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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, HJ
Published in: The Journal of bone and joint surgery. American volume
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

Published In

The Journal of bone and joint surgery. American volume

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

  • Orthopedics
  • 1103 Clinical Sciences
  • 0903 Biomedical Engineering
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Machacek, F., Easley, M. E., Gruber, F., Ritschl, P., & Trnka, H. J. (2005). Salvage of the failed Keller resection arthroplasty. Surgical technique. The Journal of Bone and Joint Surgery. American Volume, 87 Suppl 1(Pt 1), 86–94.
Machacek, F., M. E. Easley, F. Gruber, P. Ritschl, and H. J. Trnka. “Salvage of the failed Keller resection arthroplasty. Surgical technique.The Journal of Bone and Joint Surgery. American Volume 87 Suppl 1, no. Pt 1 (March 2005): 86–94.
Machacek F, Easley ME, Gruber F, Ritschl P, Trnka HJ. Salvage of the failed Keller resection arthroplasty. Surgical technique. The Journal of bone and joint surgery American volume. 2005 Mar;87 Suppl 1(Pt 1):86–94.
Machacek, F., et al. “Salvage of the failed Keller resection arthroplasty. Surgical technique.The Journal of Bone and Joint Surgery. American Volume, vol. 87 Suppl 1, no. Pt 1, Mar. 2005, pp. 86–94.
Machacek F, Easley ME, Gruber F, Ritschl P, Trnka HJ. Salvage of the failed Keller resection arthroplasty. Surgical technique. The Journal of bone and joint surgery American volume. 2005 Mar;87 Suppl 1(Pt 1):86–94.
Journal cover image

Published In

The Journal of bone and joint surgery. American volume

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

  • Orthopedics
  • 1103 Clinical Sciences
  • 0903 Biomedical Engineering