A 60-year-old man with tophaceous gout has a tophus eroding into the first MTP joint with avascular necrosis of the metatarsal head and chronic pain unresponsive to urate-lowering therapy. Serum uric acid is 12 mg/dL despite allopurinol. The orthopedic surgical option most appropriate for definitive pain relief is:

• A First MTP joint arthroscopy and tophus debridement
• B Silastic first MTP joint replacement
• C Keller's excision arthroplasty
• D First MTP joint arthrodesis (fusion) ✓

Explanation

First MTP joint arthrodesis is the gold standard surgical treatment for end-stage first MTP destruction from tophaceous gout, advanced OA, hallux rigidus, or failed previous arthroplasty. It provides reliable, durable pain relief and restores push-off mechanics. In patients with high serum uric acid levels and tophaceous burden, silastic implants are contraindicated because urate crystals accelerate silicone implant degradation and induce silicone synovitis. Keller's excision arthroplasty is a salvage procedure with significant morbidity in active patients.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.