Treatment Of First Metatarsophalangeal Joint Gouty Arthritis By Arthrodesis With En-block Resection And Structural Bone Graft

Objective: To investigate the technique and clinical outcome of arthrodesis with En-block resection and structural bone graft to treat the 1st MTPJ gouty arthritis.Methods: From June 2012 to October 2013, 9 patients suffering from 1st MTPJ gouty arthritis were treated in our hospital. There were 8 men and 1 woman with an average age of 47 years(range 25-68 years). The first MTPJ arthrodesis with En-block resection and structural bone graft was performed in all patients. X-rays were taken in regular follow-up to confirm the fusion union. Overall functional evaluation was carried out according to visual analogue scale(VAS) and the forefoot score of American Orthopaedic Foot and Ankle Society(AOFAS) at the last follow-up. Complications were also recorded.Results: All wounds were healed without any soft tissue complications of infection or skin necrosis. Eight patients got the final follow-up of an average 17.3 months(range 12-24 months). X-ray demonstrated the bone union of fusion 10 weeks postoperatively on average. AOFAS score was improved from 44.3±9.7 preoperatively to 79.4±10.1 postoperatively, while VAS score was decreased from 7.0±1.9 to 1.1±0.6. There were significant differences in AOFAS and VAS scores before and after surgery(P<0.0001). No complications, such as non-union, malunion or implant failure occurred during follow-up.Conclusions: Arthrodesis with En-block resection and structural bone graft can effectively relieve pain, achieve high fusion rate and low complication rate and improve patients’ quality of life for the treatment of 1st MTPJ gouty arthritis. It is an effective and safe procedure.