Keller excision arthroplasty aims of surgery



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topic

HALLUX RIGIDUS (ARTHRITIS OF BIG TOE)

Procedure

KELLER EXCISION ARTHROPLASTY






AIMS OF SURGERY

To reduce pain and deformity.

To improve the big toe alignment [make straighter].

To improve range of motion


advantages of THIS OPERATION

No need for internal fixation (screws)

No bone healing required



SPECIFIC RISKS of THIS OPERATION

Continued joint pain 8%

Pain in ball of foot (metatarsalgia) 12.5%

Shortening of the big toe, Big toe may not touch the ground / float above the floor



Weakness of the big toe ,

Malalignment

Recurrence






OVERVIEW




Operation time

Usually about 30 minutes

Incision placement / stitches

Usually on top or side of the toe and with absorbable stitches where possible

Procedure

Half of the joint of the big toe is removed by excising the bone at the base of the toe. Any excess bone on the top or side of the joint is removed.

Fixation

This is generally not needed although a temporary wire is sometimes used for stability. This is left sticking out of the toe and requires removal in clinic.

Will I have plaster?

No

Is this a Day Procedure?

Yes, you can usually go home the same day

Estimated time off work

Non-manual work approximately 4-6 weeks

INDICATIONS FOR The procedure

Painful Hallux Rigidus

Hallux Valgus where the joint is beyond preservation and the patient is now less active/ mobility is reduced.



ALTERNATIVE TREATMENTS

Manage your symptoms by altering activity levels, using painkillers and anti inflammatories, changing footwear, using an insole or orthotic foot support, joint injection therapy. Other surgical procedures including 1st MTP joint fusion, joint implant, exostectomy or decompression osteotomy.

GENERAL RISKS OF SURGERY

The general risks of foot surgery are outlined in the Pre-operative Information Booklet which is provided in addition to this leaflet

YOU SHOULD READ THIS LEAFLET IN CONJUNCTION WITH THE PREOPERATIVE INFORMATION BOOKLET



MORE INFO By:

1 Speaking with your consultant or one of his team

2 Reading the information provided




KELLER EXCISION ARTHROPLASTY

The operation can be performed comfortably under a Local Anaesthetic block, which is achieved by either a series of injections around the Ankle, or an injection behind your Knee. You will be fully awake during the operation and will be able to feel touch, pressure and vibration, but you will not feel any pain. If you do not wish to consider having the operation performed whilst still awake, or your Consultant does not feel this is the best option for you, you will be offered Local Anaesthetic with sedation or General Anaesthesia. If this is the case then you may need to be referred to a different surgical team to facilitate this and your consultant will be happy to discuss with you further.


The operation takes about 30 minutes, although you will be in the Day Surgery unit for some time before the surgery and afterwards, to allow you an opportunity to rest post operatively. You must have a competent adult at home for the first day and night after surgery. This allows us to be sure you will be safe for the first night.
First 2-4 days

  • This is the time you are likely to have most pain but you will be given painkillers to help. You must rest completely for 2-4 days.

  • You will be able to stand and take weight carefully (using crutches) after the operation, but you must rest, with your feet up, as much as possible.

  • You should restrict your walking to going to the bathroom and when getting about use your crutches in the way you will have been shown.

  • You can get about a little more after 3 days.

One week after surgery



  • You may need to attend for your foot to be checked and re-dressed.

  • You may start to do a little more within pain limits. An increase in pain means you are doing too much.

Two weeks after surgery



  • Sutures will be removed if necessary.

  • You will not need a bandage or crutches any longer.

  • You will be asked to start wearing a trainer type shoe.

Between 2-8 weeks after surgery



  • If there was a pin inserted, this will be removed during this period.

  • The foot starts to return to normal and the majority 87% of patients return to shoes (6-8 weeks)

  • The foot will still be quite swollen especially at the end of the day.

  • You may return to work but may need longer if you have an active job

  • You may return to driving if you can perform an emergency stop. You must check with your insurance company before driving again.

Between 8-12 weeks after surgery



  • The foot should continue to improve and begin to feel normal again.

  • There will be less swelling.

  • Sport can be considered after 3 months depending on your recovery.

Six months after surgery



  • You will have a final review between 3- 6 months following surgery.

  • The swelling should now be slight and you should be getting the full benefit of surgery.

Twelve months after surgery



  • The foot has stopped improving with all healing complete.

Please note, if a complication arises, recovery may be delayed



Data information taken from:

  1. PASCOM National Audit tool for Podiatric Surgeons. College of Podiatrists

  2. Kilmartin TE: Metatarsal Osteotomy for Hallux Rigidus. An outcome study of three different osteotomy techniques compared with Keller’s excisional arthroplasty. Br J Podiatry 2000; 3:95-101





PATIENT INFORMATION SHEET


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