Long-Term Results Following Keller Resection Arthroplasty for Hallux Rigidus

Schneider, W.; Kadnar, Georg; Kranzl, Andreas; Knahr, K.

doi:10.3113/fai.2011.0933

Cited by 18 publications

(11 citation statements)

References 46 publications

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“…Only 3 studies reported AOFAS-HMI scores ranging between 83 and 89 points with a wide spread in follow-up from 14 months to 23 years. 15,34,43,44 Our results are consistent with these studies, which showed that the good midterm results of a Keller’s arthroplasty remain stable over a long time. In addition, the fear of having a nonfunctional first ray resulting in limitations and/or pain was not proved with these results.…”

Section: Discussionsupporting

confidence: 90%

Long-term Effects of Cheilectomy, Keller’s Arthroplasty, and Arthrodesis for Symptomatic Hallux Rigidus on Patient-Reported and Radiologic Outcome

et al. 2020

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Background: Several operative interventions are available to alleviate pain in hallux rigidus, and the optimal operative technique is still a topic of debate among surgeons. Three of these are arthrodesis, cheilectomy, and Keller’s arthroplasty. Currently, it is unclear which intervention yields the best long-term result. The aim of this study was to assess which of these interventions performed best in terms of patient-reported outcome, pain scores, and disease recurrence at long-term follow-up. Methods: These data are the follow-up to the initial study published in 2006. In the original study, 73 patients (n = 89 toes) with symptomatic hallux rigidus were recruited and underwent first metatarsophalangeal joint arthrodesis (n = 33 toes), cheilectomy (n = 28 toes), or Keller’s arthroplasty (n = 28 toes). Outcome measures were AOFAS hallux metatarsophalangeal-interphalangeal (HMI) score, and pain was assessed with a visual analog scale (VAS) at a mean follow-up period of 7 years. Patients of the original study were identified and invited to participate in the current study. Data were collected in the form of AOFAS-HMI score, VAS pain score, Manchester-Oxford Foot Questionnaire (MOXFQ), and Forgotten Joint Score (FJS-12). In addition, a clinical examination was performed and radiographs were obtained. Data were available for 37 patients (45 toes), with a mean follow-up period over 22 years. Results: AOFAS-HMI and VAS pain score improved during follow-up only in arthrodesis patients. Furthermore, no statistically significant differences in clinical and patient-reported outcome were detected between groups based on AOFAS-HMI, VAS pain, MOXFQ, or FJS-12. However, clinically important differences in patient-reported outcomes and pain scores were detected, favoring arthrodesis. Radiographic disease progression was more evident after cheilectomy compared with Keller’s arthroplasty. Conclusion: Arthrodesis, cheilectomy, and Keller’s arthroplasty are 3 sucessful operative interventions to treat symptomatic hallux rigidus. Because clinically important differences were detected and symptoms still diminish many years after surgery, a slight preference was evident for arthrodesis. Level of Evidence: Level III, comparative study.

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Section: Discussionsupporting

confidence: 90%

Long-term Effects of Cheilectomy, Keller’s Arthroplasty, and Arthrodesis for Symptomatic Hallux Rigidus on Patient-Reported and Radiologic Outcome

et al. 2020

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“…In four of those cases two K-wires were used, in one case we used memory staple and in ten cases two Barouk screws to fix the arthrodesis. In three cases we performed resection of the MTP joint [24,25] (Keller’s procedure) when patients with considerably restricted physical activity refused the arthrodesis of the first MTP joint. In one case the Akin procedure [26] of the great toe was done.…”

Section: Resultsmentioning

confidence: 99%

Hypermobility of the first metatarsal bone in patients with Rheumatoid arthritis treated by lapidus procedure

Popelka

Hromádka

Vavřík

et al. 2012

BMC Musculoskelet Disord

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BackgroundFoot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis. The laxity of the medial cuneometatarsal joint and its synovitis are important factors in the development of forefoot deformity. The impaired joint causes the first metatarsal bone to become unstable in the frontal and sagittal planes. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure. We evaluated the role of the instability in a group of patients, focusing mainly on the clinical symptoms and X-ray signs of the instability.MethodsThe study group included 125 patients with rheumatoid arthritis. The indications of the Lapidus procedure were a hallux valgus deformity greater than 15 degrees and varus deformity of the first metatarsal bone with the intermetatarsal angle greater than 15 degrees on anterio-posterior weight-bearing X-ray.ResultsData of 143 Lapidus procedures of 125 patients with rheumatoid arthritis, who underwent surgery between 2004 and 2010 was evaluated. Signs and symptoms of the first metatarsal bone instability was found in 92 feet (64.3%) in our group. The AOFAS score was 48.6 before and 87.6 six months after the foot reconstruction. Nonunion of the medial cuneometatarsal joint arthrodesis on X-rays occurred in seven feet (4.9%).ConclusionThe Lapidus procedure provides the possibility to correct the first metatarsal bone varus position and its instability, as well as providing the possibility to achieve a painless foot for walking. We recommend using the procedure as a preventive surgery in poorly symptomatic patients with rheumatoid arthritis in case of the first metatarsal bone hypermobility.

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“…Schneider et al retrospectively reviewed 87 cases after Keller resection arthroplasty at average follow-up of 23 years and found a mean American Orthopedic Foot and Ankle Society (AOFAS) score of 83. 21 While 94% of patients would have their surgery again and the revision rate was 5%, due to the advancement in other treatments, this procedure is rarely performed.…”

Section: Operative Managementmentioning

confidence: 99%

Hallux rigidus

Baumhauer

2017

EFORT Open Reviews

110

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An estimated 40% of the US population have foot problems.Of all patients aged over 50 years, 2.5% report degenerative arthritis of the first metatarsophalangeal (MTP) joint, termed ‘hallux rigidus’. First MTP osteoarthritis is the most common arthritic condition in the foot.Progression of great toe arthritis is associated with pain and loss of motion. Non-surgical intervention begins with shoe modifications and orthotics designed to limit MTP motion.In patients with mild arthritis, operative procedures focus on removing excess osteophytes (cheilectomy) to prevent dorsal impingement with or without a concomitant osteotomy (Moberg) to improve or shift range of motion into a less painful arc.In patients with more advanced arthritis, operative management has centred on arthrodesis of the first MTP joint.A recent Level 1 study shows excellent function and pain relief with a small hydrogel hemi-implant into the metatarsal headMultiple joint-sparing procedures such as joint arthroplasty or resurfacing have been described with inconsistent results. Cite this article: EFORT Open Rev 2017;2:13–20. DOI: 10.1302/2058-5241.2.160031

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Long-Term Results Following Keller Resection Arthroplasty for Hallux Rigidus

Cited by 18 publications

References 46 publications

Long-term Effects of Cheilectomy, Keller’s Arthroplasty, and Arthrodesis for Symptomatic Hallux Rigidus on Patient-Reported and Radiologic Outcome

Long-term Effects of Cheilectomy, Keller’s Arthroplasty, and Arthrodesis for Symptomatic Hallux Rigidus on Patient-Reported and Radiologic Outcome

Hypermobility of the first metatarsal bone in patients with Rheumatoid arthritis treated by lapidus procedure

Hallux rigidus

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