Document Detail

Complex primary arthrodesis of the first metatarsophalangeal joint after bone loss.
MedLine Citation:
PMID:  22224326     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Complications associated with a failed Keller procedure or joint replacement include bone loss and shortening of the first ray. We treated failed Keller resection arthroplasty and joint replacement arthroplasty cases with metatarsophalangeal joint arthrodesis, using an interpositional tricortical autograft from the iliac crest and a low-profile titanium plate.
METHODS: This was a retrospective case note review of the patients treated by four consultant surgeons in a university teaching hospital. A Keller procedure was considered to have failed when patients presented with a short, painful great toe with valgus cock-up deformity. Prosthetic joint replacements were considered to have failed based on the clinico-radiological loosening with associated pain. Metatarsophalangeal joint arthrodesis was carried out using an interpositional tricortical bone autograft and a titanium plate. Patients were assessed for resolution of pain, clinical and radiological evidence of fusion and complications. Ten operated feet in nine female patients, with a mean age of 55.9 (range, 37.8 to 80.2) years were followed for a mean of 12.6 (range, 6 to 26) months. Six patients presented with failed prosthetic joint replacements and four with failed Keller arthroplasty.
RESULTS: Full clinicoradiological union was achieved in nine of the ten patients as judged by an independent consultant musculo-skeletal radiologist. Four patients needed removal of implants, one for infection, two for prominent hardware and one for implant failure. Eight of the ten patients were satisfied with the relief of pain.
CONCLUSION: Failed arthroplasty or Keller procedure is a difficult problem to manage. We recommend complex primary arthrodesis with an interpositional iliac crest autograft and a low profile plate as a salvage procedure.
Abhijit Bhosale; Ashveen Munoruth; Chris Blundell; Mark J Flowers; Stan Jones; Mark B Davies
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Foot & ankle international     Volume:  32     ISSN:  1071-1007     ISO Abbreviation:  Foot Ankle Int     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2012-01-09     Completed Date:  2012-08-14     Revised Date:  2014-08-27    
Medline Journal Info:
Nlm Unique ID:  9433869     Medline TA:  Foot Ankle Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  968-72     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Arthroplasty / adverse effects*
Bone Plates*
Bone Transplantation*
Hallux Rigidus / complications,  diagnosis,  surgery*
Metatarsophalangeal Joint*
Middle Aged
Retrospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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