Doença de Müller-Weiss: epidemiologia, série de casos cirúrgicos e revisão da literatura

Abstract

Objective: To report a surgical case series, including the epidemiological profile and clinical and functional outcomes of patients with
Müller-Weiss disease (MWD), thereby increasing knowledge of the pathology. Method: Patients diagnosed with MWD who underwent surgical treatment between January 2010 and December 2021 were included in the study. Epidemiological information, comorbidities, reported symptoms, classification according to Maceira, surgical technique, time from symptom onset to surgery, and postoperative complications were recorded. Fisher’s exact test was used to analyze the association between categorical variables, and odds ratios (ORs) were calculated with their respective 95% confidence intervals, with a significance level of 5% (p < 0.05).
Results: Forty-two patients (44 operated feet) with MWD were included in the sample, with a mean follow-up of 36.3 months. The mean age was 57.9 (± 9.4) years, and the body mass index was 32.2 (± 4.1) kg/m2. There was a higher proportion of women (80.9%) and white patients (42.8%). The main comorbidity was systemic arterial hypertension (SAH), observed in 64.3% of cases, followed by obesity and type 2 diabetes (DM2), present in 59.5% and 14.3%, respectively. Pain was the main symptom, reported by 92.8% of patients. Maceira stage IV was the most prevalent (29.5%), and 57.1% of patients had bilateral involvement. The main procedures performed were isolated triple arthrodesis (34%), isolated talonavicular arthrodesis (22.7%), and talonavicular arthrodesis with calcanectomy (18.2%). Most patients (52.3%) underwent surgery within five years of symptom onset. After 12 months of surgery, 59.1% of patients reported residual pain, and 31.8% were reoperated on. Among these patients, patients with DM2 had a higher risk of chronic pain. Conclusion: In this study, MWD presented a higher prevalence in female patients, white, over 50 years of age, hypertensive, and with obesity. Painful and bilateral presentation and diagnosis in advanced stages were observed in a large portion of cases. Triple arthrodesis was the most frequently performed procedure, followed by isolated talonavicular arthrodesis. One year after surgery, most patients reported residual pain, and this complication was more associated with the presence of DM. Level of Evidence IV; Case Series.