A patient with tophaceous gout has a large tophus eroding into the first MTP joint with joint space destruction and chronic pain unresponsive to medical therapy. The preferred surgical intervention is:
- A First MTP arthrodesis ✓
- B Surgical debridement and tophus excision alone
- C Silastic great toe implant arthroplasty
- D Keller's resection arthroplasty
Correct answer: A. First MTP arthrodesis
Explanation
When tophaceous gout causes irreversible destruction of the first MTP joint with advanced arthritis, first MTP arthrodesis (fusion) is the gold standard surgical treatment. It provides pain relief, stability, and good long-term function for ambulation. Tophus debridement alone does not address the articular destruction. Silastic implants in gout patients are associated with silicone particle-induced synovitis and poor longevity. Keller's resection arthroplasty weakens push-off and is not preferred in active patients.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.