The double-stemmed silicone-rubber implant for rheumatoid arthritis of the first metatarsophalangeal joint. Long-term results.

Sixty-seven feet in forty-five patients who had rheumatoid arthritis were followed for an average of six years (range, four to ten years) after an operation on the forefoot that included resection of the metatarsophalangeal heads or joints and the insertion of a double-stemmed silicone-rubber implant in the first metatarsophalangeal joint. There were forty-two women and three men, and the average age at the time of the operation was fifty-six years (range, thirty-six to seventy-nine years). The mean duration of known rheumatoid arthritis was fifteen years (range, three to thirty-seven years). Resection of the metatarsophalangeal heads or joints was performed through a plantar approach in forty-one feet and a dorsal approach in twenty-six feet. A double-stemmed silicone-rubber implant was placed in the first metatarsophalangeal joint in all feet. Each patient was evaluated clinically and radiographically with use of a foot-scoring system that was developed for this study. The results were assessed for relief of pain, ability to walk (including the use of shoes), presence of calluses or deformity, and radiographic findings. The average preoperative foot score was 47 points; the score had improved to an average of 81 points at the latest follow-up examination. A good or excellent result was obtained in fifty-eight feet (87 per cent). Complications were infrequent. In three feet, there was delayed healing of the wound; three implants were removed because of dislocation and infection; and four feet had revision to correct deformities of the lesser toes.