title: Salvage of a failed Keller resection arthroplasty.
abstract: 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.
authors.affiliation: Orthopaedic Hospital Gersthof, Vienna, Austria. f.machacek@chello.at
authors.forename: Felix
authors.initials: F
authors.lastname: Machacek
authors.forename: Mark E
authors.initials: ME
authors.lastname: Easley
authors.forename: Florian
authors.initials: F
authors.lastname: Gruber
authors.forename: Peter
authors.initials: P
authors.lastname: Ritschl
authors.forename: Hans-Jörg
authors.initials: HJ
authors.lastname: Trnka
mesh_terms: D001174:Arthrodesis; D001178:Arthroplasty / Q000379:methods*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D020859:Hallux Rigidus / Q000601:surgery*; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D013997:Time Factors; D014034:Toes / Q000002:abnormalities*; D017211:Treatment Failure; D016896:Treatment Outcome