Modified Oblique Keller Capsular Interposition Arthroplasty for Hallux Rigidus.

Abstract

This paper describes the modified oblique Keller capsular interposition arthroplasty, which may be indicated for patients with late-stage hallux rigidus who wish to retain joint motion. Make dorsal medial longitudinal incision over MTP joint and retract dorsal cutaneous nerve of great toe laterally. Separate extensor hallucis longus from dorsal aspect of capsule and extensor hallucis brevis and retract laterally. Leave inferior half of medial aspect of capsule attached to first metatarsal head to prevent late hallux valgus drift; make the capsular flap as long as possible. The greater the preoperative stiffness, the more bone needs to be removed from the phalanx base. Advance the dorsal aspect of the capsule over the metatarsal head and suture it into the plantar plate with absorbable suture in an interrupted fashion. Imbricate the medial aspect of the capsule with absorbable suture to hold the toe in a corrected position. Perform layered closure and apply forefoot compression dressing. Patient performs active range-of-motion exercises of great-toe MTP and IP joints, intrinsic muscle strengthening, and scar massage. We compared a cohort of patients who had the modified oblique Keller capsular interposition arthroplasty (MOKCIA) with a group who had an arthrodesis of the first MTP joint. IndicationsContraindicationsPitfalls & Challenges.