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Zhao R, Wang G, Li F, Wang J, Zhang Y, Li D, Liu S, Li J, Song J, Wei F, Wang C. Developing Machine Learning-Based Predictive Models for Hallux Valgus Recurrence Based on Measurements From Radiographs. Foot Ankle Int 2024:10711007241256648. [PMID: 38872342 DOI: 10.1177/10711007241256648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND Machine learning (ML) is increasingly used to predict the prognosis of numerous diseases. This retrospective analysis aimed to develop a prediction model using ML algorithms and to identify predictors associated with the recurrence of hallux valgus (HV) following surgery. METHODS A total of 198 symptomatic feet that underwent chevron osteotomy combined with a distal soft tissue procedure were enrolled and analyzed from 2 independent medical centers. The feet were grouped according to nonrecurrence or recurrence based on 1-year follow-up outcomes. Preoperative weightbearing radiographs and immediate postoperative nonweightbearing radiographs were obtained for each HV foot. Radiographic measurements (eg, HV angle and intermetatarsal angle) were acquired and used for ML model training. A total of 9 commonly used ML models were trained on the data obtained from one institute (108 feet), and tested on the other data set from another independent institute (90 feet) for external validation. Optimal feature sets for each model were identified based on a 2000-resample bootstrap-based internal validation via an exhaustive search. The performance of each model was then tested on the external validation set. The area under the curve (AUC), classification accuracy, sensitivity, and specificity of each model were calculated to evaluate the performance of each model. RESULTS The support vector machine (SVM) model showed the highest predictive accuracy compared to other methods, with an AUC of 0.88 and an accuracy of 75.6%. Preoperative hallux valgus angle, tibial sesamoid position, postoperative intermetatarsal angle, and postoperative tibial sesamoid position were identified as the most selected features by several ML models. CONCLUSION ML classifiers such as SVM could predict the recurrence of HV (an HVA >20 degrees) at a 1-year follow-up while identifying associated predictors in a multivariate manner. This study holds the potential for foot and ankle surgeons to effectively identify individuals at higher risk of HV recurrence postsurgery.
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Affiliation(s)
- Rui Zhao
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Guobin Wang
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Fengtan Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinchan Wang
- Department of Dermatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Zhang
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Dong Li
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Shen Liu
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Li
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Jiajun Song
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Fangyuan Wei
- Department of Hand and Foot Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
- Engineering Research Center of Chinese Orthopaedic and Sports Rehabilitation Artificial Intelligent, Ministry of Education, Beijing, China
| | - Chenguang Wang
- Department of Orthopedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
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Butler JJ, Hartman H, Rettig S, Konar K, Randall G, Samsonov AP, Kennedy JG. Similar outcomes following scarf-Akin osteotomy compared to scarf-alone osteotomy for the treatment of hallux valgus: A systematic review and meta-analysis. Foot Ankle Surg 2024; 30:299-308. [PMID: 38218662 DOI: 10.1016/j.fas.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/09/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The purpose of this systematic review and meta-analysis was to compare the clinical and radiographic outcomes between patients undergoing scarf osteotomy and scarf-Akin osteotomy for the management of hallux valgus deformity. METHODS A systematic review of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting clinical data following scarf osteotomy and scarf-Akin osteotomy for the treatment of hallux valgus were included and assessed. The level and quality of evidence of the included studies were also evaluated. RESULTS Four studies were included. In total, 388 patients (408 toes) underwent scarf osteotomy alone and 287 patients (295 toes) underwent scarf-Akin osteotomy for the treatment of hallux valgus deformity. There was no difference in postoperative American orthopedic foot and ankle society scores (p = 0.7828), visual analog scale scores (p = 0.4558), hallux valgus angle (p = 0.5116), intermetatarsal angle (p = 0.4830), proximal to distal phalangeal articular angle (p = 0.2411) between the scarf alone cohort and the scarf-Akin cohort. Similarly, there was no difference in complication rates (p = 0.6881) nor secondary surgical procedure rates (p = 0.3678) between the 2 cohorts. Finally, there was a higher recurrence rate in the scarf-alone cohort (11.4%) compared to the scarf-Akin cohort (5.7%), but this was not statistically significant (p = 0.4414). CONCLUSION This systematic review demonstrates lower recurrence rates following scarf-Akin osteotomy compared to scarf osteotomy alone for the treatment of hallux valgus deformity. No difference in complication rates were noted between the 2 cohorts. Our review demonstrates that both the scarf osteotomy and the scarf-Akin osteotomy may be effective and safe procedures, however, the scarf-Akin osteotomy may provide more long-term benefit in the setting of moderate to severe hallux valgus.
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Affiliation(s)
- James J Butler
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey St, 2nd floor, New York City, USA
| | - Hayden Hartman
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey St, 2nd floor, New York City, USA
| | - Samantha Rettig
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey St, 2nd floor, New York City, USA
| | - Kishore Konar
- School of Medicine, University of Buckingham, United Kingdom
| | - Grace Randall
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey St, 2nd floor, New York City, USA
| | - Alan P Samsonov
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey St, 2nd floor, New York City, USA
| | - John G Kennedy
- Foot and Ankle Division, Department of Orthopaedic Surgery, NYU Langone Health, 171 Delancey St, 2nd floor, New York City, USA.
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Kush S, Streeter SR, Jones ADC, Steineman B, Ellis SJ, Conti MS. Preoperative Degenerative Changes at the Tibial Sesamoid-Metatarsal Joint in Hallux Valgus: Association With Postoperative Patient-Reported Outcomes After Modified Lapidus Procedure. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241256370. [PMID: 38840786 PMCID: PMC11151770 DOI: 10.1177/24730114241256370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Background Degenerative changes at the sesamoid-metatarsal joints (SMJs) may be a source of pain following hallux valgus surgery. The aims of this study were to describe degenerative changes at the SMJs on weightbearing computed tomography (WBCT) scans and, secondarily, investigate their association with 1-year patient-reported outcome scores following a modified Lapidus procedure for hallux valgus. We hypothesized that reduced joint space in the SMJs would correlate with worse patient-reported outcomes. Methods Fifty-seven hallux valgus patients who underwent a modified Lapidus procedure had preoperative and minimum 5-month postoperative WBCT scans, and preoperative and at least 1-year postoperative PROMIS physical function (PF), pain interference, and pain intensity scores were included. Degenerative changes at the SMJs were measured using distance mapping between the sesamoids and first metatarsal head on preoperative and postoperative WBCT scans. The minimum and average distances between the first metatarsal head and tibial sesamoid (tibial-SMJ) for each patient preoperatively and postoperatively were measured. Sesamoid station was measured on WBCT scans using a 0 to 3 grading system. Linear regression was used to investigate the correlations between minimum preoperative and postoperative tibial-SMJ distances and 1-year postoperative PROMIS scores. Results The median minimum and average tibial-SMJ distances increased from 0.82 mm (interquartile range [IQR] 0.40-1.03 mm) and 1.62 mm (IQR 1.37-1.75 mm) preoperative to 1.09 mm (IQR 0.96-1.23 mm) and 1.73 mm (IQR 1.60-1.91 mm) postoperative (P < .001 and P < .001), respectively. In a subset of patients with complete sesamoid reduction, we found an association between preoperative minimum tibial-SMJ distance and 1-year postoperative PROMIS PF scores (coefficient 7.2, P = .02). Conclusion Following the modified Lapidus procedure, there was a statistically significant increase in the tibial-SMJ distance. Additionally, in patients with reduced sesamoids postoperatively, reduced preoperative tibial-SMJ distance correlated with worse PROMIS PF scores. Level of Evidence Level IV, case series.
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Affiliation(s)
- Sophie Kush
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Brett Steineman
- Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Scott J. Ellis
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Matthew S. Conti
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
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Hamre ME, Molund M, Nilsen F. A Cadaveric Study Verifying the Potential of a Rotational Biplanar Chevron Osteotomy to Correct the 3-Dimensional Hallux Valgus Deformity. Foot Ankle Spec 2024; 17:63S-67S. [PMID: 36285686 DOI: 10.1177/19386400221131910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Metatarsal pronation is present in 87% of patients with hallux valgus (HV) deformity. The chevron osteotomy is commonly used worldwide to correct mild to moderate HV deformities. Many modifications have been described, but few address the rotational deformity of the first metatarsal. The rotational biplanar chevron osteotomy (RBCO), described by M. Prado et al, presents a variation of a biplanar chevron osteotomy that can be used to address first metatarsal rotation. The objective of this study is to investigate and verify the technique of the RBCO. METHODS We conducted our study performing an RBCO on 9 cadaveric limbs. The technique uses a medial-based wedge parallel to the plantar limb of the osteotomy to make the distal fragment free to correct rotation. A goniometer was used by 2 individual surgeons to control the rotational correction achieved. RESULTS The osteotomy was considered simple to perform and we experienced no complications, such as fractures or instability. The result was satisfactory alignment and adequate stability. On average, a 2 mm wedge resulted in 11° of rotational correction. CONCLUSION We predict that RBCO can safely be used for correcting the metatarsal rotation when necessary in mild to moderate HV deformity foot. LEVELS OF EVIDENCE Level IV.
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Affiliation(s)
- Mikaela Engarås Hamre
- Orthopedic Department, Sykehuset i Østfold Kalnes (Østfold Hospital Trust), Grålum, Norway
| | - Marius Molund
- Orthopedic Department, Sykehuset i Østfold Kalnes (Østfold Hospital Trust), Grålum, Norway
| | - Fredrik Nilsen
- Orthopedic Department, Sykehuset i Østfold Kalnes (Østfold Hospital Trust), Grålum, Norway
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Del Vecchio JJ, Dealbera ED, Chemes LN, Slullitel G, Calvi JP, Dalmau-Pastor M. A Radiologic Triangle Sign for Percutaneous Adductor Tendon Release (PATR): Cadaveric Study and Case Series. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241241269. [PMID: 38559393 PMCID: PMC10981861 DOI: 10.1177/24730114241241269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background Combining osteotomies and soft tissue procedures is believed to reduce sesamoids in their anatomical position and maintain long-term correction when treating hallux valgus deformity. This study determines if a radiologic association exists between a radiolucent sign and a full percutaneous adductor tendon release (PATR), including a cadaveric study and a consecutive case series. Another aim was to determine the intra- and interobserver reliability of these observations. Methods A prospective observational study was made between 2018 and 2019. First, a PATR was done on cadaveric specimens and, after the procedures, dissected to correlate what was seen fluoroscopically. The clinical group included 39 feet that presented mild-to-moderate HV deformity and were treated with percutaneous osteotomies associated with PATR. Results Observers 1 and 2 saw a radioscopic radiolucent sign in 100% of cadavers and the patient population. They also observed a triangle-shaped image with an incidence of 75%, which we have named the "triangle sign." Conclusion The triangle sign may be helpful in the intraoperative confirmation of PATR and latero-plantar capsule release using this percutaneous technique. Level of Evidence Level II, development of diagnostic criteria.
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Affiliation(s)
- Jorge Javier Del Vecchio
- Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro–Hospital Universitario, Ciudad Autónoma de Buenos Aires (CABA), Argentina
- Department of Kinesiology and Physiatry, Universidad Favaloro, CABA, Argentina
- MIFAS (Minimally Invasive Foot and Ankle Society) by GRECMIP, Merignac, France
| | - Eric Daniel Dealbera
- Foot and Ankle Section, Fundación Favaloro–Hospital Universitario, Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA), Argentina
| | - Lucas Nicolás Chemes
- Foot and Ankle Section, Fundación Favaloro–Hospital Universitario, Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA), Argentina
| | - Gastón Slullitel
- Department of Foot and Ankle Surgery, Institute of Orthopedics “Dr. Jaime Slullitel,” Santa Fe, Argentine
| | - Juan Pablo Calvi
- Department of Foot and Ankle Surgery, Institute of Orthopedics “Dr. Jaime Slullitel,” Santa Fe, Argentine
| | - Miki Dalmau-Pastor
- MIFAS (Minimally Invasive Foot and Ankle Society) by GRECMIP, Merignac, France
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Watanabe K, Kubota M, Tanaka H, Nishiyama T, Hirao M, Fukushi JI, Kakihana M, Nozawa D, Okuda R. Japanese Orthopaedic Association (JOA) Clinical Practice Guidelines on the Management of Hallux Valgus - Secondary publication. J Orthop Sci 2024; 29:1-26. [PMID: 37451976 DOI: 10.1016/j.jos.2023.06.001] [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] [Received: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Kota Watanabe
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Japan.
| | - Makoto Kubota
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirofumi Tanaka
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Hyakutake Orthopedic Surgery and Sports Clinic, Saga, Japan
| | - Takayuki Nishiyama
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Makoto Hirao
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jun-Ichi Fukushi
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masataka Kakihana
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Japan
| | - Daisuke Nozawa
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryuzo Okuda
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, Kyoto, Japan
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7
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Wagner P, Wagner E. Republication of "Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO): Short-term Prospective Case Series With a Novel Technique and Topic Review". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231195049. [PMID: 37590285 PMCID: PMC10426300 DOI: 10.1177/24730114231195049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Background Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence IV, prospective case series.
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Affiliation(s)
- Pablo Wagner
- Orthopedic Department, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Hospital Militar de Santiago, Universidad de los Andes, Santiago, Chile
| | - Emilio Wagner
- Orthopedic Department, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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8
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Lalevee M, de Cesar Netto C, ReSurg, Boublil D, Coillard JY. Recurrence Rates With Longer-Term Follow-up After Hallux Valgus Surgical Treatment With Distal Metatarsal Osteotomies: A Systematic Review and Meta-analysis. Foot Ankle Int 2023; 44:210-222. [PMID: 36859795 DOI: 10.1177/10711007231152487] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Recurrence of hallux valgus (HV) following corrective surgery is a frequent concern. A recent systematic review estimated recurrence of HV in only 4.9%, which may be an underestimation, as most included studies had short- to mid-term follow-up. The purpose of this systematic review and meta-analysis was to assess long-term outcomes of distal osteotomies of the first metatarsal (M1) to treat HV without inflammatory disease or degenerative arthritis, and to assess HV recurrence rates reported in studies that had a minimum follow-up of 5 years. METHODS This systematic review conforms to the PRISMA guidelines. The authors conducted a search using PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. Studies that report outcomes of distal osteotomies of the M1 for noninflammatory and nondegenerative HV at a minimum follow-up of 5 years. RESULTS We found 17 eligible studies comprising 18 data sets, reporting outcomes of 4 categories of osteotomies: Chevron, Mitchell, Bösch, and "others." The HV recurrence rate was 64% considering the threshold of >15 degrees hallux valgus angle (HVA), 10% having >20 degrees, and 5% having >25 degrees. CONCLUSION At a minimum of 5 years following distal osteotomies of the M1, the mean weighted postoperative HVA was significantly higher for Mitchell osteotomies compared with the 3 other osteotomies reviewed. There were otherwise no significant differences in recurrence rates using the 3 HVA thresholds, or intermetatarsal angle among any of the surgical techniques reported in 2 or more studies. The pooled HV recurrence rates considering the various thresholds of HVA were as follows: 64% having >15 degrees, 10% having >20 degrees, and 5% having >25 degrees. The recurrence rates in the long term for all categories of surgical procedures suggest that better understanding of pathogenesis and prognosis of HV is required before modifying or introducing new surgical techniques. LEVEL OF EVIDENCE Level IV, meta-analysis.
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Affiliation(s)
- Matthieu Lalevee
- Department of Orthopedic Surgery, Rouen University Hospital, France.,CETAPS Laboratory - EA 3832, Faculty of Sports Sciences, University of Rouen Normandy, Mont Saint Aignan, France
| | - Cesar de Cesar Netto
- Carver College of Medicine, Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - ReSurg
- ReSurg SA, Nyon, Switzerland
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Abben KW, Sakow CF, Sorensen T, Chang HC, Boffeli TJ. First Tarsometatarsal Joint Fusion for Hallux Valgus Deformity: A Retrospective Comparison of Two Fixation Constructs Regarding Initial Maintenance of Correction and Complications: Traditional Crossing Screw Fixation Versus Dorsomedial Locking Plate and Intercuneiform Compression Screw. J Foot Ankle Surg 2023; 62:347-354. [PMID: 36272952 DOI: 10.1053/j.jfas.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 02/03/2023]
Abstract
Various fixation constructs exist to address hallux valgus when performing a first tarsometatarsal joint arthrodesis. The goal of this present study is to compare complication rates, and degree and maintenance of angular correction between a dorsomedial locking plate with intercuneiform compression screw construct versus traditional crossing solid screw fixation construct. The plate plus intercuneiform compression screw construct fixation utilized a combined sagittal saw and curette method of joint preparation while the crossed screw fixation group utilized a curette and bur technique. A retrospective review was conducted of consecutive patients who underwent a midfoot fusion using either constructs. Sixty four total feet in 56 patients were enrolled in the study. Twenty four consecutive patients (32 feet) who underwent a midfoot arthrodesis using the locking plate and intercuneiform fixation were fully fused (100%) by 10 weeks postoperatively, with no incidents of nonunion and one deep vein thrombosis event. Thirty two consecutive patients (32 feet) who underwent midfoot arthrodesis with crossing screw fixation had 2 nonunion events, one that was asymptomatic and the other that required a revision midfoot fusion. There was a statistically significant improvement from the pre-operative intermetatarsal angle, hallux abductus angle compared to the 10 week and 1 year radiographs (p < .05) for the entire cohort for both fixation constructs. There was a statistically significant increase in American College of Foot and Ankle Surgery first ray scores from pre-op to 1 year follow-up for both fixation constructs. Overall, the dorsomedial locking plate plus intercuneiform compression screw fixation construct better maintains Intermetatarsal angle (IMA) correction at midterm follow-up compared to the traditional crossing screw construct. Both cohorts overall demonstrate similar fusion rates at 10 weeks, nonunion events, incidences of broken hardware, hardware removal, deep vein thrombosis, neuritis at 1 year postoperatively, and hallux varus.
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Affiliation(s)
- Kyle W Abben
- Foot & Ankle Surgical Residency Program, Regions Hospital/HealthPartners Institute, TRIA Orthopedics Maple Grove, Maple Grove, MN
| | - Chloe F Sakow
- Foot & Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, Saint Paul, MN.
| | - Tyler Sorensen
- Foot & Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, Saint Paul, MN
| | - Howard C Chang
- Foot & Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, Saint Paul, MN
| | - Troy J Boffeli
- Foot & Ankle Surgery Residency Program, Regions Hospital/HealthPartners Institute for Education & Research, Saint Paul, MN
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10
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Lewis TL, Robinson PW, Ray R, Dearden PMC, Goff TAJ, Watt C, Lam P. Five-Year Follow-up of Third-Generation Percutaneous Chevron and Akin Osteotomies (PECA) for Hallux Valgus. Foot Ankle Int 2023; 44:104-117. [PMID: 36692121 DOI: 10.1177/10711007221146195] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Recent large studies of third-generation minimally invasive hallux valgus surgery (MIS) have demonstrated significant improvement in clinical and radiologic outcomes. It remains unknown whether these clinical and radiologic outcomes are maintained in the medium to long term. The aim of this study was to investigate the minimum 5-year clinical and radiologic outcomes following third-generation MIS hallux valgus surgery in the hands of a high-volume MIS surgeon. METHODS A retrospective observational single highly experienced MIS surgeon case series of consecutive patients undergoing primary isolated third-generation percutaneous chevron and Akin osteotomies (PECA) for hallux valgus with a minimum 60-month clinical and radiographic follow-up. Primary outcome was radiographic assessment of the hallux valgus angle (HVA) and intermetatarsal angle (IMA) preoperatively, 6 months, and ≥60 months following PECA. Secondary outcomes included the Manchester-Oxford Foot Questionnaire, patient satisfaction, EuroQol-5D visual analog scale and the visual analog scale for pain. RESULTS Between 2012 and 2014, 126 consecutive feet underwent isolated third-generation PECA, with complete data available for 78 (61.9%) feet. The median follow-up was 65.0 (IQR 64-69; range 60-88) months. There was a significant improvement in radiographic deformity correction; the median IMA improved from 12.0 degrees (interquartile range [IQR]: 10.8-14.2) to 6.0 degrees (IQR: 4.2-7.3) (P < .001), and the median HVA improved from 27.2 degrees (IQR: 20.6-34.4) to 7.2 degrees (IQR: 3.4-11.6). Median MOXFQ Index score at ≥60-month follow-up was 2.3 (IQR: 0.0-7.8). The radiographic recurrence rate (defined as HVA >15 degrees) was 7.7% at final follow-up. The complication rate was 4.8%. CONCLUSION Radiologic deformity correction for the 78 feet we were able to follow that had third-generation PECA performed by a single highly experienced MIS surgeon was found to be maintained at a mean follow-up of average 66.8 months, with a radiographic recurrence rate of 7.7%. Clinical PROMs and patient satisfaction levels were high and comparable to other third-generation studies with shorter duration of follow-up. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Thomas L Lewis
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Peter W Robinson
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Thomas A J Goff
- Mid Yorkshire Hospitals NHS Trust, Wakefield, United Kingdom
| | - Clare Watt
- Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
| | - Peter Lam
- Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
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11
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Li Y, Wang Y, Tang K, Tao X. Modified scarf osteotomy for hallux valgus: From a finite element model to clinical results. J Orthop Surg (Hong Kong) 2022; 30:10225536221143816. [PMID: 36459594 DOI: 10.1177/10225536221143816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Finite element (FE) analysis and clinical follow-up were used to evaluate the efficacy of modified scarf osteotomy for moderate-to-severe hallux valgus (HV). METHOD We retrospectively evaluated 42 patients (44 feet) who underwent modified rotational scarf osteotomy for moderate-to-severe HV at our institution between January 2010 and January 2019. Radiological indicators and subjective scores were recorded at different time points. To compare the results and elemental characteristics, a FE model of the metatarsophalangeal (MTP) joint that included anatomically realistic geometrical and structural characteristics was built. The biomechanical features and correction differences in dynamic loads as well as the incidence of troughing were estimated. RESULTS Both the hallux valgus angle (HVA) and intermetatarsal angle (IMA) showed significant improvement 6 weeks postoperatively (p < 0.05); additionally, the HVA increased from 6 weeks postoperatively to the last follow-up, while the IMA showed no significant changes (p > 0.05). The subjective scores significantly improved from the preoperative period to the last follow-up. The percentages of troughing and recurrence were remarkably low in our pilot study because of the innate stability of the modified rotated fixation. CONCLUSION Our preliminary findings suggest that modified rotational scarf osteotomy offers sufficient stability, correct HV deformity effectively, and good clinical outcomes for moderate to severe HV.
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Affiliation(s)
- Yan Li
- Department of Orthopaedics, Sports Medicine Center, 12525The First Affiliated Hospital of Army Military Medical University, Chongqing, China
| | - Yue Wang
- College of Physical Education and Health, 12524Chongqing Normal University, Chongqing, China
| | - Kanglai Tang
- Department of Orthopaedics, Sports Medicine Center, 12525The First Affiliated Hospital of Army Military Medical University, Chongqing, China
| | - Xu Tao
- Department of Orthopaedics, Sports Medicine Center, 12525The First Affiliated Hospital of Army Military Medical University, Chongqing, China
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Ledermann G, Baduell A, Testa E, Vega R, Ruiz P, Barrientos M, Poggio D. Short- and long-term results for severe hallux valgus correction using a first metatarsal distal osteotomy. Foot Ankle Surg 2022; 28:1458-1462. [PMID: 36055900 DOI: 10.1016/j.fas.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/29/2022] [Accepted: 08/17/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study is to analyze the short- and long-term results of severe hallux valgus (HV) treated with a L-Reverse osteotomy. METHODS Patients treated with L-Reverse osteotomy for severe HV between the years 2006-2015 were included. Patients were evaluated preoperatively, at 3 months and 4 or more years postoperatively. Changes in the HV angle (HVA) and intermetatarsal angle (IMA) were measured. Clinical outcomes were assessed using the AOFAS score. RESULTS 28 patients were included. Pre-operative IMA changed from 18.1° (18-18.9°) to 7° (6.3-8.5°), and HVA from 38.5° (34.5-41.3°) to 10.0° (8.4-11.8°) at 3 month follow up (p < 0.005). Long term follow up was of 5.6 (4.9-6.4) years. IMA value was 7.5° (6.1°-8.1°) and HVA was 10.1° (6.7°-16.3°), with no statistical difference with initial correction (p = 0.14). Median AOFAS score was 92.7 (89-4-96.1). CONCLUSION L-Reverse osteotomy can achieve correction of HV severe deformities with good outcomes in long term follow up. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Albert Baduell
- Department of Orthopedic Surgery, Hospital Clinic, Barcelona, Spain.
| | - Enrique Testa
- Department of Orthopedic Surgery, Hospital Clinic, Barcelona, Spain.
| | - Ricardo Vega
- Department of Orthopedic Surgery, Hospital Clinic, Barcelona, Spain.
| | - Pablo Ruiz
- Hospital de la Florida, Santiago, Chile.
| | | | - Daniel Poggio
- Department of Orthopedic Surgery, Hospital Clinic, Barcelona, Spain.
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13
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The Incidence of Complications Following Scarf Osteotomy for the Treatment of Hallux Valgus: A Systematic Review with Meta-Analysis. J Foot Ankle Surg 2022:S1067-2516(22)00340-4. [PMID: 37097272 DOI: 10.1053/j.jfas.2022.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
The Scarf osteotomy is a surgical procedure performed to correct a hallux valgus deformity. Multiple studies have supported use of the procedure with favorable outcomes. In contrast, there have been studies showing a significant complication rate with the procedure. Incidence of complications remains underreported in the literature. We performed a systemic review and meta-analysis examining a wide range of reported complications and associated clinical outcomes from the Scarf osteotomy. One hundred and sixteen publications were identified and 25 (21.6%) met our inclusion criteria. A total of 1583 Scarf procedures were included. Weighted mean follow-up was 26.4 months [range 12-168 months]. We found a 5.1% rate of recurrence, 3.5% rate of troughing, 1.0% rate of avascular necrosis, 1.8% rate of nonunion, 2.7% rate of malunion, 2.4% rate of infection, 5.3% rate of complex regional pain syndrome, and 3.4% rate of hallux varus. An average decrease in intermetatarsal angle of 6.3° was observed. No statistical difference was found in outcomes when comparing Scarf versus Scarf with additional procedure performed at time of surgery. To our knowledge, this systematic review and meta-analysis contains the highest number of Scarf procedures analyzed and presents complication rates on multiple adverse outcomes.
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Blouin C, Genet F, Denormandie P, Graff W, Perrier A. Development of a preoperative questionnaire to improve satisfaction with hallux valgus repair: A Delphi study. PLoS One 2022; 17:e0276303. [PMID: 36279269 PMCID: PMC9591061 DOI: 10.1371/journal.pone.0276303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Satisfaction with hallux valgus repair is often poor, despite good surgical outcomes. Many tools have been developed to assess the outcome of the procedure; however none evaluate the association between the initial motive for repair and the reasons for post-surgical dissatisfaction. The aim of this study was to develop a new tool to analyse the subjective and objective expectations of individuals during a pre-operative consultation for hallux valgus repair in order to improve post-surgical satisfaction. METHODS We first collected the reasons for dissatisfaction with repair from the medical files of dissatisfied individuals. Then, a steering committee of 4 French experts in the management of hallux valgus designed a questionnaire based on the reasons for dissatisfaction. We then used the DELPHI method to validate the questionnaire: we submitted the questionnaire to a panel of 34 francophone experts in hallux valgus repair for rating in 4 rounds. RESULTS The medical files of 853 individuals were reviewed and a 52-item questionnaire relating to expectations from hallux valgus surgery was drafted. After the 4 rounds, a final 44 item questionnaire reached consensus. Thirteen items related to clinical and psychological profile, 5 to pain, 9 to physical activity, 4 to aesthetics and 13 to footwear. CONCLUSION This tool should facilitate gathering of individuals' expectations from hallux valgus repair to ensure realistic goals and reduce post-surgical dissatisfaction.
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Affiliation(s)
- Cédric Blouin
- UFR Simone Veil-Santé, UR2020 Erphan, Université Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
- ISPC Synergies, Paris, France
- * E-mail:
| | - François Genet
- ISPC Synergies, Paris, France
- Département PARASPORT-SANTE, Unité Péri Opératoire du Handicap, (UPOH-Perioperative Disability Unit), Service de Médecine Physique et de Réadaptation, Hôpital Raymond-Poincaré, Groupe Hospitalo-Universitaire APHP-Université PARIS SACLAY, Garches, France
- UFR Simone Veil-Santé, END: ICAP, Inserm U1179, Université Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
| | - Philippe Denormandie
- Service de Chirurgie Orthopédique, Hôpital Raymond Poincaré, APHP, Garches, France
- Groupe Mutuelle Nationale des Hospitaliers (MNH), Paris, France
| | - Wilfrid Graff
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
| | - Antoine Perrier
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
- Laboratoire de Recherche Translationnelle et D’Innovation en Médecine et Complexité TIMC, CNRS, Grenoble, France
- Service de Diabétologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Weigelt L, Wild L, Winkler E, Torrez C, Jentzsch T, Wirth SH. Effect of the Reversed L-Shaped Osteotomy on the Round Sign: Not All Hallux Valgus Deformities May Need Proximal Derotation to Correct the Radiographic Appearance of Metatarsal Pronation. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221115697. [PMID: 35968539 PMCID: PMC9364216 DOI: 10.1177/24730114221115697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Metatarsal pronation has been claimed to be a risk factor for hallux valgus
recurrence. A rounded shape of the lateral aspect of the first metatarsal
head has been identified as a sign of persistent metatarsal pronation after
hallux valgus correction. This study investigated the derotational effect of
a reversed L-shaped (ReveL) osteotomy combined with a lateral release to
correct metatarsal pronation. The primary hypothesis was that most cases
showing a positive round sign are corrected by rebalancing the
metatarsal-sesamoid complex. We further assumed that the inability to
correct the round sign might be a risk factor for hallux valgus
recurrence. Methods: We retrospectively evaluated 266 cases treated with a ReveL osteotomy for
hallux valgus deformity. The radiologic measurements were performed on
weightbearing foot radiographs preoperatively, at an early follow-up
(median, 6.2 weeks), and the most recent follow-up (median, 13 months).
Univariate and multivariate logistic regression analyses identified risk
factors for hallux valgus recurrence (hallux valgus angle [HVA] ≥ 20
degrees). Results: A preoperative positive radiographic round sign was present in 40.2% of the
cases, of which 58.9% turned negative after the ReveL osteotomy
(P < .001). Hallux valgus recurred in 8.6%. Risk
factors for recurrence were a preoperative HVA >30 degrees (odds ratio
[OR] = 5.3, P < .001), metatarsus adductus (OR = 4.0,
P = .004), preoperative positive round sign (OR = 3.3,
P = .02), postoperative HVA >15 degrees (OR = 74.9;
P < .001), and postoperative positive round sign (OR
= 5.3, P = .008). Cases with a positive round sign at the
most recent follow-up had a significantly higher recurrence rate than those
with a negative round sign (22.7% vs 5.9%, P <
.001). Conclusion: The ReveL osteotomy corrected a positive round sign in 58.9%, suggesting that
not all hallux valgus deformities may need proximal derotation to negate the
radiographic appearance of the round sign. A positive round sign was found
to be an independent risk factor for hallux valgus recurrence. Further
3-dimensional analyses are necessary to better understand the effects and
limitations of distal translational osteotomies to correct metatarsal
pronation. Level of Evidence: Level IV, case series.
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Affiliation(s)
- Lizzy Weigelt
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Linda Wild
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Elin Winkler
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Carlos Torrez
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Thorsten Jentzsch
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Stephan H. Wirth
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
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Kaufmann G, Braito M, Wagner M, Putzer D, Ulmer H, Dammerer D. Correlation of Loss of Correction With Postoperative Radiological Factors After Distal Chevron Osteotomy in Dependence of Concomitant Akin Osteotomy. J Foot Ankle Surg 2022; 61:785-791. [PMID: 34973863 DOI: 10.1053/j.jfas.2021.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 09/12/2020] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
Loss of correction is frequently observed following hallux valgus correction and is associated with recurrence of a hallux valgus deformity. The purpose of this study was to correlate loss of correction and radiological parameters following distal chevron (Group C) and combined chevron/akin (Group AC) osteotomy. A total of 859 feet were included for analysis and grouped according to treatment with a distal chevron osteotomy alone or a combined chevron/akin osteotomy. Radiographs were evaluated preoperatively, postoperatively, after 6 weeks, 3 months and, if available, at long term follow-up with a mean of 34.2 (range 7.5-155.3) months. With the exception of the proximal to distal phalangeal articular angle (PDPAA), preoperative deformity was comparable between both groups. Significant correction of all examined parameters (p < .001) was seen. Loss of correction at 6 weeks with minor deterioration until follow-up was also detected, with group AC somewhat better than Group C. A strong correlation with loss of correction was found for the postoperative hallux valgus angle (HVA) (p < .002), intermetatarsal angle (IMA) (p < .001), distal metatarsal articular angle (DMAA) (p < .002), positioning of the sesamoids (p < .002) and joint congruity (p < .035) in Group C and for the DMAA (p < .033) and HVA (p < .046) in Group AC. Multiple postoperative radiological parameters correlated with loss of correction following distal chevron osteotomy. In Group AC only postoperative HVA and DMAA determined loss of correction. Correction of the deformity in Group AC showed greater stability.
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Affiliation(s)
| | - Matthias Braito
- Department of Orthopedic Surgery, District Hospital St. Johann, St. Johann, Austria
| | - Moritz Wagner
- Department of Orthopedic Surgery, District Hospital St. Johann, St. Johann, Austria
| | - David Putzer
- Department of Experimental Orthopedics, Medical University of Innsbruck, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Dammerer
- Senior Author, Department of Orthopedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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17
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The use of intramedullary devices for fixation of metatarsal osteotomies in hallux valgus surgery - A systematic review. Foot Ankle Surg 2022; 28:483-491. [PMID: 35027311 DOI: 10.1016/j.fas.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/29/2021] [Accepted: 12/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux valgus is a common foot condition with numerous surgical techniques described. Minimally invasive surgery is becoming more popular, with resultant development of suitable fixation devices. The aim of this systematic review was to evaluate the evidence on the use of intramedullary devices in hallux valgus first metatarsal corrective osteotomies, and describe clinical and radiological outcomes, with an overview of techniques and implants used. METHODS We searched PubMed, Medline, Embase and EMCare databases, conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Radiological outcomes including the hallux valgus angle (HVA) and intermetatarsal angle (IMA) were recorded, as well as clinical outcome scores and complications. Methodological quality of included studies was assessed using the MINORS score. RESULTS Ten studies were included, comprising 696 feet in 745 patients. Data pooling and metanalysis was not possible due to overall low quality of evidence. Four implants were reported (Endolog, ISO Plate, V-Tek Plate, Link Fixator) and used with distal first metatarsal osteotomies, with improvement in HVA, IMA, and clinical outcome scores comparable to other fixation techniques. There were no reported cases of non-union. Complication rates were variable (all cause range of 0-21%) across all studies, with an overall low rate. CONCLUSION Intramedullary devices are viable and safe to use for hallux valgus first metatarsal osteotomies, with comparable radiological and functional outcomes to other techniques. Current evidence base is of low methodological quality, therefore high quality studies are required to further evaluate these devices.
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18
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Hernández-Castillejo LE, Martínez-Vizcaíno V, Álvarez-Bueno C, Quijada-Rodríguez JL, Alonso-Galán M, Garrido-Miguel M. Effectiveness of hallux valgus surgery on improving health-related quality of life: A follow up study. Foot Ankle Surg 2022; 28:431-437. [PMID: 34454834 DOI: 10.1016/j.fas.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux valgus (HV) negatively impacts health-related quality of life (HRQoL). Patientreported outcome measures (PROMs) are increasingly used in clinical studies of the foot and ankle. We aimed to evaluate the effect of HV surgery on PROMs (i.e., pain scales, general HRQoL, and region-specific scales) and radiological angles. Additionally, we aimed to determine whether the effect on these outcomes depends on the type of surgery (including open and percutaneous techniques) and if it is influenced by potential confounding factors (i.e., age, HVA, 1-2 IMA, body mass index (BMI), and distal metatarsal articular angle (DMAA). METHODS This was a longitudinal prospective study. We collected the clinical data of all patients who underwent surgery for symptomatic HV deformity in the orthopedic department of the Virgen de la Luz Hospital of Cuenca (Spain).The clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Hallux metatarsophalangeal-interphalangeal (HMI) scale, visual analogue scale (VAS), Manchester Oxford foot questionnaire (MOXFQ), short form health survey (SF-12) and European Quality of Life-5 Dimensions (EQ-5D). RESULTS A total of 72 patients (70 women, 97.2%) were included in the study 72 (72 feet).The AOFAS pre-post-surgery score changed from 42.16 (SD: 10.11) to 83.31 (SD: 6.23). Considering AOFAS domains, the pre-post change was from 14.17 (SD: 9.15) to 33.19 (SD: 4.69) for pain, from 27.22 (SD: 3.90) to 37.94 (SD: 2.78) for function, and from 0.78 (SD: 2.38) to 12.18 (SD: 3.45) for alignment. For other clinical outcomes was VAS score from 5.01(SD: 1.26) to 1.26 (SD: 0.96) and MOXFQ score from 61.44 (SD: 7.09) to 12.35 (SD: 4.85). SF-12 (physical) changed from 36.26 (SD: 5.32) to 47.06 (SD: 4.82), SF-12 (mental) from 38.23 (SD: 8.04) to 46.49 (SD: 4.16), and EQ5-D from 0.64 (SD: 0.008) to 0.90 (SD: 0.10). CONCLUSIONS Our data confirmed the improvements in the clinical and radiological outcomes after HV surgery, and provided some evidence of these improvements not depending on the type of surgery or on some potential confounding factors such as BMI, HVA, 1-2 IMA, and DMAA.
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Affiliation(s)
- Luis Enrique Hernández-Castillejo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Hospital Virgen de La Luz, Department of Orthopedic Surgery, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.
| | | | | | - Miriam Garrido-Miguel
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Faculty of Nursing, Universidad de Castilla-La Mancha, Albacete, Spain
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Abstract
Hallux valgus deformity is nowadays one of the most common and symptomatic disorders affecting the foot. Surgical corrections of hallux valgus deformity are among the most common orthopedic procedures. Despite the general high success rate complications can occur. The treatment of complications start before the first incision has been performed by thorough preoperative planning and choice of the right procedure. Once the complication is evident, thorough planning is necessary to address the patient's individual needs. In this paper the treatment of recurrent hallux valgus, hallux varus, malunion, and avascular necrosis are discussed.
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Affiliation(s)
- Hans-Jörg Trnka
- Foot and Ankle Center Vienna, Alserstrasse 43/8d, Vienna 1080, Austria.
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Najefi AA, Katmeh R, Zaveri AK, Alsafi MK, Garrick F, Malhotra K, Patel S, Cullen N, Welck M. Imaging Findings and First Metatarsal Rotation in Hallux Valgus. Foot Ankle Int 2022; 43:665-675. [PMID: 35135368 DOI: 10.1177/10711007211064609] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Failure to identify and correct malrotation of the first metatarsal may lead to recurrent hallux valgus deformity. We aimed to identify the proportion of hallux valgus patients with increased first metatarsal pronation using weightbearing computed tomography (WBCT) and to identify the relationship with conventional radiographic measurements. METHODS WBCT scans were analyzed for 102 feet with a hallux valgus angle (HVA) and intermetatarsal angle (IMA) greater than or equal to 16 and 9 degrees, respectively. Metatarsal pronation angle (MPA), alpha angle, sesamoid rotation angle (SRA), and sesamoid position were measured on standardized coronal WBCT slices. Pronation was recorded as positive. Hindfoot alignment angle (HAA) was assessed using dedicated software. Pearson correlation and multiple regression analyses were used to assess differences between groups. RESULTS Mean HVA was 29.8±9.4 degrees and mean IMA was 14.1±3.7 degrees. Mean MPA was 11.9±5.8 (range 0-26) degrees and mean alpha angle was 11.9±6.8 (range -3 to 29) degrees. In a previous study, we demonstrated the upper limit of normal MPA as 16 degrees and alpha angle as 18 degrees. Based on these criteria, we identified abnormal metatarsal pronation in 32 feet (31.4%). We found a strong positive correlation between SRA and HVA/IMA (R = 0.67/0.60, respectively, P < .001). IMA and HAA weakly correlated with MPA and alpha angle (IMA: R = 0.26/0.27, respectively, P < .01; HAA: R = 0.26/0.27, respectively, P < .01). Regression analyses suggested that increasing IMA was the most significant radiographic predictor of increased pronation. In this cohort, there was no correlation between HVA or sesamoid position and MPA / alpha angle (HVA: P = .36/.12, respectively, sesamoid position, P = .86/.77, respectively). CONCLUSION In this cohort of 102 feet that met plain radiographic criteria for hallux valgus deformity, first metatarsal pronation was found abnormal in 31.4% of patients. We found a weak association between the IMA and hindfoot valgus, but not the HVA.
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Affiliation(s)
- Ali-Asgar Najefi
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Rateb Katmeh
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Amit Kamal Zaveri
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Mohammad Khalid Alsafi
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Frances Garrick
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Karan Malhotra
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Shelain Patel
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Nicholas Cullen
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
| | - Matthew Welck
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom
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Klos K, Lenz M, Hofmann GO, Schubert W, Knobe M, Roth KE, Simons P, Aurich M. The Correction Potential of the Lateral Release of the Hallux Valgus: A Comparative Anatomical Study of Minimally Invasive Versus Open Surgical Technique Using a Dorsal Approach. Indian J Orthop 2022; 56:887-894. [PMID: 35547352 PMCID: PMC9043079 DOI: 10.1007/s43465-021-00575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/18/2021] [Indexed: 02/04/2023]
Abstract
Background Lateral release (LR) is an integral part of surgical correction of hallux valgus. A comparison was made between the open and minimally invasive LR techniques using a dorsal approach. The reliability and safety of the two methods were compared. Besides, the release of specific structures was investigated with special emphasis on ascertaining if the release was partial or a total one. Methods In this study on cadavers, LR was performed on nine pairs of foot and ankle specimens. The group assignments were randomized for each case. The operations were followed by anatomical preparation, data collection, photo documentation, and statistical analysis. Results A statistically significant advantage was observed with the open dorsal approach as there was a complete release of the adductor hallucis muscle from the lateral sesamoid and the lateral metatarsosesamoid ligament (p = 0.015 in each case). In terms of releasing the adductor hallucis muscle from the proximal phalanx, the lateral joint capsule, and the lateral collateral ligament, none of the investigated procedures showed better performance. However, open dorsal access tends to show a higher degree of release more frequently. Conclusions Splitting of the lateral joint capsule, including the lateral collateral ligament and lateral metatarsosesamoid ligament via the dorsal approach can be performed reliably and completely using the open surgical technique. The open dorsal technique shows better rates of detachment when the adductor hallucis muscle is released from the lateral sesamoid. Both techniques resulted in incomplete release of the adductor hallucis muscle from the proximal phalanx. Study Type Therapeutic-investigating the results of a treatment. Level of Evidence II (Prospective cohort study). Supplementary Information The online version contains supplementary material available at 10.1007/s43465-021-00575-3.
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Affiliation(s)
- Kajetan Klos
- Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
- Gelenkzentrum Rhein-Main, Fuß- Und Sprunggelenkschirurgie, Frankfurter Straße 94, 65239 Hochheim, Germany
| | - Mark Lenz
- Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Gunther O. Hofmann
- Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
- Department of Trauma- and Reconstructive Surgery, Berufsgenossenschaftliche Kliniken Bergmannstrost, Merseburger Str. 165, 06112 Halle (Saale), Germany
| | - Wiebke Schubert
- Department of Anesthesiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16, Switzerland
| | - Klaus Edgar Roth
- Gelenkzentrum Rhein-Main, Fuß- Und Sprunggelenkschirurgie, Frankfurter Straße 94, 65239 Hochheim, Germany
| | - Paul Simons
- Gelenkzentrum Rhein-Main, Fuß- Und Sprunggelenkschirurgie, Frankfurter Straße 94, 65239 Hochheim, Germany
| | - Matthias Aurich
- Department of Trauma- and Reconstructive Surgery, Berufsgenossenschaftliche Kliniken Bergmannstrost, Merseburger Str. 165, 06112 Halle (Saale), Germany
- Section of Trauma- and Reconstructive Surgery, Department of Orthopaedics, Trauma- and Reconstructive Surgery, University Hospital Halle, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
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22
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Meyr AJ, Doyle MD, King CM, Kwaadu KY, Nasser EM, Ramdass R, Theodoulou MH, Zarick CS. The American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Hallux Valgus. J Foot Ankle Surg 2022; 61:369-383. [PMID: 34706857 DOI: 10.1053/j.jfas.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | - Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship - Palo Alto Medical Foundation, Mountain View, CA
| | - Christy M King
- Residency Director, Kaiser San Francisco Bay Area Foot & Ankle Residency Program and Attending Surgeon, Kaiser Foundation Hospital, Oakland, CA
| | - Kwasi Y Kwaadu
- Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| | | | - Roland Ramdass
- Residency Training Committee, INOVA Fairfax Medical Campus, Fairfax, VA
| | - Michael H Theodoulou
- Chief Division of Podiatric Surgery, Cambridge Health Alliance, and Instructor of Surgery, Harvard Medical School, Boston, MA
| | - Caitlin S Zarick
- Assistant Professor, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
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23
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Tay AYW, Goh GS, Koo K, Yeo NEM. Third-Generation Minimally Invasive Chevron-Akin Osteotomy for Hallux Valgus Produces Similar Clinical and Radiological Outcomes as Scarf-Akin Osteotomy at 2 Years: A Matched Cohort Study. Foot Ankle Int 2022; 43:321-330. [PMID: 34609174 DOI: 10.1177/10711007211049193] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The minimally invasive chevron-Akin (MICA) osteotomy is an increasingly popular technique for the correction of hallux valgus. However, there is a paucity of literature comparing it with traditional open techniques. The purpose of this study was to compare the clinical and radiological outcomes of the MICA osteotomy using a new-generation MICA screw and scarf-Akin osteotomy for hallux valgus correction. METHODS Thirty cases of MICA osteotomy were propensity score matched 1:1 with a control group of 30 scarf-Akin osteotomy cases. The groups were matched for age, sex, body mass index, preoperative visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) metatarsophalangeal-interphalangeal (MTP-IP) score, 36-Item Short-Form Health Survey (SF-36) physical component score (PCS) and mental component score (MCS), preoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), and concomitant procedures. Outcomes were compared at 6 and 24 months postoperatively. Early postoperative VAS scores were also compared. RESULTS Both groups demonstrated significant improvements in VAS score, AOFAS score, and SF-36 PCS and MCS at 6 and 24 months postoperatively. For the MICA group, HVA improved from 23.5 to 7.7 degrees, and IMA improved from 13.5 to 7.5 degrees. For the scarf-Akin osteotomy group, HVA improved from 23.7 to 9.3 degrees, and IMA improved from 13.6 to 7.8 degrees. The first 24-hour postoperative VAS score was significantly lower in the MICA group compared with the scarf-Akin group (2.0 ± 2.0 vs 3.4 ± 2.6, P = .029). However, there was no significant difference in clinical or radiological outcomes between the groups at 6 and 24 months. CONCLUSION The MICA procedure with the new-generation MICA screw is an attractive option for the correction of hallux valgus, yielding similar midterm radiological and clinical outcomes compared with the well-established scarf-Akin osteotomy. The first 24-hour postoperative VAS score in the MICA group was also statistically lower, although its clinical significance remains to be determined. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Adriel You Wei Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.,The Bone and Joint Centre, Mount Elizabeth Hospital, Singapore, Singapore
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24
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Hartenbach F, Höger B, Kristen KH, Trnka HJ. Interdigital vs Transarticular Lateral Release With Scarf Osteotomy. Foot Ankle Int 2022; 43:193-202. [PMID: 34414786 DOI: 10.1177/10711007211035374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We compare the clinical and radiographic outcomes of the interdigital approach vs the medial transarticular approach for lateral release combined with scarf osteotomy. METHODS Seventy-seven feet with moderate to severe hallux valgus underwent scarf osteotomy and lateral soft tissue release, using an interdigital approach (n = 36) vs medial transarticular approach (n = 41). The clinical measurements (range of motion, American Orthopaedic Foot & Ankle Society [AOFAS] score) and radiographic data were evaluated preoperatively and at final follow-up (93-124 months postoperatively). Additionally, the numeric pain rating scale and Foot and Ankle Outcome score [FAOS] were assessed postoperatively. RESULTS The AOFAS score improved from 60 (q1 = 54, q3 = 70) to 93 (q1 = 85, q3 = 98) in the transarticular group, and from 59 (q1 = 50, q3 = 64) to 95 (q1 = 85, q3 = 100) in the interdigital group. The hallux valgus angle improved from 35.7±6.5 degrees to 15.5±7.6 degrees in the transarticular group, and from 36.0±6.8 degrees to 12.9±13.0 degrees in the interdigital group. The intermetatarsal angle improved from 16.5±2.5 degrees to 6.5±2.7 degrees within the transarticular group and from 17.2±2.5 degrees to 7.3±4.3 degrees in the interdigital group. None of the clinical or radiographic parameters showed any significant differences between the treatment groups. CONCLUSION Comparison of outcomes between the interdigital approach and the transarticular approach for lateral soft-tissue release with scarf osteotomy are equally successful. The transarticular approach can thus be considered safe and effective, with the additional benefits of just one scar as opposed to 2. LEVEL OF EVIDENCE Level III, therapeutic.
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Affiliation(s)
- Florian Hartenbach
- Foot & Ankle Centre Vienna, Vienna, Austria
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Brigitta Höger
- Institute of Sport Science, University of Vienna, Vienna, Austria
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25
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Najefi AA, Malhotra K, Patel S, Cullen N, Welck M. Assessing the Rotation of the First Metatarsal on Computed Tomography Scans: A Systematic Literature Review. Foot Ankle Int 2022; 43:66-76. [PMID: 34167335 DOI: 10.1177/10711007211020676] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus is a multiplanar deformity that is often treated on the basis of 2-dimensional (2D) parameters and radiographs. Recurrence rates after surgical correction remain high, and failure to correct pronation of the metatarsal is increasingly stipulated as being part of the problem. Multiple methods of assessing metatarsal pronation have been proposed. METHODS We performed a systematic literature review identifying studies that measured metatarsal pronation and torsion on computed tomography (CT) scans. Specific methodology, patient groups, results, and reliability assessments were all reported. RESULTS We identified 14 studies that fulfilled the inclusion criteria. Eleven studies measured 2D values on CT scan, and 3 studies used computer-based 3-dimensional (3D) modeling and artificial intelligence systems to help calculate pronation. Metatarsal pronation angle, α angle, sesamoid rotation angle, and measurements for torsion were the most commonly used methods. All angles and measurements were performed as 2D measurements, but the metatarsal pronation angle was also performed with 3D modeling. Reliability and reproducibility of the α angle and metatarsal pronation angle were excellent, despite being performed on studies with small numbers. CONCLUSION Multiple methods have been reported to demonstrate first metatarsal pronation on CT, of which the α angle and the metatarsal pronation angle are the most pragmatic and useful in a clinical setting. Further work is needed to further validate the reliability of these measurements in larger series and to identify normal pronation and metatarsal torsion on weightbearing imaging. Further work is required to determine whether addressing pronation reduces recurrence rates and improves outcomes in surgery for hallux valgus. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Ali-Asgar Najefi
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Karan Malhotra
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Shelain Patel
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Nicholas Cullen
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Matthew Welck
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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26
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The effect of Scarf osteotomy on the distal metatarsal articular angle in hallux valgus: a case series. LA TUNISIE MEDICALE 2022; 100:66-71. [PMID: 35822335 PMCID: PMC9006791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hallux valgus is a deformity of the forefoot involving a phalangeal valgus and a metatarsal adductus. In most cases its correction requires surgical treatment with different types of osteotomies. The best known is Scarf osteotomy. AIM To study the effet of Scarf osteotomy on distal metatarsal articular angle (DMAA) as well as the validitiy of this angle and the value of its correction after review of the literature. METHODS It was a retrospective study including patients operated on for severe hallux valgus by a Scarf osteotomy. The clinical assessment was based on the the American-Orthopedic-Foot-and-Ankle-society (AOFAS) score. Radiologically, we calculated the metatarsophalangeal angle, the inter-metatarsal angle and the DMAA. This assessment was performed preoperatively and one year postoperatively. RESULTS We collected 37 cases of evolved hallux valgus. The average AOFAS score went from 60.7 to 85.8 / 100 postoperatively with a gain of 25 points. We've noted a significant correction of the 3 angular measurements at one year postoperatively (the metatarsophalangeal angle, the inter-metatarsal angle and the DMAA) which went from 38.8° to 20.5°, from 17° at 10° and 13.5° to 8.5° respectively (p<0.05). CONCLUSION The literature has shown that there is no consensus regarding the effect of HV surgery on the DMAA. As for the accuracy, reproducibility and interest of correcting this angle we deduce that the DMAA is an interesting measure in the pathology of HV. Its correction seems not to be necessary in order not to hamper the correction of metatarsus varus. But in cases where the preoperative DMAA is high (> 15 °), efforts should be made to correct it to avoid recurrence.
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27
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Ezzatvar Y, López-Bueno L, Fuentes-Aparicio L, Dueñas L. Prevalence and Predisposing Factors for Recurrence after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10245753. [PMID: 34945049 PMCID: PMC8708542 DOI: 10.3390/jcm10245753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 01/21/2023] Open
Abstract
Recurrence is a frequent and undesirable outcome after hallux valgus (HV) surgery. However, the prevalence of HV recurrence and the pre- and postoperatory factors associated with it have not been adequately studied. This study aimed to quantify the prevalence rate of HV recurrence and to analyze its predisposing factors. MEDLINE and EMBASE databases were systematically searched for observational studies including individuals undergoing HV surgical correction. The random-effects restricted maximum likelihood model was used to estimate the pooled effect size (correlation coefficient (r)). Twenty-three studies were included, yielding a total of 2914 individuals. Pooled prevalence of HV recurrence was 24.86% (95% confidence interval (CI), 19.15 to 30.57, I2 = 91.92%, p = 0.00). Preoperative HV angle (HVA) (r = 0.29; 95% CI, 0.14 to 0.43) and preoperative intermetatarsal angle (IMA) (r = 0.13; 95% CI, 0.00 to 0.27) showed a moderate positive relationship with recurrence. Postoperative HVA (r = 0.57; 95% CI, 0.21 to 0.94) and sesamoid position (r = 0.46; 95% CI, 0.31 to 0.60) showed strong relationships with recurrence. In conclusion, preoperative HVA, IMA, and postoperative HVA and sesamoid position are significant risk factors for HV recurrence, and the association of these factors with recurrence is affected by age.
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Affiliation(s)
- Yasmin Ezzatvar
- Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Laura López-Bueno
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Correspondence:
| | - Laura Fuentes-Aparicio
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (L.F.-A.); (L.D.)
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (L.F.-A.); (L.D.)
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28
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Rouveyrol M, Harrosch S, Curvale G, Rochwerger A, Mattei JC. Does screwless scarf osteotomy for hallux valgus increase the risk of transfer metatarsalgia? Orthop Traumatol Surg Res 2021; 107:102853. [PMID: 33578039 DOI: 10.1016/j.otsr.2021.102853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/08/2020] [Accepted: 07/01/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The scarf osteotomy is a reliable surgical technique for treating hallux valgus. The aim of our study was to analyze the occurrence of transfer metatarsalgia after surgery on the first ray using a screwless Scarf osteotomy technique that we have been using in our department since 1995, which consists of stabilization by axial impaction without internal fixation. We hypothesized that the alleged shortening of the first metatarsal produced by this technique may be at the origin of postoperative metatarsalgia. PATIENTS AND METHODS This was a case series of first ray metatarsal screwless Scarf osteotomies reviewed in the medium term. We did a clinical and radiological review of all patients operated using this technique between 2012 and 2017 who did not meet the following exclusion criteria: procedure on the other lateral metatarsals, concurrent hindfoot pathology, incomplete medical records. RESULTS Of 114 feet, 96 were included in the study and 18 were excluded. The mean follow-up was 1 year and 8 months [1-4years]. The mean AOFAS score was 90.3 and 96% of patients were either satisfied or very satisfied with the outcome. All the parameters improved significantly: shoe wearing, pain, function, alignment. Fourteen feet had transfer metatarsalgia, which appeared during the first year postoperative (AOFAS 75/100). Ten other complications occurred: two Morton's neuromas, three cases of complex regional pain syndrome, one superficial infection, one paresthesia, two recurrences with surgical revision, one nonunion. No general complications were found. Based on radiographs, the mean M1 shortening was 3.3mm (6.3mm in metatarsalgia group versus 3.0 mm in the non-metatarsalgia group, P=0.2) and the mean angular correction was 16.2° (±6°). DISCUSSION The overall results of screwless Scarf osteotomy are comparable and satisfactory, allowing large deformities to be corrected (28°±8° preoperatively in our cohort). M1 shortening and the transfer metatarsalgia rate appear to be higher than with other techniques. CONCLUSION Screwless scarf osteotomy of M1 yields good functional and radiological outcomes in the medium term. However, it appears to cause more shortening and transfer metatarsalgia. LEVEL OF EVIDENCE IV Retrospective, non-interventional in current practice (Recommendation grade C, low level of scientific proof).
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Affiliation(s)
| | - Sylvain Harrosch
- Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Georges Curvale
- Assistance Publique des Hopitaux de Marseille, Marseille, France
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29
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McAleer JP, Dayton P, DeCarbo WT, Hatch DJ, Smith WB, Ray JJ, Santrock RD. A Systematic Approach to the Surgical Correction of Combined Hallux Valgus and Metatarsus Adductus Deformities. J Foot Ankle Surg 2021; 60:1048-1053. [PMID: 34167887 DOI: 10.1053/j.jfas.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/18/2020] [Indexed: 02/03/2023]
Abstract
The presence of metatarsus adductus (MTA) adds complexity to the diagnosis and treatment of hallux valgus (HV). Identification and careful analysis of these combined deformities is of paramount importance. The inability to completely correct HV and an increased incidence of recurrence has been established when MTA deformity is present. We present an option for correction of the combined deformities with multiplanar angular correction arthrodesis of the first, second, and third tarsometatarsal (TMT) joints.
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Affiliation(s)
- Jody P McAleer
- Department of Podiatry, Jefferson City Medical Group, Jefferson City, MO.
| | - Paul Dayton
- Foot & Ankle Center of Iowa, Midwest Bunion Center, Ankeny, IA
| | | | | | - W Bret Smith
- Mercy Orthopedic Associates, Mercy Regional Medical Center, Durango, CO
| | - Justin J Ray
- Department of Orthopaedics, West Virginia University, Morgantown, WV
| | - Robert D Santrock
- Department of Orthopaedics, West Virginia University, Morgantown, WV
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30
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Clarke TAC, Platt SR. Treatment of hallux valgus by Scarf osteotomy - rates and reasons for recurrence and rates of avascular necrosis: A systematic review. Foot Ankle Surg 2021; 27:622-628. [PMID: 32891491 DOI: 10.1016/j.fas.2020.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/15/2020] [Accepted: 08/24/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND We reviewed the rates of and reasons for hallux valgus (HV) recurrence and the rates of avascular necrosis following Scarf osteotomy. METHODS We searched the Cochrane Library, PubMed, and Embase databases for studies reporting operative management of HV using Scarf osteotomy. The primary endpoints were reasons for and rates of HV recurrence. The secondary endpoint was the rate of avascular necrosis. RESULTS We included 15 studies with 946 operations for HV. Seven studies reported no recurrence, six reported recurrence rates of 3.6-11.3%, one reported a recurrence rate of 30%, and one reported a recurrence rate of 78%. Thirteen studies (678 feet) reported other complications from Scarf osteotomy without avascular necrosis. CONCLUSIONS Although HV recurrence is not uncommon following Scarf osteotomy, patient-related factors, surgical competence, and longer follow-up are more likely to be associated with recurrence. Avascular necrosis is an infrequent complication in HV patients treated using Scarf osteotomy.
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Affiliation(s)
- Thomas A C Clarke
- Department of Musculoskeletal Services - Surgical, Anaesthetics and Procedural Services (SaPS), Gold Coast University Hospital, Gold Coast Health, 1 Hospital Boulevard, Southport, Queensland 4215, Australia.
| | - Simon R Platt
- Department of Musculoskeletal Services - Surgical, Anaesthetics and Procedural Services (SaPS), Gold Coast University Hospital, Gold Coast Health, 1 Hospital Boulevard, Southport, Queensland 4215, Australia
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31
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Biz C, Crimì A, Fantoni I, Tagliapietra J, Ruggieri P. Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus. Foot Ankle Int 2021; 42:409-424. [PMID: 33319594 DOI: 10.1177/1071100720969676] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study was aimed at assessing clinical and radiographic outcomes of the Minimally Invasive Intramedullary Nail Device (MIIND) to correct moderate to severe hallux valgus (HV) and the long-term persistence of its effects. METHODS This case series study involved 100 patients, 84 women and 16 men (mean age, 59 years), who underwent the MIIND procedure with a mean follow-up of 97 months. Assessment was performed preoperatively, postoperatively, at 6 and 12 months, and at last follow-up. Clinical outcomes were evaluated with American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and patient satisfaction. Intermetatarsal angle (IMA), metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and tibial sesamoid position were assessed. Statistical analysis was performed. RESULTS The mean AOFAS score improved from 57.9 to 90.5 points, VAS scale was 1.5 ± 2.0, and patients' satisfaction was 8.7 ± 1.4. The mean correction of the HVA and IMA showed a significant correction; however, the effect of time was not statistically significant on DMAA. Sex (P = .047), severity (P = .050), associated procedures (P = .000), and preoperative angle (P = .000) showed significant association with HVA correction and its persistence over time. Age was not statistically significant. Complications were 9 cases of superficial wound infection and 6 recurrences. CONCLUSIONS The MIIND technique proved a viable procedure to correct moderate to severe HV with a low rate of complications and recurrence, producing significant correction of most radiographic parameters assessed and their persistence, even at long term. LEVEL OF EVIDENCE Level IV, case series study.
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Affiliation(s)
- Carlo Biz
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Alberto Crimì
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Ilaria Fantoni
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Jacopo Tagliapietra
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Orthopaedic, Traumatology and Oncology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
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32
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Wirth SH, Fuernstahl Fürnstahl P, Meyer DC, Viehoefer Viehöfer AF. Planning tool for first metatarsal length in hallux valgus surgery. Foot (Edinb) 2021; 46:101774. [PMID: 33516117 DOI: 10.1016/j.foot.2020.101774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 11/25/2020] [Accepted: 12/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The precise planning of metatarsal (MT) I length in hallux valgus surgery is important. However, currently no tool exists which allows the surgeon to reliably predict this parameter. METHODS 30 virtual 3-dimensional hallux valgus surgeries were performed on varied deformation models based on cadaveric feet scans. The shortening of the first ray during distal metatarsal I osteotomy for different osteotomy angles were measured. An algebraic 2-dimensional calculation was done and compared to the results obtained from the 3-dimensional models. RESULTS Inadvertent shortening of the first metatarsal bone can be as much as 8 mm depending on the amount of intermetatarsal angle (IMA) correction and osteotomy angle. Comparison of the 3 dimensional simulations and the 2 dimensional model resulted in a very strong correlation (R > 0.99 p < 0.00001). Based on our findings an anterior pointing osteotomy of approximately 10° is necessary to restore the length in distal metatarsal I hallux valgus surgery. CONCLUSION A slight misdirection of the osteotomy plane in distal hallux valgus surgery may result in relevant unwanted alterations in first metatarsal bone length and triangulation by eye is insufficient in this complex geometrical situation without appropriate planning. The present study provides surgeons a practical tool to plan and control the change of first metatarsal length during hallux valgus procedure through exact orientation of the osteotomy angle. If no alteration of length is intended, it may be generalized that an anterior direction of the cut relative to the second metatarsal bone will preserve the length of the first metatarsal bone.
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Affiliation(s)
- Stephan H Wirth
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.
| | | | - Dominik C Meyer
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.
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33
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Mahmoud K, Metikala S, Mehta SD, Fryhofer GW, Farber DC, Prat D. The Role of Weightbearing Computed Tomography Scan in Hallux Valgus. Foot Ankle Int 2021; 42:287-293. [PMID: 33148045 DOI: 10.1177/1071100720962398] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hyperpronation of the first metatarsal in hallux valgus (HV) is poorly understood by conventional weightbearing radiography. We aimed to evaluate this parameter using weightbearing computed tomography (WBCT) and to understand its association with other standard measurements. METHODS Retrospective evaluation of WBCT and weightbearing radiographs (WBXRs) was performed for 20 patients with HV feet and 20 controls with no such deformity. Axial computed tomography images of both groups were compared for the first metatarsal pronation angle (alpha angle) and tibial sesamoid subluxation (TSS) grades. The HV angle (HVA), first-second intermetatarsal angle (IMA), first metatarsal-medial cuneiform angle (MMCA), Meary's angle, and calcaneal pitch (CP) angle of the study and control groups were compared on both WBXR and the corresponding 2-dimensional images of WBCT. All measurements were independently performed by 1 musculoskeletal radiology fellow and 1 foot and ankle surgical fellow. Measurements were averaged and interobserver reliability was calculated. RESULTS The HV group demonstrated significantly higher values for TSS grade (P < .001) but not for alpha angle (P = .121) compared with controls. Likewise, significantly elevated HVA and IMA were noted in the HV group on both imaging modalities, while no such differences were observed for the CP angle. Higher MMCA and Meary's angle in the HV group were evident only on WBXR (MMCA, P = .039; Meary's, P = .009) but not on WBCT (MMCA, P = .183; Meary's, P = .171).Among all, the receiver operating characteristic (ROC) curves demonstrated the greatest area under the curve (AUC) for HVA, followed by IMA. The alpha angle performed only just outside the range of chance (AUC, 0.65; 95% CI, 0.52-0.69). The Pearson's correlations of the alpha angle, in the HV group, revealed a significant linear relationship with TSS grade and with HVA on WBXR, and only trended toward a weak linear relationship with IMA and with HVA on WBCT. CONCLUSION The alpha angle, a measure of abnormal hyperpronation of the first metatarsal, was an independent factor that may coexist with other parameters in HV, but in isolation had limited diagnostic utility. "Abnormal" alpha angles were even observed in individuals without HV. Increases in IMA and MMCA were not necessarily associated with similar increases in alpha angle, despite moderate correlations with TSS grade and HVA on WBXR. Nevertheless, the WBCT was a useful method for assessing hyperpronation and guiding surgical management in individual cases. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Karim Mahmoud
- Orthopaedic Foot and Ankle Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Sreenivasulu Metikala
- Orthopaedic Foot and Ankle Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Samir D Mehta
- Musculoskeletal Radiology, Penn Medicine University City, Philadelphia, PA, USA
| | - George W Fryhofer
- Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Daniel C Farber
- Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Dan Prat
- Orthopaedic Foot and Ankle Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
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Hernández-Castillejo LE, Álvarez-Bueno C, Garrido-Miguel M, Torres-Costoso A, Reina-Gutiérrez S, Martínez-Vizcaíno V. The effect of hallux valgus open and percutaneous surgery on AOFAS scale: a systematic review and meta-analysis. Qual Life Res 2021; 30:957-966. [PMID: 33387287 DOI: 10.1007/s11136-020-02715-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE To estimate the comparative effect of open and percutaneous hallux valgus (HV) surgery on patients' quality of life (QoL) using the American Orthopedic Foot and Ankle Society (AOFAS) scale including total score and individual domains (pain, function, and alignment). METHODS MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2020 for studies on the effect of HV surgery on patients' QoL using the AOFAS score. A standardized mean difference score was calculated on the total AOFAS score and on each AOFAS domain (pain, function, and alignment) using Cohen's d index. RESULTS Considering the 53 published studies included, the pooled effect size (ES) estimates for the AOFAS total score were 3.69 (95% CI 3.37-4.01; I2 = 95.5%) for open surgery and 3.40 (95% CI 2.99-3.80, I2 = 88.2%) for percutaneous surgery. The total pooled ES estimate was 3.61 (95% CI 3.35-3.87, I2 = 94.5%). Considering the pain domain, the pooled ES estimates were 2.21 (95% CI 1.98-2.43, I2 = 64%) for open surgery and 2.52 (95% CI 1.83-3.20, I2 = 92.6%) for percutaneous surgery. For the function domain, the pooled ES estimates were 1.37 (95% CI 0.93-1.81, I2 = 91%) for open surgery and 2.28 (95% CI 1.10-3.47, I2 = 96.8%) for percutaneous surgery. Finally, the pooled ES estimates for the alignment domain were 3.99 (95% CI 3.51-4.47, I2 = 85.7%) for open surgery and 2.66 (95% CI 2.23-3.09, I2 = 78.5%) for percutaneous surgery. CONCLUSION Our data support that HV surgery increases the total AOFAS score as well as the AOFAS scores by domain (pain, function, and alignment). Furthermore, our data show that HV surgery increases patients' QoL, after both open and percutaneous surgery, without differences between them.
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Affiliation(s)
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain. .,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay.
| | | | - Ana Torres-Costoso
- School of Nursing and Physiotherapy, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Sara Reina-Gutiérrez
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain.,Facultad de Ciencias de La Salud, Universidad Autónoma de Chile, Talca, Chile
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Heyes GJ, Vosoughi AR, Weigelt L, Mason L, Molloy A. Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy. Foot Ankle Int 2020; 41:1212-1218. [PMID: 32672066 DOI: 10.1177/1071100720937645] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus recurrence is an unsatisfactory complication, with many causes postulated. This study investigated the effect of pes planus on recurrence after scarf osteotomy. METHODS A total of 183 feet were retrospectively reviewed. All patients were treated with a scarf osteotomy and if required Akin osteotomy. We measured preoperative lateral talus first metatarsal angle (T1MA) to study pes planus; an angle of under -4 degrees was considered pes planus. We measured pre and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), and sesamoid location. In total 164 feet were suitable for inclusion, with follow-up of at least 6 months (10 males and 154 females, mean age: 52 years). RESULTS Recurrence frequency (HVA greater than 15 degrees) was 27 feet (16%). Hallux valgus recurrence was not influenced by gender (P value = .66) or preoperative IMA (P value = .48). Preoperative HVA greater than 35 degrees was associated with increased frequency of recurrence (P value = .004). Those with T1MA less than -10 degrees demonstrated progression in HVA and deterioration in sesamoid location up to 6 months postoperatively (P value = .038). HVA did not progress beyond 6 months. The prevalence of recurrent hallux valgus with normal T1MA was 1%, in T1MA -4 to -10 degrees it was 29% and in T1MA less than -10 degrees it was 47% (P value <.001). Breaks in T1MA less than -4 degrees were found at the naviculocuneiform joint in 68% of feet in this series. CONCLUSION The prevalence of hallux valgus recurrence correlated with the severity of pes planus. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Gavin John Heyes
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Lower Ln, Liverpool, United Kingdom
| | - Amir R Vosoughi
- Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Lizzy Weigelt
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Lower Ln, Liverpool, United Kingdom
| | - Lyndon Mason
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Lower Ln, Liverpool, United Kingdom
| | - Andrew Molloy
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Lower Ln, Liverpool, United Kingdom
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Del Vecchio JJ, Dalmau-Pastor M. Percutaneous Lateral Release in Hallux Valgus: Anatomic Basis and Indications. Foot Ankle Clin 2020; 25:373-383. [PMID: 32736735 DOI: 10.1016/j.fcl.2020.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the last decade, minimally invasive or percutaneous surgery has evolved rapidly through the development of novel techniques. Treatment of hallux valgus deformity is one of the indications for percutaneous surgery, both for bony and soft tissue correction. The release of the structures on the lateral part of the first metatarsophalangeal joint (lateral release) is one of the best indications for percutaneous surgery in the forefoot. In this article, a detailed description of the anatomy of the metatarsophalangeal joint is provided, along with the indications and tips to perform a safe percutaneous lateral release.
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Affiliation(s)
- Jorge Javier Del Vecchio
- GRECMIP - MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied - Minimally Invasive Foot and Ankle Society), Merignac, France; Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro -Hospital Universitario, Solis 461, Ciudad Autónoma de Buenos Aires (CABA) CP 1078, Argentine; Department of Kinesiology and Physiatry, Universidad Favaloro, Av. Entre Ríos 495, CABA CP 1079, Argentina
| | - Miki Dalmau-Pastor
- GRECMIP - MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied - Minimally Invasive Foot and Ankle Society), Merignac, France; Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona. C/ Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Office 5304, Barcelona, Spain.
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Kaufmann G, Giesinger JM, Hofer P, Braito M, Biedermann R, Dammerer D. Does preoperative deformity diminish radiographic outcome after hallux valgus correction with scarf osteotomy?: A retrospective study of 102 cases. Foot Ankle Surg 2020; 26:425-431. [PMID: 31202526 DOI: 10.1016/j.fas.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 02/25/2019] [Accepted: 05/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Scarf osteotomy is a frequently used technique to correct moderate to severe hallux valgus deformities. Recurrence of a deformity is a commonly reported complication after surgery. The aim of our study was to evaluate the impact of preoperative deformity on radiological outcome in terms of postoperative loss of correction after scarf osteotomy. METHODS 102 patients, in which a hallux valgus deformity was corrected with an isolated scarf osteotomy were included. Weightbearing radiographs were analyzed preoperatively, postoperatively, after 6 weeks and after three months (mean 10.9 months SD 17.2 months). The following radiological parameters were used for analysis: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), position of the sesamoids, first metatarsal length, and first metatarsophalangeal joint congruity. RESULTS Significant correction of IMA, HVA, DMAA, sesamoid position and joint congruity was achieved (p < 0.001). The IMA improved from 15.8 ± 2.3 to 4.3 ± 2.8°, the HVA from 32.6 ± 6.8 to 9.1 ± 7.2, and the DMAA from 11.4 ± 6.9 to 8.4 ± 5.2°, respectively. In contrast to DMAA, throughout followup we could detect loss of correction for HVA and for IMA amounting 6.3° ± 5.8 and 3.8° ± 2.8 respectively. Loss of HVA correction revealed a significant correlation with preoperative DMAA, but not with the other preoperative radiological parameters. CONCLUSIONS Preoperative deformity does not correlate with postoperative loss of correction after scarf osteotomy, except DMAA. CLINICAL RELEVANCE Our results may be helpful in counseling patients regarding recurrence of hallux valgus deformity after scarf osteotomy. LEVEL OF EVIDENCE Therapeutic, Level IV, retrospective case series.
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Affiliation(s)
- Gerhard Kaufmann
- OFZ Innsbruck, Orthopedic and Foot Centre Innsbruck, Innrain 2/3. Stock, 6020, Innsbruck, Austria.
| | - Johannes M Giesinger
- Institute of Patient-centered Outcome Research (IIPCOR), Dr. Stumpf Straße 56, 6020, Innsbruck, Austria.
| | - Philipp Hofer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Matthias Braito
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Rainer Biedermann
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Dietmar Dammerer
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Castioni D, Fanelli D, Gasparini G, Iannò B, Galasso O. Scarf osteotomy for the treatment of moderate to severe hallux valgus: Analysis of predictors for midterm outcomes and recurrence. Foot Ankle Surg 2020; 26:439-444. [PMID: 31208876 DOI: 10.1016/j.fas.2019.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/25/2019] [Accepted: 05/16/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Controversies remain regarding the predictors for outcomes and recurrence after scarf osteotomy for hallux valgus deformity. METHODS Sixty-two patients (70 feet) underwent scarf osteotomy for hallux valgus deformity. The radiological angles, tibial sesamoid position, articular congruence, demographics, comorbidities, AOFAS, VAS and SF-12 scores, and the postoperative compliance were tested as predictors for outcomes and recurrence. RESULTS After a mean 38±15.4 months follow-up, all of the radiological angles, the total AOFAS, PCS-12 and VAS scores significantly improved (all P<0.001). Preoperative MCS-12 was directly related to the total postoperative AOFAS score (P=0.003). A higher number of cardiovascular risk factors negatively affected the postoperative total AOFAS score, VAS and PCS-12 (β=-3.42, P=0.030; β=0.262, P=0.022; β=-0.181, P=0.025, respectively). The BMI influenced postoperative PCS-12 (β=-0.244, P=0.002). Preoperative HVA was directly related to postoperative DMAA (P=0.002) and tibial sesamoid position (P=0.005). Preoperative joint incongruence and postoperative noncompliance were associated with recurrence (P=0.043 and P=0.035, respectively). CONCLUSIONS Satisfactory results can be expected after scarf osteotomy. Higher BMI and number of cardiovascular risk factors, and low mental status should be carefully considered when counselling patients for this procedure. Adherence to postoperative care instructions influences deformity recurrence.
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Affiliation(s)
- Davide Castioni
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy
| | - Daniele Fanelli
- Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy.
| | - Bruno Iannò
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy
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Weng-Io N, Kwok-Bill C, Yuk-Nam Y. Long-term clinical outcomes of scarf osteotomy in regional hospital Hong Kong. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2020. [DOI: 10.1177/2210491719881768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Lack of local data concerning the long-term clinical outcomes of scarf osteotomy in Hong Kong. Methods: This is a retrospective review of 75 patients (88 feet) who underwent scarf osteotomy with a mean follow-up of 94.20 months (60–144 months). Clinical ratings were based on visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scale. Weight-bearing radiographs were used to perform angular measurements: (i) hallux valgus angle (HVA), (ii) intermetatarsal angle, (iii) distal metatarsal articular angle, and (iv) tibial sesamoid position before operation and at the time of latest follow-up. Results: The mean overall AOFAS scales improved from 29.66 (5–49) points preoperatively to 86.83 (39–100) points at the time of final follow-up. The VAS improved from 6.61 (5 to 9) to 0.66 (0 to 4). The average HVA correction was 25.42 (8–46). The 8- to10-year recurrence rate (HVA > 20) was 31.80%. A higher degree of preoperative HVA predicts higher recurrence rate. Conclusion: Scarf osteotomy is an effective procedure for symptom control and improvement in radiological parameters for hallux valgus deformity. However, recurrence rate is relatively high.
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Affiliation(s)
- Ng Weng-Io
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, HKSAR Tuen Mun, Hong Kong
| | - Chan Kwok-Bill
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, HKSAR Tuen Mun, Hong Kong
| | - Yeung Yuk-Nam
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, HKSAR Tuen Mun, Hong Kong
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Abstract
Hallux valgus deformity is a progressive forefoot deformity consisting of a prominence derived from a medially deviated first metatarsal and laterally displaced great toe, with or without pronation. Although there is agreement that the deformity is likely caused by multifactorial intrinsic and extrinsic factors, the best method of operative management is debated despite the creation of basic algorithms. Our understanding of the deformity and the development of newer techniques is continuously evolving. Here, we review the general orthopaedic principles of operative decision-making and management of hallux valgus deformity.
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Abstract
Coronal malalignment is an important deformity parameter in hallux valgus feet. Approximately 90% of patients with hallux valgus have some degree of metatarsal pronation. In operated hallux valgus, persistent metatarsal pronation is an independent deformity relapse factor. Coronal malalignment can be identified through an anteroposterior (AP) weight-bearing foot radiograph and a weight-bearing forefoot scan. The AP foot view can identify 3 levels of rotation: mild, moderate and severe metatarsal pronation. Regarding the treatment options, some techniques are capable of rotational correction, such as the proximal rotational metatarsal osteotomy, Lapidus, dome osteotomy, and proximal oblique sliding closing wedge.
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Affiliation(s)
- Pablo Wagner
- Universidad de Desarrollo - Clinica Alemana de Santiago, Universidad de los Andes - Hospital Militar de Santiago, Vitacura 5951, Vitacura, Santiago, Chile.
| | - Emilio Wagner
- Universidad de Desarrollo - Clinica Alemana de Santiago, Vitacura 5951, Vitacura, Santiago, Chile
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Filippi J, Briceno J. Complications after Metatarsal Osteotomies for Hallux Valgus: Malunion, Nonunion, Avascular Necrosis, and Metatarsophalangeal Osteoarthritis. Foot Ankle Clin 2020; 25:169-182. [PMID: 31997743 DOI: 10.1016/j.fcl.2019.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Avascular necrosis (AVN), nonunion, malunion, and metatarsophalangeal (MTP) osteoarthritis following hallux valgus osteotomies, as well as pathophysiology, diagnosis, prevention strategies, and treatment are discussed in this article. AVN and nonunion are very infrequent, and they can be effectively prevented taking into consideration local anatomy preservation, biomechanics, and patient comorbidities. Shortening, elevation, plantarflexion, varus/valgus, and rotational of the first metatarsal are the most common types of malunion. They can lead to pain, stiffness, deformity recurrence, and transfer metatarsalgia. MTP osteoarthritis can develop after metatarsal malunion or AVN. Treatment options include cheilectomy, osteotomies to correct malunions, and MTP arthrodesis.
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Affiliation(s)
- Jorge Filippi
- Foot and Ankle Division, Department of Orthopedic Surgery, Clinica Las Condes, Estoril 450, Las Condes, Santiago 7591047, Chile.
| | - Jorge Briceno
- Foot and Ankle Service, Department of Orthopedic Surgery, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, Piso 3, Santiago 8330077, Chile
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Magnesium-based bioabsorbable screw fixation for hallux valgus surgery - A suitable alternative to metallic implants. Foot Ankle Surg 2019; 25:727-732. [PMID: 30321917 DOI: 10.1016/j.fas.2018.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/29/2018] [Accepted: 09/04/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The primary aim of this pilot study was to prospectively evaluate outcomes of the MgYREZr bioabsorbable screw in the setting of hallux valgus corrective surgery. The secondary aim was to compare the outcomes against a control group treated with conventional titanium screws. METHODS A consecutive series of patients with hallux valgus deformity (n=24) underwent forefoot reconstruction surgery with a scarf osteotomy to the first metatarsal using MgYREZr screws. Functional scores, radiological outcomes, and complication profile were recorded over 12 months. Results were compared against a control group of patients (n=69) using titanium alloy screws. RESULTS At 1-year post-operative, both functional and radiological outcomes showed significant improvements. Compared to the control group, there was no significant difference in functional outcomes, yet radiological improvements were significantly better in the control group. CONCLUSIONS The MgYREZr bioabsorbable screw is a suitable alternative to titanium alloy screws for hallux valgus corrective surgery.
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Wirth SH, Renner N, Niehaus R, Farei-Campagna J, Deggeller M, Scheurer F, Palmer K, Jentzsch T. The influence of obesity and gender on outcome after reversed L-shaped osteotomy for hallux valgus. BMC Musculoskelet Disord 2019; 20:450. [PMID: 31615482 PMCID: PMC6794844 DOI: 10.1186/s12891-019-2823-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hallux valgus deformity (HV) affects around every fourth individual, and surgical treatment is performed in every thousandth person. There is an ongoing quest for the best surgical management and reduction of undesirable outcomes. The aim was to explore associations of obesity and gender with radiological and clinical outcome after reversed L-shaped osteotomy (ReveL) for HV. MATERIALS AND METHODS This study was carried out in a retrospective cohort design at a single University Hospital in Switzerland between January 2004 and December 2013. It included adult patients treated with ReveL for HV. The primary exposure was body mass index (BMI) at the time of ReveL. The secondary exposure was gender. The primary outcome was radiological relapse of HV (HV angle [HVA] > 15 degrees [°]) at the last follow-up. Secondary outcomes were improvable patient satisfaction, complication, redo surgery, and optional hardware removal. Logistic regression analysis adjusted for confounders. RESULTS The median weight, height, and BMI were 66.0 (interquartile range [IQR] 57.0-76.0) kilograms (kg), 1.65 (IQR 1.60-1.71) metres (m), and 24.0 (IQR 21.3-27.8) kg/m2. Logistic regression analysis did not show associations of relapse with BMI, independent of age, gender, additional technique, and preoperative HVA (adjusted odds ratio [ORadjusted] = 1.10 [95% (%) confidence interval (CI) = 0.70-1.45], p = 0.675). Relapse was 91% more likely in males (ORadjusted = 1.91 [95% CI = 1.19-3.06], p = 0.007). Improvable satisfaction was 79% more likely in males (ORadjusted = 1.79 [CI = 1.04-3.06], p = 0.035). Hardware removal was 47% less likely in males (ORadjusted = 0.53 [95% CI 0.30-0.94], p = 0.029). CONCLUSIONS In this study, obesity was not associated with unsatisfactory outcomes after ReveL for HV. This challenges the previous recommendation that preoperative weight loss may be necessary for a successful surgical treatment outcome. Males may be informed about potentially higher associations with unfavourable outcomes. Due to the risk of selection bias and lack of causality, findings may need to be confirmed with clinical trials.
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Affiliation(s)
- Stephan H Wirth
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Niklas Renner
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Richard Niehaus
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Jan Farei-Campagna
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | | | | | | | - Thorsten Jentzsch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
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Kaufmann G, Hofer P, Braito M, Bale R, Putzer D, Dammerer D. Effect of Akin Osteotomy on Hallux Valgus Correction After Scarf Osteotomy With Hallux Valgus Interphalangeus. Foot Ankle Int 2019; 40:1182-1188. [PMID: 31200616 DOI: 10.1177/1071100719855043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recurrence after hallux valgus correction is a relatively frequent occurrence. Little is known about the importance of initial correction on radiologic outcome. The objective of our study was to determine postoperative radiologic parameters correlating with loss of correction after scarf osteotomy and the combined scarf/akin osteotomy, respectively. METHODS Loss of correction was evaluated based on a group of 53 feet with isolated scarf osteotomy (S group) and a group of 17 feet with combined scarf and akin osteotomy (SA group) in a retrospective analysis. The intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), the proximal to distal phalangeal articular angle (PDPAA), the position of the sesamoids, and joint congruity were measured in weight-bearing radiographs preoperatively and postoperatively throughout a mean follow-up of 44.8 ± 23.6 months. RESULTS Loss of correction was comparable between the S and the SA group (P > .05). In contrast, we found higher loss of HVA correction in the S subgroup with a preoperative PDPAA above 8 degrees (P = .011), whereas loss of correction in the S subgroup below 8 degrees of PDPAA was comparable to the SA group. In the S group, loss of correction showed significant correlation with postoperative IMA (P = .015) and PDPAA (P = .008), whereas in the SA group a correlation could be detected for IMA only (P = .045). CONCLUSION In cases with a PDPAA above 8 degrees, we recommend a combined scarf/akin osteotomy to diminish the potential for loss of correction. LEVEL OF EVIDENCE Level III, therapeutic, retrospective comparative series.
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Affiliation(s)
| | - Philipp Hofer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Braito
- Orthopedic Department, Medical University of Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - David Putzer
- Department of Experimental Orthopedics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Dammerer
- Orthopedic Department, Medical University of Innsbruck, Innsbruck, Austria
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Kaufmann G, Hofmann M, Braito M, Ulmer H, Brunner A, Dammerer D. Need for concomitant Akin osteotomy in patients undergoing Chevron osteotomy can be determined preoperatively: a retrospective comparative study of 859 cases. J Orthop Surg Res 2019; 14:277. [PMID: 31455364 PMCID: PMC6712706 DOI: 10.1186/s13018-019-1319-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background The Chevron osteotomy is a frequently used surgical method for hallux valgus correction. This method is often combined with an Akin osteotomy. To date, clear guidelines for the implementation of an additional Akin osteotomy are missing. The purpose of this study was to elucidate the impact of concomitant phalangeal correction on the outcome after hallux valgus surgery and to define indication criteria for an additional Akin osteotomy. Methods Patients (859 feet) undergoing distal Chevron osteotomy at our department were retrospectively grouped into group C (Chevron, 785 feet) and group AC (Chevron plus Akin, 74 ft). Radiological assessment including the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), and the proximal to distal phalangeal articular angle (PDPAA) was performed preoperatively, postoperatively, after 6 weeks, and after 3 months. Longer-term follow-up with a mean of 36.4 months was available for 248 cases (29%). Results A significant improvement of all parameters could be found to all points of survey (p < 0.001). Loss of correction was detected for HVA (p < 0.001) and IMA (p < 0.007) with higher levels in group C. Preoperative PDPAA exceeding 8° correlated significantly with loss of HVA correction in group C (p < 0.001). Conclusion The combined Chevron and Akin osteotomy allowed for better correction of the hallux valgus deformity with better maintenance of the achieved correction. Recommendation for concomitant Akin osteotomy may be determined by a preoperative PDPAA exceeding 8°. Trial registration Retrospectively registered. UN5080. Level of evidence Therapeutic, Level III, retrospective comparative series.
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Affiliation(s)
| | - Maximilian Hofmann
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Matthias Braito
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Alexander Brunner
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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48
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Ray JJ, Koay J, Dayton PD, Hatch DJ, Smith B, Santrock RD. Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing. Foot Ankle Int 2019; 40:955-960. [PMID: 31056950 DOI: 10.1177/1071100719847700] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus is a multiplanar deformity of the first ray. Traditional correction methods prioritize the transverse plane, a potential factor resulting in high recurrence rates. Triplanar first tarsometatarsal (TMT) arthrodesis uses a multiplanar approach to correct hallux valgus in all 3 anatomical planes at the apex of the deformity. The purpose of this study was to investigate early radiographic outcomes and complications of triplanar first TMT arthrodesis with early weightbearing. METHODS Radiographs and charts were retrospectively reviewed for 57 patients (62 feet) aged 39.7 ± 18.9 years undergoing triplanar first TMT arthrodesis at 4 institutions between 2015 and 2017. Patients were allowed early full weightbearing in a boot walker. Postoperative radiographs were compared with preoperative radiographs for hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), and lateral round sign. Any complications were recorded. RESULTS Radiographic results demonstrated significant improvements in IMA (13.6 ± 2.7 degrees to 6.6 ± 1.9 degrees), HVA (24.2 ± 9.3 degrees to 9.7 ± 5.1 degrees), and TSP (5.0 ± 1.3 to 1.9 ± 0.9) from preoperative to final follow-up (P < .001). Lateral round sign was present in 2 of 62 feet (3.2%) at final follow-up compared with 52 of 62 feet (83.9%) preoperatively. At final follow-up, recurrence was 3.2% (2/62 feet), and the symptomatic nonunion rate was 1.6% (1/62 feet). Two patients required hardware removal, and 2 patients required additional Akin osteotomy. CONCLUSION Early radiographic outcomes of triplanar first TMT arthrodesis with early weightbearing were promising with low recurrence rates and maintenance of correction. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Justin J Ray
- 1 Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Jennifer Koay
- 2 Department of Radiology, West Virginia University, Morgantown, WV, USA
| | | | - Daniel J Hatch
- 4 Department of Podiatric Medicine and Surgery, North Colorado PMS Residency, Greeley, CO, USA
| | - Bret Smith
- 5 Orthopedics, University of South Carolina, Palmetto Health-USC Orthopedic Center, Lexington, SC, USA
| | - Robert D Santrock
- 1 Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
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Kaufmann G, Hofmann M, Ulmer H, Putzer D, Hofer P, Dammerer D. Outcomes after scarf osteotomy with and without Akin osteotomy a retrospective comparative study. J Orthop Surg Res 2019; 14:193. [PMID: 31242910 PMCID: PMC6595682 DOI: 10.1186/s13018-019-1241-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/16/2019] [Indexed: 12/04/2022] Open
Abstract
Background The scarf osteotomy is a well-established surgical method for correcting a hallux valgus deformity. It is often combined with an Akin osteotomy. However, clear guidelines defining indication criteria are missing. The purpose of this study was to analyze the radiological outcome after scarf osteotomy in dependence of additional Akin osteotomy. Methods This study included 184 patients in whom a hallux valgus deformity was corrected with a scarf osteotomy (group S), and 63 patients in whom an additional Akin osteotomy was performed (group SA). Weight-bearing radiographs were evaluated preoperatively, postoperatively, after 6 weeks, after 3 months and at a follow-up with a mean of 45.4 months. Analysis was made for the following radiological parameters: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), the proximal to distal phalangeal articular angle (PDPAA), and the position of the sesamoids as well as the joint congruity. Results Radiographic recurrence (HVA > 20°) was detected in 1 patient (1.6% of recurrence) in the SA group, and in 27 patients in the S group (14.7% of recurrence) at follow-up. Outcome between the two groups differed significantly showing reduced loss of HVA correction in the SA group (p < 0.001). The subgroup with a preoperative PDPAA above eight degrees showed significant inferiority of outcome for the S group compared to the SA group. Conclusion Radiological outcome after scarf osteotomy is superior with concomitant Akin osteotomy. A preoperative PDPAA above eight degrees makes additional Akin osteotomy recommendable. Level of evidence Therapeutic, Level III, retrospective comparative series
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Affiliation(s)
| | - Maximilian Hofmann
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - David Putzer
- Department of Experimental Orthopedics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Philipp Hofer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Dietmar Dammerer
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Desai S, Peterson AC, Wing K, Younger A, Crump T, Liu G, Veljkovic A, Penner M, Sutherland JM. Minimally Important Difference in the Foot and Ankle Outcome Score Among Patients Undergoing Hallux Valgus Surgery. Foot Ankle Int 2019; 40:694-701. [PMID: 30873859 DOI: 10.1177/1071100719831392] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient-reported outcomes are increasingly used as measures of effectiveness of interventions. To make the tools more useful, therapeutic thresholds known as minimally important differences have been developed. The objective of this study was to calculate minimally important differences for the domains of the Foot and Ankle Outcome Score for hallux valgus surgery. METHODS The study was based on a retrospective analysis of patients newly scheduled for bunion correction surgery and completing patient-reported outcomes between October 2013 and January 2018. This study used anchor- and distribution-based approaches to calculate the minimally important difference for the instrument's 5 domains. Confidence intervals were calculated for each approach. There were 91 participants included in the study. RESULTS Using anchor- and distribution-based approaches, the minimally important difference for the pain domain ranged from 5.8 to 10.2, from 0.3 to 6.9 for the symptoms domain, 8.3 to 10.3 for the activities of daily living domain, 7.4 to 11.1 for the quality of life domain, and from 7.0 to 15.7 for the sports and recreation domain. Small differences in the activities of daily living domain may be more clinically important for patients with better function. DISCUSSION The range of minimally important difference values for each domain indicate how the Foot and Ankle Outcome Score corresponded to bunion correction surgery. The sports and recreation domain showed considerable variability in the range of values and may be associated with the domain's lack of responsiveness. Overall, most minimally important difference values for the domains of FAOS ranged from above 4 to below 16. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Sameer Desai
- 1 School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Alexander C Peterson
- 2 Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kevin Wing
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Alastair Younger
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Trafford Crump
- 4 Department of Surgery, University of Calgary, Calgary, Alberta
| | - Guiping Liu
- 2 Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Andrea Veljkovic
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Murray Penner
- 3 Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Jason M Sutherland
- 2 Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
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