Comparison of Dorsal and Plantar Approaches for Hoffmann Resection Arthroplasty in Rheumatoid Forefoot

Category: Midfoot/Forefoot; Lesser Toes Introduction/Purpose: Forefoot involvement in patients with Rheumatoid Arthritis (RA) is the most frequent reason for consultation in patients with Rheumatoid Arthritis. Although the use of biologics has substantially improved forefoot deformity at the time of consultation, there are still patients with severe deformities who are not candidates for joint-sparing procedures. Resection arthroplasty is a commonly used procedure for severe deformities of the lesser toes, To our knowledge, no studies have compared the use of plantar and dorsal approaches from the point of view of functional and radiological results and associated complications. Methods: Retrospective study including RA patients with symptomatic foot deformities who underwent 1stMTP arthrodesis and Hoffman resection arthroplasty using a double dorsal longitudinal or transverse plantar approach. AOFAS and VAS scores were applied to all patients pre-and postoperatively at one-year follow-up. In addition, radiological results were evaluated by reestablishing the post-resection metatarsal formula in weight-bearing radiographs. General complications and those associated with the type of approach were recorded. Results: Twenty-four patients were included and divided into two groups: dorsal approach (DA) with 11 patients and plantar approach (PA) with 13 patients. All hallux arthrodesis showed complete healing. Patients in both groups achieved a statistically significant improvement in function and pain compared to their preoperative status. A comparison between both approaches showed no significant differences in the AOFAS scores (p=0.17) and VAS scores (p=0.88). There were no significant differences in the rates of complications associated with the approach or restoration of the metatarsal formula. Conclusion: Dorsal and plantar approaches presented similar results in terms of function and postoperative pain. In this group of patients, there were no significant differences in complications associated with the approach. The metatarsal formula was successfully re-established in both groups.