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.