RT Journal
A1 MachacekJr., Felix
A1 Easley, Mark E.
A1 Gruber, Florian
A1 Ritschl, Peter
A1 Trnka, Hans-Jörg
T1 Salvage of a Failed Keller Resection Arthroplasty
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2004
FD June 1
VO 86
IS 6
SP 1131
OP 1138
DO 
UL http://dx.doi.org/
AB Background: A number of typical complications have been associated
with Keller resection arthroplasty. Recurrent valgus deformity, cock-up
deformity, and a flail toe may be difficult problems for the treating surgeon
because options for salvage are limited. In this study, we evaluated
arthrodesis of the first metatarsophalangeal joint as a salvage technique
following a failed Keller procedure. In addition, the outcomes of
motion-preserving procedures were reviewed in a separate series.Methods: Arthrodesis of the first metatarsophalangeal joint was
performed in twenty-eight patients (twenty-nine feet, group A), and either a
repeat Keller procedure or an isolated soft-tissue release was performed in
eighteen patients (twenty-one feet, group B). The patients were evaluated at
least twenty-four months postoperatively, with a personal interview and a
clinical examination with use of a modification of the hallux
metatarsal-interphalangeal scale. Radiographs were also made for the group
treated with the arthrodesis.Results: In group A, the average duration of follow-up was
thirty-six months and fusion was achieved in twenty-six of the twenty-nine
feet. Satisfaction was excellent or good in twenty-three cases, and the
postoperative score according to the modified hallux
metatarsal-interphalangeal scale averaged 76 points (maximum, 90 points). A
repeat arthrodesis was necessary in five feet because of malposition or
pseudarthrosis. In group B, the average duration of follow-up was seventy-four
months. Satisfaction was excellent or good in only six cases, and the patient
was dissatisfied in eleven cases. The score according to the modified hallux
metatarsal-interphalangeal scale averaged 48 points. Valgus deviation and
cock-up deformity had recurred in the majority of the feet at the time of
follow-up.Conclusions: Although it is more technically demanding, we recommend
arthrodesis for salvage following a failed Keller procedure since it may be
associated with a higher rate of patient satisfaction and better clinical
results.Level of Evidence: Therapeutic study, Level III-2
(retrospective cohort study). See Instructions to Authors for a complete
description of levels of evidence.