The long-term patient focused outcomes of the Keller's arthroplasty for the treatment of hallux rigidus.

Abstract

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.

• Authors: Andrew Coutts, Timothy E Kilmartin, Mairghread J H Ellis
• Journal: Foot (Edinburgh, Scotland) (Foot (Edinb)) Vol. 22 Issue 3 Pg. 167-71 (Sep 2012) ISSN: 1532-2963 [Electronic] Scotland
• PMID: 22560255 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Elsevier Ltd. All rights reserved.

Topics

• Adult
• Aged
• Ambulatory Surgical Procedures
• Arthroplasty (methods)
• Esthetics
• Female
• Follow-Up Studies
• Hallux Rigidus (surgery)
• Humans
• Male
• Metatarsalgia (etiology)
• Metatarsophalangeal Joint (surgery)
• Middle Aged
• Patient Satisfaction (statistics & numerical data)
• Postoperative Complications
• Toe Phalanges (surgery)
• Treatment Outcome