SLR - November 2020 - Spenser Alan Soldano

Minimally Invasive Vs Open Distal Metatarsal Osteotomy for Hallux Valgus - A Systematic Review And Meta-Analysis

Reference: Singh, M. S., Khurana, A., Kapoor, D., Katekar, S., Kumar, A., & Vishwakarma, G. (2020). Minimally Invasive Vs Open Distal Metatarsal Osteotomy for Hallux Valgus - A Systematic Review And Meta-Analysis. Journal of Clinical Orthopaedics and Trauma.

Level of Evidence: 2

Scientific Literature Review

Reviewed By: Spenser Alan Soldano, DPM
Residency Program: University of Florida Health Jacksonville – Jacksonville FL

Podiatric Relevance: A growing body of scientific literature demonstrating the use of Minimally Invasive Surgery (MIS) for the treatment of Hallux Valgus deformity has demonstrated that MIS techniques may achieve similar results as Open techniques with added potential benefits such as better cosmesis, early weight bearing and decreased operative time. Several studies comparing MIS with Open Distal procedures have been published, therefore this study seeks to examine and analyze all studies comparing these two procedure techniques in order to determine any superiority between them.

Methods: This is a systematic review and meta-analysis of literature comparing minimally invasive vs open distal metatarsal osteotomy for hallux valgus. Literature from January 2000-January 2020 was extracted from Pubmed, Embase and Scopus with key words (‘hallux valgus’ OR bunion) AND (‘minimally invasive’ OR percutaneous). Nine out of 473 records were used in the analysis and review. This review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data synthesis following extraction included analysis of change in Intermetatarsal angle (IMA), hallux valgus angle (HVA), VAS score, AOFAS score, risk for complications, satisfaction and duration of surgery between MIS and distal open hallux valgus procedures. 

Results: When comparing IMA and HVA between groups that included these radiographic parameters, no significant difference was found. Similarly, VAS score was found to have no significance when comparing MIS and Open groups among all studies. AOFAS scores between groups was found to be significant in favor of Open techniques. There was no significant difference between Open and MIS groups in regards to risk involved with surgery or patient satisfaction. Duration of surgery was found to be less for MIS groups than that of Open groups. 

Conclusions: The authors conclude that AOFAS scores were found to be favorable in the Open group and duration of surgery was found to be favorable toward MIS groups. Although no significant difference was found between the Open and MIS groups in regards to all other parameters listed above, the authors concluded that MIS offers similar satisfactory outcomes in treating mild to moderate bunion deformity with only AOFAS scores being better in regard to long term outcomes. Overall this article focuses on key parameters when focusing on distal correction of bunion deformities. No differences were found in radiographic parameters such as IMA and HVA as well as complications. MIS is continuing to show viability as an alternative and comparable procedure to Open techniques however, there is still a learning curve with MIS and inherent bias toward open techniques. Further studies comparing MIS vs Open procedures are needed to justify the use of MIS surgery over Open techniques. 

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