Efficacy of rhBMP-2-loaded self-setting calcium phosphate cement combined with nose ring drain technique in the treatment of gouty tophus with bone defect of the first metatarsophalangeal joint

Background: This study aimed to compare the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2)-loaded self-setting calcium phosphate cement (CPC) combined with the nose ring drain (NRD) technique versus conventional surgery with conventional drainage in treating gouty tophus with bone defect of the first metatarsophalangeal joint. Methods: This study was a retrospective study. A total of 40 patients with gouty tophus and bone defect of the first metatarsophalangeal joint were enrolled from the Department of Foot and Ankle Surgery, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, between January 2019 and April 2026. The study group comprised 13 patients (20 feet) treated with rhBMP-2-loaded CPC combined with the NRD technique, while the control group comprised 27 patients (32 feet) treated with conventional surgery plus conventional drainage. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and serum uric acid (UA) were assessed preoperatively and at 3 days postoperatively. Visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and incision healing time were evaluated preoperatively and at the last follow-up. Postoperative complications were also recorded. Results: Significant differences were observed between the two groups in CRP, ESR, VAS score, AOFAS score, incision healing time, incidence of delayed incision healing, and overall complication rate (all P  < 0.05). No significant differences were found in UA, incidence of flap necrosis, or infection (all P  > 0.05). Conclusion: The combined use of rhBMP-2-loaded CPC and the NRD technique for gouty tophus with bone defect of the first metatarsophalangeal joint can shorten incision healing time, reduce infection and reoperation rates, and shorten hospital stay. It may also relieve pain, improve joint function and quality of life, and create favorable conditions for bone regeneration. This approach appears clinically valuable and worthy of further promotion.