Understanding Keller Excision Arthroplasty: A Guide for Patients
- Coriel
- Jun 4
- 3 min read
Hallux rigidus, or arthritis of the big toe, can cause significant pain and limit mobility. Keller excision arthroplasty is a surgical procedure designed to alleviate discomfort, improve toe alignment, and restore range of motion. Here’s a detailed guide to help you understand the procedure and recovery process.
What is Keller Excision Arthroplasty?
Keller excision arthroplasty involves the removal of part of the big toe joint to reduce pain and improve functionality. During the procedure, the base of the big toe joint is excised, and any excess bone is removed. This surgery does not require internal fixation (such as screws) or bone healing, making recovery more straightforward in many cases.
The procedure typically lasts about 30 minutes and is performed under local anaesthesia. In some cases, a temporary wire may be used to stabilise the joint; this wire will be removed during a follow-up appointment.
Why Consider This Surgery?
The main goals of Keller excision arthroplasty are:
To reduce pain caused by arthritis or deformity.
To improve big toe alignment.
To restore range of motion and improve overall foot function.
Advantages:
No internal fixation or bone healing is required.
Relatively short procedure and recovery time.
Risks and Considerations
While the surgery is generally effective, there are specific risks to consider:
Continued joint pain.
Pain in the ball of the foot (metatarsalgia).
Shortening of the big toe, which may result in the toe not touching the ground.
Weakness or malalignment of the big toe.
Recurrence of deformity or the toe drifting into hallux varus (a deformity where the big toe points inward).
Your consultant will discuss these risks with you and explain how they are managed to ensure the best outcome.
Who is a Candidate for This Procedure?
This surgery is typically recommended for individuals with:
Painful hallux rigidus that has not responded to non-surgical treatments.
Hallux valgus (bunions) with severe arthritis in the joint.
Reduced activity levels due to mobility limitations.
Alternative treatments include:
Activity modification.
Painkillers and anti-inflammatory medications.
Custom footwear and orthotic foot supports.
Joint injections or other surgical options, such as joint fusion or decompression osteotomy.
What to Expect During Surgery
The procedure is performed under local anaesthesia, ensuring you remain awake but pain-free. If preferred, local anaesthesia with sedation or general anaesthesia can also be considered. Following the surgery, you will spend time in the day surgery unit for post-operative monitoring before going home.
A responsible adult must accompany you home and assist you during the first night after surgery.
Recovery Timeline
Initially (First 2 Weeks):
Pain is most pronounced during this phase, but prescribed painkillers will help manage discomfort.
Rest is essential. Keep your foot elevated and minimise movement.
Use crutches if needed, and limit walking to essential activities such as bathroom trips.
Two Weeks After Surgery:
Attend a follow-up appointment to check your progress. Sutures may be removed, and additional dressings applied if necessary.
If a temporary wire is used, it will be removed at this stage.
Many patients can transition to wearing regular shoes, though some may require additional time.
2-8 Weeks After Surgery:
Swelling and mild discomfort are common but will gradually decrease.
You may begin light activities and weight-bearing as tolerated, wearing supportive shoes.
Physiotherapy or rehabilitation exercises may be recommended to improve strength and mobility.
8-12 Weeks After Surgery:
The foot should feel more functional and natural.
Swelling continues to subside, and you may consider returning to sports and other activities based on your recovery progress.
Beyond 12 Weeks:
You will have a final review 6-8 months post-surgery to evaluate long-term progress.
Improvements in pain, alignment, and mobility will continue to be noticeable over time.
Planning for Recovery
To ensure a smooth recovery:
Arrange for assistance with daily tasks during the initial weeks.
Follow all post-operative care instructions provided by your consultant.
Attend all follow-up appointments to monitor healing and address any concerns.
Keller excision arthroplasty is an effective option for individuals with hallux rigidus seeking pain relief and improved mobility. With proper preparation and adherence to recovery guidelines, most patients experience significant improvements in their quality of life. Consult your healthcare provider to determine if this procedure is the right choice for your needs.
