-Hun (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Nam, Il-Hyun (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Ahn, Gil-Yeong (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Lee, Yeong-Hyeon (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Lee, Yong-Sik (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Choi, Young-Deuk (Department of Orthopedic Surgery, Pohang St. Mary's Hospital) ;
  • Lee, Hee-Hyung (Department of Orthopedic Surgery, Pohang St. Mary's Hospital)
  • 이태훈 (포항성모병원 정형외과) ;
  • 남일현 (포항성모병원 정형외과) ;
  • 안길영 (포항성모병원 정형외과) ;
  • 이영현 (포항성모병원 정형외과) ;
  • 이용식 (포항성모병원 정형외과) ;
  • 최영득 (포항성모병원 정형외과) ;
  • 이희형 (포항성모병원 정형외과)
  • Received : 2018.09.18
  • Accepted : 2018.10.24
  • Published : 2018.12.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Chronic tophaceous gout is a painful and disabling inflammatory disease. Surgical treatment for chronic tophaceous gout is very difficult with many complications. This study evaluated the efficacy of shortening scarf osteotomy on the treatment of chronic tophaceous gout in the 1st metatarso-phalangeal (MTP) joint. Materials and Methods: From January 2006 to December 2015, 14 patients (19 cases) who underwent axial shortening scarf osteotomy for chronic tophaceous gout were reviewed. All patients were male. The average age at the time of surgery was 59.6 years (42~66 years). The minimum follow-up was 24 months. Total removal of the tophi mass with the adhered medial capsule of the 1st MTP joint was attempted. Axial shortening scarf osteotomy was done on the 1st metatarsal shaft. The visual analogue scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was assessed preoperatively and postoperatively. The range of motion (ROM) of the 1st MTP joint was also compared pre- and postoperatively. Results: The average size of the extracted tophaceous mass was 32 mm. The mean amount of the length of metatarsal shortening was 4.9 mm. The mean ROM of the 1st MTP joint was improved from $30.4^{\circ}$ to $62.3^{\circ}$. The mean AOFAS forefoot score improved from 51.4 to 86.6 points. The mean VAS for pain improved from 4.6 to 0.3 points. Conclusion: The axial shortening scarf osteotomy used on chronic tophaceous gout could reconstruct the 1st MTP joint with an improved ROM and was free of pain. Axial shortening scarf osteotomy is suggested as a useful and effective method for the treatment of chronic tophaceous gout.

Keywords

References

  1. Brook RA, Forsythe A, Smeeding JE, Lawrence Edwards N. Chronic gout: epidemiology, disease progression, treatment and disease burden. Curr Med Res Opin. 2010;26:2813-21. https://doi.org/10.1185/03007995.2010.533647
  2. Poratt D, Rome K. Surgical Management of gout in the foot and ankle. A systematic review. J Am Podiatr Med Assoc. 2016;106:182-8. https://doi.org/10.7547/14-128
  3. Khanna D, Khanna PP, Fitzgerald JD, Singh MK, Bae S, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken). 2012;64:1447-61.
  4. Kemp TJ, Hirose CB, Coughlin MJ, Otto R. Treatment of chronic tophaceous gout with a wound vacuum-assisted device. Foot Ankle Int. 2010;31:729-31. https://doi.org/10.3113/FAI.2010.0729
  5. Lin CT, Chang SC, Chen TM, Dai NT, Fu JP, Deng SC, et al. Freeflap resurfacing of tissue defects in the foot due to large gouty tophi. Microsurgery. 2011;31:610-5. https://doi.org/10.1002/micr.20949
  6. Wunschel M, Wulker N, Walter C. Surgical treatment of a young patient with bilaterally destroyed first metatarsophalangeal joints suffering from gout. J Am Podiatr Med Assoc. 2012;102:334-7. https://doi.org/10.7547/1020334
  7. Kim YS, Park EH, Lee HJ, Koh YG. First metatarsophalangeal joint arthrodesis for the treatment of tophaceous gouty arthritis. Orthopedics. 2014;37:e141-7. https://doi.org/10.3928/01477447-20140124-15
  8. Wang CC, Lien SB, Huang GS, Pan RY, Shen HC, Kuo CL, et al. Arthroscopic elimination of monosodium urate deposition of the first metatarsophalangeal joint reduces the recurrence of gout. Arthroscopy. Arthroscopy. 2009;25:153-8. https://doi.org/10.1016/j.arthro.2008.09.002
  9. Barouk LS. Forefoot reconstruction. 2nd ed. Paris: Springer; 2005. p.305-12.
  10. Barouk LS, Barouk P. Joint-preserving surgery in rheumatoid forefoot: preliminary study with more-than-two-year followup. Foot Ankle Clin. 2007;12:435-54, vi. https://doi.org/10.1016/j.fcl.2007.05.006
  11. Coughlin MJ. Arthrodesis of the first metatarsophalangeal joint. Orthop Rev. 1990;19:177-86.

Cited by

  1. Beyond Medical Treatment: Surgical Treatment of Gout vol.23, pp.1, 2021, https://doi.org/10.1007/s11926-020-00969-6