Keller and Interphalangeal Joint Resection Arthroplasties for Chronic Noncomplicated Diabetic Ulcers of the Hallux: A Systematic Review and Meta-analysis
Background: Surgery is often needed for resistant plantar diabetic foot ulcers (DFUs) of the big toe. For noninfected ulcers, 2 types of surgery are available: the Keller and the hallux interphalangeal joint arthroplasty (HIPJ-A) procedures. Yet, no evidence synthesis on the outcomes of these proced...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2024-11-01
|
| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/24730114241300139 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846141345876410368 |
|---|---|
| author | Kaissar Yammine MD, MPH, PhD Joseph Mouawad MD Mohammad Omar Honeine MD Chahine Assi MD |
| author_facet | Kaissar Yammine MD, MPH, PhD Joseph Mouawad MD Mohammad Omar Honeine MD Chahine Assi MD |
| author_sort | Kaissar Yammine MD, MPH, PhD |
| collection | DOAJ |
| description | Background: Surgery is often needed for resistant plantar diabetic foot ulcers (DFUs) of the big toe. For noninfected ulcers, 2 types of surgery are available: the Keller and the hallux interphalangeal joint arthroplasty (HIPJ-A) procedures. Yet, no evidence synthesis on the outcomes of these procedures has been conducted; thus, this systematic review is an attempt to fill this gap. Methods: Only studies reporting the results of Keller (or its variants) and HIPJ-A (or its variants) procedures for noncomplicated ulcers (Texas 1A/2A, or Wagner I/II) were included. Ulcers located beneath the metatarsal head were excluded. Ultimately, 11 studies were selected for inclusion and were analyzed. The primary outcome was defined as the ulcer healing frequency. The secondary outcomes were mean healing time, ulcer recurrence frequency, ulcer transfer frequency, postoperative infection rate, and revision surgery rate. Results: The overall (combined techniques) weighted healing rate was 94% with a mean healing time of 3.1 ± 0.4 weeks. The ulcer recurrence frequency was 6%, the ulcer transfer frequency 4.5%, the postoperative infection rate 18%, and the revision surgery rate 3.8%. No significant differences were found between both techniques. When compared to standard of care, the odds ratio of ulcer healing frequency was 27.1 (95% CI 1.442-508.174, P = .01) in favor of the Keller arthroplasty with a faster healing time ( P = .02). Conclusion: Both surgical offloading procedures are highly effective in treating chronic noncomplicated DFU of the plantar aspect of the hallux along with low complication frequencies. There is a need to fine-tune the indication in relation to the location of the plantar wound with future comparative controlled research studies with far more patients than we could include in this meta-analysis. |
| format | Article |
| id | doaj-art-4c7e5d095c364dababfe54087f28c0d9 |
| institution | Kabale University |
| issn | 2473-0114 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj-art-4c7e5d095c364dababfe54087f28c0d92024-12-04T11:03:39ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142024-11-01910.1177/24730114241300139Keller and Interphalangeal Joint Resection Arthroplasties for Chronic Noncomplicated Diabetic Ulcers of the Hallux: A Systematic Review and Meta-analysisKaissar Yammine MD, MPH, PhD0Joseph Mouawad MD1Mohammad Omar Honeine MD2Chahine Assi MD3Department of Orthpedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, LebanonDiabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, LebanonDiabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, LebanonDepartment of Orthpedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, LebanonBackground: Surgery is often needed for resistant plantar diabetic foot ulcers (DFUs) of the big toe. For noninfected ulcers, 2 types of surgery are available: the Keller and the hallux interphalangeal joint arthroplasty (HIPJ-A) procedures. Yet, no evidence synthesis on the outcomes of these procedures has been conducted; thus, this systematic review is an attempt to fill this gap. Methods: Only studies reporting the results of Keller (or its variants) and HIPJ-A (or its variants) procedures for noncomplicated ulcers (Texas 1A/2A, or Wagner I/II) were included. Ulcers located beneath the metatarsal head were excluded. Ultimately, 11 studies were selected for inclusion and were analyzed. The primary outcome was defined as the ulcer healing frequency. The secondary outcomes were mean healing time, ulcer recurrence frequency, ulcer transfer frequency, postoperative infection rate, and revision surgery rate. Results: The overall (combined techniques) weighted healing rate was 94% with a mean healing time of 3.1 ± 0.4 weeks. The ulcer recurrence frequency was 6%, the ulcer transfer frequency 4.5%, the postoperative infection rate 18%, and the revision surgery rate 3.8%. No significant differences were found between both techniques. When compared to standard of care, the odds ratio of ulcer healing frequency was 27.1 (95% CI 1.442-508.174, P = .01) in favor of the Keller arthroplasty with a faster healing time ( P = .02). Conclusion: Both surgical offloading procedures are highly effective in treating chronic noncomplicated DFU of the plantar aspect of the hallux along with low complication frequencies. There is a need to fine-tune the indication in relation to the location of the plantar wound with future comparative controlled research studies with far more patients than we could include in this meta-analysis.https://doi.org/10.1177/24730114241300139 |
| spellingShingle | Kaissar Yammine MD, MPH, PhD Joseph Mouawad MD Mohammad Omar Honeine MD Chahine Assi MD Keller and Interphalangeal Joint Resection Arthroplasties for Chronic Noncomplicated Diabetic Ulcers of the Hallux: A Systematic Review and Meta-analysis Foot & Ankle Orthopaedics |
| title | Keller and Interphalangeal Joint Resection Arthroplasties for Chronic Noncomplicated Diabetic Ulcers of the Hallux: A Systematic Review and Meta-analysis |
| title_full | Keller and Interphalangeal Joint Resection Arthroplasties for Chronic Noncomplicated Diabetic Ulcers of the Hallux: A Systematic Review and Meta-analysis |
| title_fullStr | Keller and Interphalangeal Joint Resection Arthroplasties for Chronic Noncomplicated Diabetic Ulcers of the Hallux: A Systematic Review and Meta-analysis |
| title_full_unstemmed | Keller and Interphalangeal Joint Resection Arthroplasties for Chronic Noncomplicated Diabetic Ulcers of the Hallux: A Systematic Review and Meta-analysis |
| title_short | Keller and Interphalangeal Joint Resection Arthroplasties for Chronic Noncomplicated Diabetic Ulcers of the Hallux: A Systematic Review and Meta-analysis |
| title_sort | keller and interphalangeal joint resection arthroplasties for chronic noncomplicated diabetic ulcers of the hallux a systematic review and meta analysis |
| url | https://doi.org/10.1177/24730114241300139 |
| work_keys_str_mv | AT kaissaryamminemdmphphd kellerandinterphalangealjointresectionarthroplastiesforchronicnoncomplicateddiabeticulcersofthehalluxasystematicreviewandmetaanalysis AT josephmouawadmd kellerandinterphalangealjointresectionarthroplastiesforchronicnoncomplicateddiabeticulcersofthehalluxasystematicreviewandmetaanalysis AT mohammadomarhoneinemd kellerandinterphalangealjointresectionarthroplastiesforchronicnoncomplicateddiabeticulcersofthehalluxasystematicreviewandmetaanalysis AT chahineassimd kellerandinterphalangealjointresectionarthroplastiesforchronicnoncomplicateddiabeticulcersofthehalluxasystematicreviewandmetaanalysis |