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Choi JY, Song TH, Suh JS. Outcome comparison of minimally invasive proximal and distal chevron Akin osteotomies in patients with severe hallux valgus deformity: A randomized prospective study. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06204-6. [PMID: 38705891 DOI: 10.1007/s00264-024-06204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To date, the surgical treatment of severe hallux valgus deformity remains challenging despite the various methods presented. This study aimed to compare the effectiveness of minimally invasive distal chevron Akin osteotomies (d-MICA) and minimally invasive proximal chevron Akin osteotomies (p-MICA) in correcting severe hallux valgus deformities. METHODS This prospective follow-up study included patients randomly assigned to undergo p-MICA or d-MICA for hallux valgus deformities with a preoperative hallux valgus angle (HVA) ≥ 40° and/or a first to second intermetatarsal angle (IMA) ≥ 16°. After a minimum follow-up period of two years, we compared various clinico-radiographic parameters of patients whose HVA exceeded 15° at the final follow-up. RESULTS In the p-MICA and d-MICA groups, seven of 40 cases (17.5%) and 16 of 41 cases (39.0%), respectively, exhibited HVA > 15° at the final follow-up (P = 0.048). The preoperative parameters showed no significant differences. However, at the first weight-bearing assessment, the HVA, IMA, and relative second metatarsal length were significantly smaller, and the distal metatarsal articular angle (DMAA) was greater in the p-MICA group (all P < 0.05) compared with the d-MICA group. Postoperatively, both groups exhibited significant decreases in HVA and IMA at the final follow-up (P < 0.001 for all parameters). The p-MICA group showed no significant changes in DMAA and the relative length of the second metatarsal (P = 0.253 and 0.185, respectively). However, the d-MICA group showed a significant decrease in DMAA (P < 0.001) and an increase in the relative length of the second metatarsal at the final follow-up (P = 0.01). CONCLUSIONS p-MICA and d-MICA procedures demonstrated effective correction potential for severe hallux valgus deformities; however, the d-MICA procedure exhibited a notably higher incidence of unsatisfactory correction at the final follow-up than p-MICA. Therefore, d-MICA may be less predictable in achieving successful outcomes than p-MICA in treating severe hallux valgus deformities.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea
| | - Tae Hun Song
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea
| | - Jin Soo Suh
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea.
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Shoji T, Shozen H, Ueki S, Kaneta H, Yaunaga Y, Adachi N. Evaluation of the long-term patient-reported outcomes after hip arthroplasty or joint preserving with Sugioka femoral osteotomy in patients with femoral head osteonecrosis. INTERNATIONAL ORTHOPAEDICS 2024; 48:1201-1208. [PMID: 38376531 PMCID: PMC11001741 DOI: 10.1007/s00264-024-06118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE This study retrospectively evaluated long-term clinical outcomes and patient-reported outcome measures (PROMs) in patients with osteonecrosis of the femoral head (ONFH) who underwent transtrochanteric rotational osteotomy (TRO), curved varus osteotomy (CVO), and total hip arthroplasty (THA). METHODS We retrospectively reviewed the 109 hips in 96 patients (46 men, 50 women) who underwent CVO, TRO, or THA for ONFH treatment. The mean follow-up period for the TRO, CVO, and THA groups was 14.8, 11.5, and 13.3 years, respectively. RESULTS The THA conversion rate of the TRO patients was significantly higher than that of the patients with CVO, and the final clinical scores in the patients with TRO did not improve compared with preoperative scores. Postoperative PROMs showed that the total and pain scores of the patients with THA were significantly higher than those of patients with TRO and CVO, while the PROM score did not change between patients with TRO and CVO. The analysis further showed that the preoperative type C2, stage 3A, or postoperative type C1 and C2 were significant predictors of decreased final PROM scores. CONCLUSION This study found that CVO and THA are clinically effective treatments for ONFH, with significant improvements compared with preoperative scores. However, THA was associated with significantly higher PROMs and pain scores than those of CVO and TRO in long-term follow-up. Furthermore, our results suggest that postoperative PROMs depend mainly on the preoperative level of collapse and postoperative transposed intact ratio of the articular surface of the femoral head.
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Affiliation(s)
- Takeshi Shoji
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Hideki Shozen
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Shinichi Ueki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Hiroki Kaneta
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yuji Yaunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-Town, Higashi-Hiroshima, 739-0036, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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Huh J, Louis-Ugbo J, Hembree WC, Wagner E, Chodos MD, Zingas CN, Vopat BG, Dalal A, Alhadhoud M, Sherman TI. 2023 Evidence-Based Medicine (EBM) Update. Foot Ankle Int 2024; 45:547-554. [PMID: 38676415 DOI: 10.1177/10711007241242133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Affiliation(s)
- Jeannie Huh
- Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | | | - Walter C Hembree
- MedStar Orthopaedic Institute, Georgetown University School of Medicine, Baltimore, MD, USA
| | - Emilio Wagner
- Traumatologo Subespecialista en Cirugia de Tobillo y Pie, Santiago, Chile
| | | | | | - Bryan G Vopat
- University of Kansas Health System, Kansas City, KS, USA
| | - Aliasgar Dalal
- St. Louis University Care Physician Group, St. Louis, MO, USA
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Kyung MG, Park GY, Yang H, Lee DY. A Modified 90-Degree Distal Chevron Metatarsal Osteotomy for Correcting Moderate Hallux Valgus Deformity. J Clin Med 2023; 12:6902. [PMID: 37959367 PMCID: PMC10648121 DOI: 10.3390/jcm12216902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Various modifications of distal chevron metatarsal osteotomy (DCMO) have been introduced for correcting moderate hallux valgus deformity; however, the amount of correction may be limited, and complications, such as the recurrence of the deformity and avascular necrosis of the metatarsal head, have been a problem. This study aimed to present a modified 90-degree DCMO technique that overcomes the previously reported shortcomings and to report a successful short-term radiographic outcome. Sixty-eight consecutive patients who underwent the operation with our modified DCMO technique and twenty-two consecutive patients with the conventional DCMO technique (control group) were retrospectively analyzed. The radiographic measurements were evaluated preoperatively, at two months post operation, and at the final follow-up. Both groups showed a significant correction of the hallux valgus angle, first-second intermetatarsal angle, distal metatarsal articular angle, and sesamoid position at the final follow-up, while the amount of correction was significantly greater in the modified DCMO group. In both groups, there were no cases of complications such as avascular necrosis of the metatarsal head, nonunion, and surgical site infection appearing throughout the follow-up period. Therefore, the modified 90-degree DCMO technique is effective and safe, which could serve as a favorable option to treat moderate hallux valgus deformity.
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Affiliation(s)
- Min Gyu Kyung
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea; (M.G.K.); (H.Y.)
| | - Gil Young Park
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul 07803, Republic of Korea;
| | - Hanbual Yang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea; (M.G.K.); (H.Y.)
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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He T, Zhou L, Sun Y. Letter to the Editor: Does Minimally Invasive Surgery Provide Better Clinical or Radiographic Outcomes Than Open Surgery in the Treatment of Hallux Valgus Deformity? A Systematic Review and Meta-analysis. Clin Orthop Relat Res 2023; 482:00003086-990000000-01383. [PMID: 37815373 PMCID: PMC10723868 DOI: 10.1097/corr.0000000000002890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Tianda He
- Department of Bone and Joint, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, PR China
| | - Liping Zhou
- Department of Bone and Joint, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, PR China
| | - Yu Sun
- Department of Bone and Joint, The First People’s Hospital of Changzhou, Changzhou, Jiangsu, PR China
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Motta LM, Manchado I, Blanco G, Quintana-Montesdeoca MP, Garcés L, Garcés GL. Temporal Changes in Clinical Outcomes after Minimally Invasive Surgery for Hallux Valgus Correction in Women without Postoperative Complications. J Clin Med 2023; 12:4368. [PMID: 37445403 DOI: 10.3390/jcm12134368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Minimally invasive surgery (MIS) is currently used to correct hallux valgus deformities. Most studies reporting on MIS techniques to correct hallux valgus deformities included patients with postoperative complications. These reported complications, with an average rate of 23%, had significant negative effects on the clinical outcomes in this patient population. In the present study, a cohort of 63 women who underwent MIS hallux valgus correction was assessed preoperatively and at a mean follow-up of 1.0, 4.7, and 6.5 years using the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the Manchester Oxford Foot Questionnaire (MOXFQ). The main criterion for inclusion in this cohort was a lack of complications during the entire follow-up period. The results showed significant improvements in both AOFAS and MOXFQ scores between the preoperative and 1-year follow-up assessments. By contrast, clinically small and nonsignificant changes were observed among postoperative follow-up values. The number of enrolled patients needs to be increased in future studies, with different surgeons and techniques included. Nevertheless, our study findings will inform patients about the outcomes they can expect over the years if no complications occur.
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Affiliation(s)
- Luci M Motta
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain
- Department of Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, 35007 Las Palmas, Spain
| | - Ignacio Manchado
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain
- Department of Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, 35007 Las Palmas, Spain
| | | | | | - Laura Garcés
- Terapias Acuáticas Canarias SL, 35007 Las Palmas, Spain
| | - Gerardo L Garcés
- Hospital Perpetuo Socorro, 35007 Las Palmas, Spain
- Department of Ciencias Médicas y Quirúrgicas, University of Las Palmas de Gran Canaria, 35007 Las Palmas, Spain
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Xiong B, Bai Z, Cao X, Nie D, Zhang C, Sun X, Guo Z, Wen J, Sun W. Causal relationship between thyroid dysfunction and hallux valgus: A two-sample Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1115834. [PMID: 36967762 PMCID: PMC10030973 DOI: 10.3389/fendo.2023.1115834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Previous observational studies have reported that thyroid dysfunction is associated with hallux valgus (HV). However, the causal effect of thyroid dysfunction on hallux valgus is still unknown. To assess whether there is a causal relationship between thyroid dysfunction and hallux valgus, we performed a two-sample Mendelian randomization (MR) study. METHODS The data of the two-sample Mendelian randomization study were obtained from public databases. In this study, hypothyroidism, hyperthyroidism, free thyroxine (FT4), and thyrotropin (TSH) were chosen as exposures. The single nucleotide polymorphisms (SNP) of hypothyroidism and hyperthyroidism were from the genome-wide association studies (GWAS) of the IEU database, including 337,159 subjects. Data for FT4 and TSH (72,167 subjects) were extracted from the ThyroidOmics Consortium. HV was used as the outcome. The SNPs associated with HV were selected from a GWAS of 202,617 individuals in the fignngen database. The inverse variance weighted (IVW) method was used as the primary analysis. Four complementary methods were applied, including MR-presso, MR-Egger, and weighted median. In addition, Cochran's Q test, MR-presso, MR-Egger regression, and the leave-one-out test were used as sensitivity analysis, and the MR-pleiotropy test was performed to examine pleiotropy. RESULTS According to the results of IVW, we found that there was a causal relationship between hypothyroidism and HV, and hypothyroidism increased the incidence of HV (OR = 2.838 (95% CI: 1.116-7.213); p = 0.028). There were no significant causal effects of hyperthyroidism, FT4, and TSH on HV (p > 0.05). Sensitivity analyses showed that the results were robust and reliable, and no horizontal pleiotropy was detected. CONCLUSIONS Our findings provided genetic support that hypothyroidism might increase the risk of HV. It will predict the occurrence of HV in patients with hypothyroidism and provide suggestions for early prevention and intervention.
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Affiliation(s)
- Binglang Xiong
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Zixing Bai
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuhan Cao
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Duorui Nie
- Graduate School, Hunan University of Traditional Chinese Medicine, Changsha, China
| | - Cheng Zhang
- Fourth Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Xudong Sun
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Ziyan Guo
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianmin Wen
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Weidong Sun
- Second Department of Orthopedics, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Weidong Sun,
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