Long-term Results of Keller-Brandes Hallux Valgus Resection Arthroplasty in Patients over 50 Years with Metatarsophalangeal Osteoarthritis

Abstract

Purpose To analyze the long-term clinical, radiological and functional results of a significant number of patients operated on for hallux valgus with the Keller-Brandes technique and to identify factors that may lead to a poor prognosis. Materials and methods A clinical and radiological review was made of a group of 30 patients operated on for 55 instances of hallux valgus using the Keller-Brandes technique with a minimum follow-up of 8 years. Their mean age at the time of surgery was 62 years. Results Patients subjected to a resection arthroplasty showed a reduction in their metatarsophalangeal angle from 36.9° to 25.4° over a mean follow-up period of 9.6 years. At the same time, the intermetatarsal angle went from 14.9° to 11°. Reduction of the sesamoid-metatarsal head articulation was achieved in 65% of cases. Subjective results were excellent in 20% of patients, good in 38.2%, fair in 23.6% and poor in 18.2%. Radiological recurrences were 36% and residual metatarsalgias 24%. There was one single case (2%) of a cock-up deformity (2%) and no cases at all of residual varus. None of the patients had to be reoperated for any of the above mentioned complications. Conclusions In our experience, the long-term clinical and radiological results of the Keller-Brandes operation in patients over 50 years of age can be considered acceptable and show a low complications rate provided that the technique is applied carefully. For this reason, it should still be recommended as the technique of choice for patients over 50 years of age with low functional demands and degenerative joint disease.