Salvage of the failed Keller resection arthroplasty. Surgical technique.
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.
Machacek
Felix
F
Orthopaedic Hospital Gersthof, Wielemansgasse 28, 1180 Vienna, Austria. f.machacek@chello.at
Easley
Mark E
ME
Gruber
Florian
F
Ritschl
Peter
P
Trnka
Hans-Jörg
HJ
D001174:Arthrodesis / Q000379:methods*; D001178:Arthroplasty; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008683:Metatarsophalangeal Joint / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012086:Reoperation; D016879:Salvage Therapy / Q000379:methods; D017211:Treatment Failure