Revision of Failed Keller Arthroplasty With Intercalary Bone Graft

Abstract The purpose of this article is to report a new technique in the treatment of patients first metatarsophalangeal (MTP1) joint with arthrodesis after a failed Keller arthroplasty. A 3-cm intercalary bone graft, taken from the iliac crest, is used as a salvage procedure for bone-block distraction arthrodesis of the painful shortened MTP joint. Indications are younger patients with a short first metatarsal, cock-up deformity, and associated metatarsalgia of the lesser metatarsals in addition to a painful MTP1 joint. Using gait analysis preoperatively and postoperatively, a trend to normalization of the load-bearing pattern under the metatarsal heads and toes is observed. Although generally good results are observed, the complication rate is high, mainly because of malunion and nonunion.

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