Is the Keller Bunionectomy Outdated?

By Mark Hofbauer, DPM, and Steven Kravitz, DPM

Yes, Mark Hofbauer, DPM, cites the limited indications of the procedure. He says the first MPJ fusion is a better option for hallux abductovalgus patients as it provides enhanced stability and biomechanical effects.

For the past 10 to 15 years, there has been a great debate over whether the Keller bunionectomy has become an outdated procedure. Proponents on both sides have been able to make solid arguments. The Keller bunionectomy began to get a black eye years ago when surgeons stretched the indications for its use. This was due in part because it was an easy, quick procedure to perform. As time has passed, the indications have narrowed significantly, not necessarily to the point of extinction, but at least to the endangered list.
When deciding on a procedure for hallux abductus valgus repair, one has to weigh many considerations including joint destruction versus joint preservation, the patient’s activity level and his or her chance for the best long-term results.
The reason for failed hallux abductovalgus surgery is almost always poor procedure selection. Having said that, we need to focus on what procedures will provide the best long-term results for the patient. Notice that I did not say “what procedure works best in my hands” or make statements such as “People have been doing Kellers for years” or “All of my patients with Kellers do great.” These types of statements and thought processes only slow the progression of a more scientifically based process toward accurate procedure selection for patients with a hallux abductovalgus deformity.
What’s the first question we should ask when evaluating a patient with hallux abductovalgus? Is a joint preservation procedure or joint destructive procedure indicated? The answer in this case is a joint destructive procedure. The second question is: What joint destructive procedure will provide the patient with the most predictable, functional, best long-term result? When answering this question for almost all patients, the answer is first metatarsal phalangeal joint (MPJ) fusion, not a Keller bunionectomy.

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