EVALUATION OF ARTHROGRYPOTIC FOOT TREATMENT: MINIMUM 10 YEARS FOLLOW-UP

To evaluate patients with arthrogryposis submitted to extensive surgical treatment with a minimum of 10 years of follow-up regarding the clinical and radiological aspects and the quality of life, using the 36-Item Short Form (SF-36) and the Disease-Specific Instrument (DSI).

Methods:

A retrospective study selected 33 patients, totaling 64 operated feet.

Results:

The mean age of the patients was 17.9 years (12-39 years), and the mean follow-up time was 14.8 years (11-17). Amyoplasia represented 78.7% of syndromic diagnoses. Isolated posteromedial lateral release (PMLR) was performed in 21.8% of the feet, 27.2% of which required additional bone surgery, and about 50 feet (78.1%) were submitted to PMLR, lateral column shortening, and/or talectomy. In total, 46 talectomies were performed (71.8% of the feet), out of which 44 were the first procedure of choice. SF-36 questionnaire was evaluated and showed that 93.9% of the patients did not have restrictive and disabling pain, and the same percentage considered themselves as healthy and had good expectations for the future.

Conclusion:

Arthrogrypotic feet are difficult to treat, require many recurrent surgical procedures, and relapses are the rule. Stiffness is a common feature of these feet, and residual deformities were frequent. Level of Evidence IV; Case Series, Therapeutic Studies.

Keywords:
Arthrogryposis; Clubfoot; Quality of Life; Surgical Procedures; Operative

Patient	Gender	Age (years)	Diagnosis
DPS	Female	18	AMC
APPS	Female	16	Larsen
MAP	Male	26	AMC
WJA	Male	11	AMC
JLF	Male	17	Schuwartz Jampel
VHR	Female	21	AMC
GAR	Male	15	AMC
MVMN	Male	13	AMC
NOC	Female	20	AMC
ALA	Male	15	AMC
NDJ	Female	18	AMC
TM	Male	15	AMC
VCS	Female	11	AMC
YSS	Female	15	AMC
EMP	Male	18	Moebius
LCM	Female	14	AMC
MAS	Male	13	AMC
KMC	Male	14	AMC
GAS	Male	16	Streeter
DPS	Male	20	Larsen
DAFS	Female	17	Moebius
VVS	Male	16	AMC
CNG	Female	17	AMC
GSC	Male	24	AMC
JCS	Female	23	AMC
BVLM	Male	25	AMC
GAM	Male	14	AMC
GTS	Male	12	AMC
MHSR	Male	15	Moebius
GRQ	Male	14	AMC
JKJS	Male	21	AMC
GIM	Male	39	AMC
MAP	Male	28	AMC

Patient	Age at the first surgery (years)	Follow-up time (years)	Laterality	First surgery^* * First surgery: 0 (No procedure); 1 (PMR); 2 (PMR+LCS); 3 (PMR + LCS+Talectomy); 4 (PMR+Talectomy).	Follow-up surgery^§ § Follow-up surgery: 0 (No procedure); 1 (PMR review); 2 (Debridement); 3 (Tarsectomy); 4 (Arthrodesis); 5 (LCS); 6 (Talectomy).
DPS	2	16	R	0	0
DPS	2	16	L	3	3
APPS	1	15	R	1	1
APPS	1	15	-	1	0
MAP	14	12	R	4	0
MAP	14	12	L	4	0
WJA	2	11	R	3	0
WJA	2	11	L	3	0
JLF	5	12	R	4	0
JLF	5	12	L	1	0
VHR	3	17	R	1	1
VHR	3	17	L	1	1
GAR	1	14	R	3	0
GAR	1	14	L	3	0
MVMN	2	11	R	3	1
MVMN	2	11	L	3	0
NOC	8	12	R	3	0
NOC	8	12	L	3	0
ALA	3	14	R	3	0
ALA	3	14	L	3	0
NDJ	3	15	R	1	0
NDJ	3	15	L	2	0
TM	1	14	R	3	0
TM	1	14	L	3	0
VCS	2	11	R	4	0
VCS	2	11	L	4	0
YSS	4	11	R	3	3
YSS	4	11	L	3	0
EMP	4	18	R	3	2
EMP	4	18	L	-	2
LCM	3	11	R	1	1
LCM	3	11	L	3	1
MAS	1	12	R	3	1
MAS	1	12	L	3	3
KMC	1	13	R	3	3
KMC	1	13	L	3	0
GAS	1	13	R	3	3
GAS	1	13	L	3	0
DPS	2	18	R	3	0
DPS	2	18	L	2	0
DAFS	5	14	R	3	0
DAFS	5	14	L	3	0
VVS	2	14	R	3	1
VVS	2	14	L	3	0
CNG	3	14	R	3	2
CNG	3	14	L	3	2
GSC	6	18	R	4	0
GSC	6	18	L	1	0
JCS	1	22	R	1	5
JCS	1	22	L	1	5
BVLM	6	19	R	2	4
BVLM	6	19	L	2	0
GAM	3	11	R	3	3
GAM	3	11	L	3	3
GTS	1	10	R	3	0
GTS	1	10	L	3	0
MHSR	4	11	R	3	0
MHSR	4	11	L	3	0
GRQ	1	13	R	1	6
GRQ	1	13	L	1	6
JKJS	5	15	R	4	3
JKJS	5	15	L	4	0
GIM	4	35	R	1	3
GIM	4	35	L	1	3
MAP	4	24	R	2	0
MAP	4	24	L	2	0

Patient	Physical functioning	Physical role functioning	Pain	General health	Vitality	Social functioning	Emotional well-being	Mental Health	Total
DPS	40	50	100	97	95	75	100	72	120.4
APPS	10	100	51	75	55	87.5	66.7	40	91.1
MAP	30	25	72	87	50	100	0	56	98.6
WJA	60	75	100	72	85	100	100	92	125.4
JLF	45	50	72	92	85	50	66.7	92	117.6
VHR	40	100	41	67	40	62.5	0	32	85.5
GAR	0	100	62	95	65	100	100	76	107.2
MVMN	55	50	100	100	80	87.5	66.7	88	130.8
NOC	5	75	100	65	75	100	100	96	113
ALA	45	75	100	100	75	62.5	66.6	88	111.4
NDJ	20	75	84	52	45	100	100	44	102.8
TM	80	100	62	62	50	100	50	88	121.4
VCS	35	75	52	60	90	100	66.6	88	119.2
YSS	10	75	72	65	70	62.5	66.6	68	102.2
EMP	0	100	74	47	45	62.5	100	60	90.8
LCM	35	75	62	50	75	75	100	28	107.6
MAS	45	100	62	57	80	100	100	20	112.6
KMC	85	100	100	60	80	100	66.6	72	125
GAS	85	100	62	60	80	100	72	72	123.2
DPS	10	25	84	70	65	87.5	50	64	107.4
DAFS	70	75	62	72	40	50	66.6	60	102.6
VVS	40	75	100	67	70	75	66.6	80	109.4
CNG	50	100	64	65	40	37.5	0	36	80.4
GSC	75	100	100	60	50	100	66.6	80	122
JCS	75	0	61	65	80	62.5	0	60	97.1
BVLM	70	100	74	70	80	100	100	88	105.4
GAM	5	75	74	57	65	100	66.6	80	103.8
GTS	50	75	52	57	50	75	66.6	32	93.6
MHSR	70	100	62	75	25	50	66.6	40	98.2
GRQ	20	25	62	47	85	100	66.6	80	105.6
JKJS	20	75	100	75	65	100	66.6	80	113
GIM	35	25	82	92	80	87.5	100	64	116.4
MAP	35	25	82	92	80	87.5	100	64	115.6

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[1] Correspondence: Monica Paschoal Nogueira, 1800, Pedro de Toledo Street, Vila Clementino, São Paulo, SP, Brazil. 04039-004. monipn@uol.com.br

Isolated PMLR (14) = 21.8%	- (4) 28.5% no more procedures were required - (6) 42.8% required additional bone surgery - (4) 28.5% required review of PMLR
PMLR + bone procedure (LCS and/or talectomy) = (50) 78.1% Of those 44 were talectomies, 68.7% of all procedures	- (9) 18% required additional bone surgery: Arthrodesis (3 feet) / Tarsectomy (6 feet) - (34) 68% no more procedures were required - (4) 8% required review of PMLR - (3) 6% required debridement