The role of joint preserving surgery for Rheumatoid Forefoot is being explored. This involves a Scarf osteotomy of the first Metatarsal along with shortening osteotomy of the lesser metatarsals.

This prospective study includes 49 patients (17 Bilateral; Total 66 procedures) with Rheumatoid Forefoot deformities who underwent Scarf Osteotomy of the First Metatarsal and Weil osteotomy of the lesser metatarsals. The minimum follow up was 33 months and the maximum follow up was 58 months with a mean of 43.95 months. All patients were evaluated clinically and radiologically. AOFAS score for forefoot was collected prospectively.

The majority (90%) were females with mean age of 56.1 years. There was a significant improvement in the HVA, IMA and SP. The AOFAS score improved significantly from a mean of 39.8 to 88.7(p=< 0.001). Subjective improvement was also noted with In our study patients rated their outcome as excellent in 51 feet (77.27%), good in twelve feet (18.18%) and as fair in three feet (4.54%). Before surgery no patient was pain free but 44 feet (66.66%) caused severe,19 feet (28.78%) caused moderate and 3 feet (4.54%) caused mild pain. After surgery 55 feet (83.33%) were pain free, 7 feet ((10.6%) caused moderate, 4 feet (6.06%) caused mild pain. Residual deformity in terms of recurrence of lesser toes varus deformity was reported in 5 feet (7.5%). Stiffness of toes was reported in 5 feet and 11 (16.7%) had some residual pain.

Forefoot joint preserving reconstructive procedure for rheumatoid forefoot is a reliable procedure and should be considered as a safe method for treating rheumatoid forefoot deformities. However in severe hallux valgus with radiological destruction of the first MTPJ we recommend a primary fusion. Therefore joint preserving surgery should be regarded as a complement to various surgical treatments of rheumatoid forefoot.

Purpose: The purpose of this study is to evaluate the arthroscopic findings in patients who presented with persistent lateral elbow pain despite conventional conservative measures, with special regard to diagnosis specific results. The controversy regarding the etiopathogenesis, whether intraarticular, extraarticular or both continues to exist.

Method: This is a retrospective review of 280 arthroscopies of elbow in 262 patients over a period of 6 years with a minimum follow-up of 6 months. All of them are therapeutic procedures involving ECRB release, excision of plica, synovectomy or debridement of the joint. The functional outcome was assessed and recorded independently by two experienced upper limb physiotherapists using the Mayo elbow performance score.

Results: Dominant hand was involved in 68% of the cases. The average age was 54 years. Isolated pathology such as common extensor inflammation was identified in 138 (49%), synovial plica in 24 (8%) and degenerative changes confined to lateral compartment with normal appearance of articular cartilage of medial compartment is noted in 31 (11%). In the rest mixed pathology with various combinations were identified.

Conclusion: Good to excellent results were seen in those with isolated common extensor inflammation and poor outcomes were noted in 20 (7%) of patients and the common intraoperative finding seen was degenerative changes of radiocapitellar joint. This was found to be statistically significant.