Resection arthroplasty with and without capsular interposition for treatment of severe hallux rigidus

Resection arthroplasty-known as the Keller procedure-is used for the treatment of severe hallux rigidus. As a modification of this procedure, resection arthroplasty is combined with cheilectomy and interposition of the dorsal capsule and extensor hallucis brevis tendon, which are then sutured to the flexor hallucis brevis tendon on the plantar side of the joint (capsular interposition arthroplasty). In this study the clinical and radiological outcome of 22 feet treated by interposition arthroplasty were investigated and compared with those of 30 feet on which the Keller procedure was performed. The mean follow-up period was 15 months. No statistically significant difference was found between either group concerning patient satisfaction, clinical outcome and increase in range of motion of the first metatarsophalangeal joint. At follow-up, patients who had undergone interposition arthroplasty did not show statistically significantly better American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores than those of the Keller procedure group. A high rate of osteonecrosis of the first metatarsal head was found in both groups. These radiological findings did not correlate with the clinical outcome at follow-up. In conclusion, no significant benefit in clinical or radiological outcome was found for capsular interposition arthroplasty compared with the Keller procedure.