Surgical Management of Gout in the Foot and Ankle

NewsBot · Jun 7, 2016

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Surgical Management of Gout in the Foot and Ankle
A Systematic Review
Daniel Poratt and Keith Rome
Journal of the American Podiatric Medical Association: May 2016, Vol. 106, No. 3, pp. 182-188.

Background: The surgical management of tophaceous gout has been well documented in the literature, including its effect on foot pain and disability. To date, there have been no systematic reviews assessing the quality of the literature relating to the operative management of tophaceous gout and the outcomes in the foot and ankle.

Methods: The following electronic databases were searched (1980?2014): Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Scopus, and the Cochrane Library. The articles identified were published in English and included adult participants (age ≥18 years) with diagnosed gout and surgical intervention to the foot and ankle. The Downs and Black Quality Index was modified to assess the quality of the articles being reviewed.

Results: Six articles were reviewed and were of moderate quality (mean quality score of 71%). Surgical management was conducted on men (88%) with a mean age of 52 years. There was wide variation in the types of surgical procedures performed, with 28% of studies reporting surgery to the first metatarsophalangeal joint. Most studies were retrospective. A wide range of outcome measures were reported: foot pain, function, preoperative and postoperative activity levels, monitoring of uric acid levels, and patient satisfaction after surgery.

Conclusions: The review demonstrated a limited number of good-quality studies. Several surgical procedures for the foot and ankle in people with chronic tophaceous gout were reported. Future studies should include prospective observational studies using validated and reliable patient-reported outcome measures.
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Admin2 · Jun 7, 2016

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NewsBot · Feb 21, 2017

Use of Masquelet’s technique for treating the first metatarsophalangeal joint in cases of gout combined with a massive bone defect
Liu Feng, Huang Ruo-kun, MD, , Xie Ming, Pan Hao, Zhao Jing-jing, Lei Bo
Foot and Ankle Surgery; 17 February 2017

Highlights
•To examine the safety and efficacy of Masquelet’s technique as a surgical method for treating the first metatarsophalangeal joint in cases of gout accompanied by a massive bone defect.
•During the first stage of Masquelet’s technique, we removed the tophus and infused that area with artificial bone cement that contained antibiotics. Two months later, we performed the second stage, in which the prosthesis was replaced with iliac cancellous bone, and the operated area was stabilized via locking plate fixation.
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Background
To examine the safety and efficacy of Masquelet’s technique as a surgical method for treating the first metatarsophalangeal joint in cases of gout accompanied by a massive bone defect.

Methods
From January 2010 to January 2016, eleven patients (7 males and 4 females; mean age 33.1 years; range, 23–43 years) received surgical treatment for a first metatarsophalangeal joint tophus which caused a serious bone defect. The first metatarsophalangeal bone defects ranged from 3–6 cm, or nearly 50% of the length of normal bone. During the first stage of Masquelet’s technique, we removed the tophus and infused that area with bone cement that contained antibiotics. Two months later, we performed the second stage, in which the prosthesis was replaced with iliac cancellous bone, and the operated area was stabilized via locking plate fixation.

Results
All of the surgeries were successful, and the 11 patients were followed up for an average of 10.9 months. Postoperative evaluations showed that 10 of the 11 patients healed between 9 and 14 days after the initial surgery. Bone fusion occurred between 2.3 and 3.6 months after the operation, and the average healing time was 3.0 months. One foot wound became infected, but healed after vacuum aspiration. When the American Association of Foot and Ankle Surgery Maryland Foot scoring system was used to evaluate the foot function of the 11 patients prior to surgery, all 11 patients were graded as “failures.” Following surgery, 2 patients were graded excellent, 5 were good, 3 were fair, and only 1 patient failed. The total combined excellent and good rate was 63.6%. The total mean Maryland scores pre- and post-surgery were 27.8 points and 74.1 points, respectively; thus the average patient score increased by 46.3 points.

Conclusions
Joints with advanced tophus nodules develop segmental bone defects. Masquelet’s technique is an effective method for treating such nodules and their associated bone defects.
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NewsBot · Jul 28, 2019

Clinical characteristics and risk factors for gout flare during the postsurgical period.
Jeong H, Jeon CH
Adv Rheumatol. 2019 Jul 25;59(1):31

OBJECTIVES:
To evaluate the clinical features and risk factors for gout flare during postsurgical period in patients who were previously diagnosed with gout.

METHODS:
Seventy patients who had histories of gout and had been consulted in the rheumatologic clinic before surgery under general anesthesia were included. Clinical characteristics of patients who developed a postsurgical gout flare were compared with those of patients who did not develop gout flare.

RESULTS:
Among 70 patients, 31 (44.3%) developed gout flare during the postsurgical period. Mean intervals from surgery to gout flare was 3.7 days. Flares tended to involve monoarticular joints (61.3%) and affect lower extremity joints (83.9%). Knee joints (26%) and foot joints except the first metatarsophalangeal (MTP) joint (26%) were more frequently involved than the first MTP joint (13%). Presurgical uric acid level ≥ 9 mg/dL (OR 3.77, 95% CI 1.28-11.10, p = 0.016) and amount of uric acid changes between before and after surgery (OR 1.62, 95% CI 1.21-2.18, p = 0.001) were risk factors for postsurgical gout flare. Taking allopurinol reduced the risk of postsurgical gout flare (OR 0.15, 95% CI 0.05-0.45, p = 0.001). Operation time, amount of blood loss during surgery, and surgery site were not significantly associated with postsurgical gout flare.

CONCLUSIONS:
Adequate uric acid control before surgery could prevent the postsurgical gout flare.
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