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K-wire transfixation or distraction following the Keller-Brandes arthroplasty in Hallux rigidus and Hallux valgus?

ABSTRACT: A total of 118 feet with Hallux valgus and Hallux rigidus treated by the Keller-Brandes method were re-examined clinically and radiologically after 9.1 years (range: 1.7-24.3). Correction of the Hallux valgus angle was obtained from an average of 40 degrees to 23 degrees in the Hallux valgus group. Improvement in the postoperative range of motion was observed when the aftertreatment consisted of Kirschner-wire distraction instead of an axial Kirschner-wire transfixation. The patients who underwent Keller-Brandes surgery for Hallux valgus had less pain when the aftertreatment was carried out using an axial Kirschner wire, while those operated on for Hallux rigidus had less pain when the aftertreatment consisted of distraction. The percentage of satisfied or very satisfied patients with the cosmetic results of the Keller-Brandes arthroplasty was more than 66.7%. Patients with Hallux valgus and postoperative aftertreatment with Kirschner wire transfixation were the most satisfied patients, while patients with Hallux rigidus were very satisfied with the postoperative distraction. Our good results are comparable to those in other studies and confirm the success of the Keller-Brandes resection arthroplasty in Hallux valgus with osteoarthritis of the first metatarsophalangeal joint in older patients whose demand for movement is less, and in Hallux rigidus in less active older patients.

SUBMITTER: Reize P

PROVIDER: S-EPMC2267583 | biostudies-other | 2007 Jun

REPOSITORIES: biostudies-other

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Project description:BackgroundThe traditionally recommended fixed valgus cutting angle (VCA) of 3° is used as the standard method in total knee arthroplasty (TKA) for valgus deformity. The accuracy of distal femur cutting can be affected by the type of valgus deformity because the intramedullary rod for distal femoral resection can become impinged on the femoral cortex. The purpose of this study is to analyze the accuracy and precision of a VCA of 3° in mechanical alignment in TKA for valgus deformity, based on the type of the deformity.MethodsTKAs with a fixed VCA of 3° performed in 110 intra-articular and 102 juxta-articular valgus knees were retrospectively reviewed. The age (65.8 vs. 66.1 years), sex (female: male =78/32 vs. 70/32), body mass index (26.0 vs. 26.0), and severity of deformities (valgus 12.1 vs. valgus 12.5) were not significantly different (P>0.647). The mechanical-lateral-distal-femoral angle (mLDFA) and anatomical-mechanical-axis angle (AMA-A) were evaluated. The adjusted-VCA (aVCA) was defined as the maximum angle within the range without the intramedullary rod impinging on the femoral cortex. The proportion of well-aligned femoral component (mLDFA <90°±3°) was assessed. The correlation between AMA-A-3° or aVCA-3° and postoperative mLDFA-90° was analyzed.ResultsDespite the larger AMA-A in the juxta-articular group (6.2° vs. 6.8°, P<0.001), the aVCA was lesser in the juxta-articular group (5.4° vs. 4.1°, P<0.001). The mLDFA was more varus in the intra-articular group (91.7° vs. 90.6°, P<0.001) postoperatively. The proportion of well-aligned femoral component was higher in the juxta-articular group (85.3% vs. 70%, P=0.009). Postoperative mLDFA-90° was moderately correlated with aVCA-3° (r=0.301, r=387), but weakly correlated with AMA-A-3° (r=0.274, r=294) in both groups.ConclusionsAlthough a fixed VCA of 3° is a reliable method in achieving mechanical alignment in valgus deformity, it can be more appropriate in juxta-articular deformity than in intra-articular deformity. The aVCA is a more reasonable predictor of femoral component alignment than the AMA-A, considering the femoral cortex impingement of the intramedullary rod.

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K-wire transfixation or distraction following the Keller-Brandes arthroplasty in Hallux rigidus and Hallux valgus?

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