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Technique Tip: A Modification to the Keller Arthroplasty Using Interposition Allograft

Resection arthroplasty of the first metatarsophalangeal (MTP) joint, initially described by Keller11 in 1904, can be used to treat both hallux valgus and hallux rigidus. Reported complications with the Keller arthroplasty include a cockup toe deformity, clawing of the interphalangeal joint, a flail toe, transfer metatarsalgia, recurrent hallux valgus deformity, first MTP joint instability or stiffness, impaired foot function, and lesser metatarsal stress fractures.2,6,8,13 Modifications to the Keller resection arthroplasty have included a variety of soft-tissue interposition arthroplasties in an attempt to minimize shortening and to create a stable arthroplasty site.1,5,6,9,10,12,15 Soft-tissue arthroplasty techniques include decompression of the first MTP joint followed by interposition of soft tissue. Decompression of the first MTP joint has been done with or without cheilectomy by shortening the proximal phalanx with partial proximal phalangectomy (resecting between one-third and one-half of the proximal phalanx), osteotomy, reaming the joint surfaces, or performing an oblique resection of the base of the proximal phalanx to maintain the plantar intrinsic attachments.1,5,6,9–12,15 Soft-tissue interposition techniques have included either a capsular interposition arthroplasty with transfer of the extensor hallucis brevis (EHB) tendon4 and the use of an interpositional autograft using the plantaris tendon, gracilis, peroneus longus, or fascia lata.1,5,6,9,10,12,15 In an attempt to avoid potential donor site morbidity from the use of either a local or free autologous tissue transfer, we used a soft-tissue allograft as a biologic spacer.