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The Modified Oblique Keller Capsular Interpositional Arthroplasty for Hallux Rigidus
R. Brian Mackey, MD1; A. Brian Thomson, MD2; Ohyun Kwon, PT, PhD3; Michael J. Mueller, PT, PhD3; Jeffrey E. Johnson, MD4
1 Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address: rbmackey@hotmail.com
2 Vanderbilt Orthopaedic Institute, 1215 21st Avenue South, 4200 Medical Center, South Tower, Nashville, TN 37232
3 Program of Physical Therapy and Department of Radiology, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO 63108-2212
4 Foot and Ankle Service, Department of Orthopedics, Barnes-Jewish Hospital at Washington University, 14532 South Outer 40 Drive, Chesterfield, MO 63017
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Midwest Stone Institute. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 (Midwest Stone Institute and OrthoHelix Surgical Designs, Inc. [OSDI]) and of less than $10,000 (Midwest Therapy) or a commitment or agreement to provide such benefits from these commercial entities.

Investigation performed at Barnes-Jewish Hospital at Washington University Medical Center, Chesterfield, Missouri
A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Aug 18;92(10):1938-1946. doi: 10.2106/JBJS.I.00412
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Hallux rigidus is a common problem characterized by localized osteoarthritis and limited range of motion of the hallux. First metatarsophalangeal joint arthrodesis has been the accepted procedure for the treatment of late-stage disease. Despite the success of arthrodesis, some patients object to the notion of eliminating motion at the metatarsophalangeal joint. For this reason, motion-sparing procedures such as the modified oblique Keller capsular interpositional arthroplasty have been developed.


We compared a cohort of ten patients (ten toes) who had undergone the modified Keller arthroplasty with a group of twelve patients (twelve toes) who had undergone a first metatarsophalangeal joint arthrodesis at an average of sixty-three and sixty-eight months, respectively. Clinical outcomes were evaluated, and range of motion, great toe dynamometer strength, plantar pressures, and radiographs were assessed.


Clinical outcome differences existed between the groups, with the American Orthopaedic Foot and Ankle Society score being significantly higher for the arthroplasty group than for the arthrodesis group. The arthroplasty group had a mean of 54° of passive and 30° of active range of motion of the first metatarsophalangeal joint. The plantar pressure data revealed significantly higher pressures in the arthrodesis group under the great toe but not under the second metatarsal head.


The modified oblique Keller capsular interpositional arthroplasty appears to be a motion-sparing procedure with clinical outcomes equivalent to those of arthrodesis, and it is associated with a more normal pattern of plantar pressures during walking.

Level of Evidence: 

Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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