Modified scarf osteotomy with capsular interposition as salvage for resection or silicone implant arthroplasty in patients with rheumatoid arthritis. A report of three cases.

This study investigated modified scarf osteotomy as a salvage procedure after resection arthroplasty or silicone implant arthroplasty to preserve mobility of the 1st metatarsophalangeal (MTP) joint after hallux valgus surgery in patients with rheumatoid arthritis (RA). We investigated 3 feet with rheumatoid forefoot deformities that showed recurrence of forefoot deformity or breakage of the implant after resection or silicone implant arthroplasty in the 1st MTP joint. All feet were treated using modified scarf osteotomy with capsular interposition. All cases achieved obvious correction after modified scarf osteotomy despite resection of the 1st MTP joint, and consequently showed both radiographic and clinical improvements. Modified scarf osteotomy offers potential as a definitive salvage procedure after resection arthroplasty or silicone implant arthroplasty for forefoot deformity in patients with RA, because the procedure can realign the 1st MTP joint obviously with preservation of the ROM. Concomitant medial capsular interposition into the newly formed 1st MTP joint is also recommended where possible, to protect the edges of the proximal basal phalanx and distal 1st metatarsal, and also to smoothen the motion of newly formed 1st MTP joint.