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[Hallux rigidus operated on by Keller and Brandes method: radiological parameters of success and prognosis]
M J Breitenseher1, C D Toma, F Gottsauner-Wolf
1Abteilung für Osteologie, Universitätsklinik für Radiodiagnostik, Wien.
Purpose:
The aim of this study was to evaluate the pre- and postoperative radiographic findings of hallux rigidus treated with Keller and Brandes arthroplasty to determine the radiographic outcome and to identify a prognostic marker.
Methods:
83 patients with a total of 121 cases of hallux rigidus operated using Keller and Brandes arthroplasty were followed up (mean 9.7 y). A comparison of the pre- and postoperative radiographs, the clinical and subjective findings was predicated on a five point scale: 1. percentage of proximal phalanx resected ( < 33%, 33-50%, > 50%), 2. joint space, 3. ratio of the length of the first and second metatarsals, 4. first intermetatarsal angle, and 5. hallux valgus angle.
Results:
In the patient group which had 33-50% of the proximal phalanx excised (n = 67. 55%) the highest patient satisfaction was observed (96%). If resection of the proximal phalanx exceeded 50% (n = 13. 11%), non physiologic dorsiflexion of the toe occurred and patients were dissatisfied (62%). Excision of less than 33% of the hallux (n = 41. 34%) was associated with a recurrent hallux rigidus. No other evaluated radiological parameter proved to be of significance.
Conclusion:
The most important radiological parameter in the evaluation of the outcome of Keller and Brandes arthroplasty as a surgical treatment method for hallux rigidus was the percentage of the proximal phalanx which had ben excised.
