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

Tae-Hun Lee; Il-Hyun Nam; Gil-Yeong Ahn; Yeong-Hyeon Lee; Yong-Sik Lee; Young-Deuk Choi; Hee-Hyung Lee

doi:10.14193/jkfas.2018.22.4.156

Journal List > J Korean Foot Ankle Soc > v.22(4) > 1130310

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Lee, Nam, Ahn, Lee, Lee, Choi, and Lee: Surgical Treatment of Chronic Tophaceous Gout in the 1st Metatarso-Phalangeal Joint

Original Article

J Korean Foot Ankle Soc 2018;22(4):156-160.

Published online: 19 January 2018

DOI: https://doi.org/10.14193/jkfas.2018.22.4.156

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

Tae-Hun Lee, Il-Hyun Nam, Gil-Yeong Ahn, Yeong-Hyeon Lee, Yong-Sik Lee, Young-Deuk Choi, Hee-Hyung Lee

Department of Orthopedic Surgery, Pohang St. Mary’s Hospital, Pohang, Korea

Corresponding Author: Il-Hyun Nam Department of Orthopedic Surgery, Pohang St. Mary’s Hospital, 17 Daejamdong-gil, Nam-gu, Pohang 37661, Korea Tel: 82-54-260-8041, Fax: 82-54-260-8010, E-mail: nammd60@hanmail.net ORCID: https://orcid.org/0000-0003-1048-9084

Received 18 September 201816 October 2018 Accepted 24 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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° to 62.3°. 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: Tophaceous gout, Scarf osteotomy, Shortening

REFERENCES

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Figure 1.

Preoperative radiograph (A) and clinical photograph (B).

Figure 2.

(A, B) Removal of tophi mass with medial capsule of 1st metatarso-phalangeal (MTP) joint. (C) The status of articular cartilage of the 1st MTP joint was checked and the entire articular cartilage was covered by the chalky white materials.

Figure 3.

For shortening the 1st metatarsal, we cut the 1st metatarsal on both ends of scarf osteotomy fragments (plantar and dorsal fragments). (A) Plantar fragment. The distance between the two arrows shows the length of shortening. (B) Dorsal fragment. The distance between the two arrows shows the length of shortening.

Figure 4.

After shortening scarf was done, we could achieve sufficient joint space (A; double-headed arrow) and improved range of motion of 1st metatarso-phalangeal joint compared to that of preoperative state. Passive dorsiflexion was improved after shortening at operation field (C) and follow-up (D) compared to that before shortening (B). Passive plantar flexion was improved after shortening at operation field (F) and follow-up (G) compared to that before shortening (E).

Figure 5.

Radiograph (A) and clinical photograph (B) at 4-year followup.

Table 1.

Size of Tophi Mass, Length of Shortened 1st Metatarsal (MT) Bone, Preoperative and Final Follow-up Range of Motion of Metatarso-Phalangeal Joint

Patient no.	Side	Age (yr)	Sex	Size of tophi mass (mm)	Length of shortened MT (mm)	Range of motion (^°)
Patient no.	Side	Age (yr)	Sex	Size of tophi mass (mm)	Length of shortened MT (mm)	Preoperative	Final follow-up
1	Right	64	Male	43	6	25	53
	Left		Male	38	5	25	50
2	Right	48	Male	34	4	25	60
	Left		Male	23	4	30	73
3	Right	64	Male	35	6	25	70
	Left		Male	47	6	28	65
4	Right	59	Male	19	4	40	65
	Left		Male	24	5	35	70
5	Right	64	Male	42	7	25	65
	Left		Male	32	4	30	65
6	Right	42	Male	32	5	25	55
7	Right	66	Male	12	4	40	75
8	Right	66	Male	39	6	35	70
9	Left	54	Male	16	4	35	53
10	Left	65	Male	39	5	20	45
11	Right	66	Male	39	5	35	65
12	Left	61	Male	36	5	30	65
13	Left	63	Male	24	4	40	70
14	Right	52	Male	34	4	30	50
Mean		59.6		32	4.9	30.4	62.3

Table 2.

Preoperative and Final Follow-up VAS of Pain and AOFAS Score

Patient no.	Side	VAS		AOFAS forefoot score
Patient no.	Side	Preoperative	F/U	Preoperative	F/U
1	R	5	0	42	97
	L	5	0	48	81
2	R	5	0	37	87
	L	4	0	58	94
3	R	3	0	62	86
	L	3	0	70	100
4	R	6	1	44	75
	L	3	0	80	98
5	R	4	1	78	83
	L	6	2	52	73
6	R	6	0	35	81
7	R	5	0	62	93
8	R	5	0	37	95
9	L	4	0	55	83
10	L	5	0	41	93
11	R	6	0	35	87
12	L	5	2	32	70
13	L	4	0	52	89
14	R	3	0	56	81
Mean		4.6	0.3	51.4	86.6

VAS: visual analogue scale, AOFAS: American Orthopaedic Foot and Ankle Society, F/U: follow-up, R: right, L: left.

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