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Salvage of the failed Keller resection arthroplasty. Surgical technique.

Publication ,  Journal Article
Machacek, F; Easley, ME; Gruber, F; Ritschl, P; Trnka, H-J
Published in: J Bone Joint Surg Am
March 2005

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.

Duke Scholars

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Published In

J Bone Joint Surg Am

DOI

ISSN

0021-9355

Publication Date

March 2005

Volume

87 Suppl 1

Issue

Pt 1

Start / End Page

86 / 94

Location

United States

Related Subject Headings

  • Treatment Failure
  • Salvage Therapy
  • Reoperation
  • Range of Motion, Articular
  • Patient Satisfaction
  • Orthopedics
  • Metatarsophalangeal Joint
  • Humans
  • Hallux Valgus
  • Follow-Up Studies
 

Citation

APA
Chicago
ICMJE
MLA
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Machacek, F., Easley, M. E., Gruber, F., Ritschl, P., & Trnka, H.-J. (2005). Salvage of the failed Keller resection arthroplasty. Surgical technique. J Bone Joint Surg Am, 87 Suppl 1(Pt 1), 86–94. https://doi.org/10.2106/JBJS.D.02703
Machacek, Felix, Mark E. Easley, Florian Gruber, Peter Ritschl, and Hans-Jörg Trnka. “Salvage of the failed Keller resection arthroplasty. Surgical technique.J Bone Joint Surg Am 87 Suppl 1, no. Pt 1 (March 2005): 86–94. https://doi.org/10.2106/JBJS.D.02703.
Machacek F, Easley ME, Gruber F, Ritschl P, Trnka H-J. Salvage of the failed Keller resection arthroplasty. Surgical technique. J Bone Joint Surg Am. 2005 Mar;87 Suppl 1(Pt 1):86–94.
Machacek, Felix, et al. “Salvage of the failed Keller resection arthroplasty. Surgical technique.J Bone Joint Surg Am, vol. 87 Suppl 1, no. Pt 1, Mar. 2005, pp. 86–94. Pubmed, doi:10.2106/JBJS.D.02703.
Machacek F, Easley ME, Gruber F, Ritschl P, Trnka H-J. Salvage of the failed Keller resection arthroplasty. Surgical technique. J Bone Joint Surg Am. 2005 Mar;87 Suppl 1(Pt 1):86–94.
Journal cover image

Published In

J Bone Joint Surg Am

DOI

ISSN

0021-9355

Publication Date

March 2005

Volume

87 Suppl 1

Issue

Pt 1

Start / End Page

86 / 94

Location

United States

Related Subject Headings

  • Treatment Failure
  • Salvage Therapy
  • Reoperation
  • Range of Motion, Articular
  • Patient Satisfaction
  • Orthopedics
  • Metatarsophalangeal Joint
  • Humans
  • Hallux Valgus
  • Follow-Up Studies