Keller Procedure and Chevron Osteotomy in Hallux Valgus: Five-Year Results of Different Surgical Philosophies in Comparable Collectives

Abstract

We evaluated 97 Keller procedures and 64 chevron osteotomies, both combined with the “Cerclage fibreux” distal soft-tissue procedure, with a minimum follow-up period of five years to assess the limits of indications of these two different operations. We then formed two subgroups providing a statistical midrange of the metatarsophalangeal angle, intermetatarsal angle I-II and degree of arthrosis of the first metatarsophalangeal joint to obtain comparable collectives of 40 Keller and 36 chevron procedures.

The postoperative AOFAS score averaged 85.4 for the Keller procedure and 83.0 for chevron patients. The metatarsophalangeal angle was improved to an average of 11.0° and 13.9°, the intermetatarsal angle to values of 8.8° and 9.4°, respectively. The patient's overall satisfaction rated “very satisfied” and “satisfied” in 92.5% and 94.4%, respectively.

The main reason for dissatisfaction was pain. Compared to the literature, the good long-term results in this series following resection arthroplasty are attributed to the routine use of the “Cerclage fibreux” technique. This contemporary type of the Keller procedure is still a valuable surgical procedure for older patients with minor functional expectations. Excellent outcome after chevron osteotomy was not only seen in younger patients with minor deformities, but also in an older population. The chevron osteotomy should not be restricted to younger patients. The combination of the chevron distal metatarsal osteotomy with a distal soft-tissue procedure does not increase the risk of clinically manifest avascular necrosis of the metatarsal head and helps to correct higher metatarsophalangeal and intermetatarsal angles.