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

BackgroundThe 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.ObjectiveThis study sought to review the place for Keller arthroplasty in the management of hallux rigidus by considering outcomes from the patient's perspective.MethodsFrom 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.ResultsSeventy-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.ConclusionThe 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.