Keller's arthroplasty outcomes

NewsBot · May 9, 2012

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The long-term patient focused outcomes of the Keller's arthroplasty for the treatment of hallux rigidus.
Coutts A, Kilmartin TE, Ellis MJ.
Foot (Edinb). 2012 May 3. [Epub ahead of print]

BACKGROUND:
The Keller arthroplasty has been used to treat painful conditions of the first MTP joint for over 100 years. More recently the procedure has fallen out of favour, due to a high incidence of transfer metatarsalgia and poor function of the first MTP joint post-operatively.

OBJECTIVE:
This study sought to review the place for Keller arthroplasty in the management of hallux rigidus by considering outcomes from the patient's perspective.

METHODS:
From 1997 to 2005, 104 patients (131 feet) underwent a Keller excisional arthroplasty for the treatment of hallux rigidus. All subjects were classed as grade III on the Hattrup and Johnson scale of joint classification and had a primary complaint of painful hallux rigidus. The American orthopaedic foot and ankle scale was applied pre-operatively and post-operatively. Thirty-two participants (42 feet) were available for a final review (6 male feet and 34 female feet). The range of follow up was 36-154 months with a mean average follow up of 92 months (7.6 years). The age range at the time of surgery was 42-78 years with a mean average age of 62 years at surgery and 69 years and eight months at review.

RESULTS:
Seventy-six percent of participants were completely satisfied, 21.5% satisfied with reservations and 2.5% were dissatisfied. High levels of satisfaction were recorded for pain relief, activity levels and overall patient satisfaction. Ninety-five percent of participants reported their symptoms were improved at long-term follow up compared to pre operatively; however 9.5% of the group complained of transfer metatarsalgia. Nineteen percent of participants, all female, were not happy with the cosmetic appearance of their foot. The mean pre-operative AOFAS clinical rating scale scores was 38. At final follow up the mean score was 89.

CONCLUSION:
The Keller excisional arthroplasty is a simple reliable procedure for the treatment of severe hallux rigidus. Furthermore, it is effective in achieving pain-free movement of the first MTP joint, but carries a risk of creating transfer metatarsalgia. For nearly 20% of participants post-operative cosmetic appearance was disappointing.
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Admin2 · May 10, 2012

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Other threads tagged with hallux rigidus

NewsBot · May 11, 2017

Keller arthroplasty vs hemi-implant arthroplasty for the surgical treatment of hallux rigidus: Mid-term comparative analysis
Luis Lucinio Durán Alarcón et al
Revista Española de Podología Vol. 28. Núm. 1. Enero - Junio 2017

Introduction
There is no clear consensus regarding the best surgical treatment options in patients with hallux rigidus. The present study compares the effectiveness of two commonly used techniques in advanced cases of hallux rigidus: Keller arthroplasty and hemi-implant arthroplasty.

Patients and methods
All cases of hallux rigidus that underwent surgical treatment with either Keller or hemi-implant arthroplasties during the year 2004 were analyzed. AOFAS scale and angles in A/P X-rays were used to compare at the preoperative moment and at 6 months, 1, 3 and 5 years postoperatively.

Results
A total of 54feet were included in the study (27 in each group of treatment). No differences were observed between groups in the AOFAS scale in all the postoperative moments analyzed. Significant differences were observed in the AOFAS score and in the complications of the techniques in each separate group by age factor.

Discussion
The results of the techniques of podiatric surgery of Keller and hemi-implant arthroplasty seem to be dependent on the age of the patient and progress time. Keller arthroplasty has offered better results in patients over 55, independently of the sex, but transfer metatarsalgia at 3 and 5 years is a common postoperative finding. The hemi-implant procedure seems to be more beneficial in patients less that 55.
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NewsBot · Jan 11, 2024

Gait and dynamic pedobarographic analyses in hallux rigidus patients treated with Keller’s arthroplasty, arthrodesis or cheilectomy 22 years after surgery
Robin de Bot et al
SOurce

Background
Keller’s arthroplasty, arthrodesis and cheilectomy are well-known surgical interventions for hallux rigidus. This study aimed to evaluate the effects of these surgical interventions on gait, plantar pressure distribution and clinical outcome in patients treated for hallux rigidus 22 years after surgery.

Methods
Spatio-temporal gait parameters and plantar pressure distribution, determined as pressure time integrals (PTIs) and peak pressures (PPs), were analyzed using a 7-foot tone analysis model. Patient-reported outcome was assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ). Of the 73 patients (89 feet) from the original study, 27 patients (33 feet) and 13 healthy controls (26 feet) were available for evaluation 22 years after hallux rigidus surgery.

Results
Spatio-temporal gait parameters were comparable between all groups and were in line with healthy controls (P > 0.05). No differences (P > 0.05) in PTIs and PPs were found in the seven plantar zones between groups and as compared to healthy controls. MOXFQ scores in all domains (walking/standing, range 21.4–24.1; pain, range 16.5–22.2 and social interaction, range 23.8–35.4) were not clinically and statistically different (P > 0.05) between the three different surgical interventions.

Conclusion
These results suggest no long-term functional and biomechanical differences after these surgical interventions for hallux rigidus correction. The interventions seem to be appropriate treatment options for a selective group of patients with symptomatic hallux rigidus.
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