Arthrodesis versus resection arthroplasty for failed hallux valgus operations

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Surgery

Background:

• Hallux valgus surgery can fail, necessitating revision procedures.
• Salvage options are crucial for managing failed hallux valgus corrections, particularly in older patient populations.

Purpose of the Study:

• To compare the outcomes of Keller resection arthroplasty and arthrodesis as salvage treatments for failed hallux valgus surgery.
• To evaluate patient satisfaction, pain relief, appearance, and complication rates for both procedures.

Main Methods:

• Retrospective review of 18 patients (20 feet) who underwent salvage surgery after failed hallux valgus procedures.
• Patients were divided into two groups: Keller resection arthroplasty (11 feet) and arthrodesis (9 feet).
• Outcomes were assessed based on radiographic improvement, clinical results (good, fair, poor), patient satisfaction, pain, appearance, footwear, and complications.

Main Results:

• Arthrodesis group: Mean hallux valgus angle improved by 23 degrees, intermetatarsal angle by 2 degrees. Good results in 67% of feet.
• Resection arthroplasty group: Mean hallux valgus angle improved by 11 degrees, intermetatarsal angle by 2 degrees. Good results in 54% of feet.
• Complications, especially malalignment, were more frequent in the resection group. Metatarsalgia incidence was similar. No revision surgeries were needed.

Conclusions:

• Both Keller resection arthroplasty and arthrodesis are viable salvage options for failed hallux valgus surgery in older patients.
• Arthrodesis demonstrated a higher rate of good outcomes and fewer complications compared to resection arthroplasty.
• Resection arthroplasty offers a simpler procedure without cast immobilization, while arthrodesis provides more significant angular correction.