SLR - January 2023 - Robert Sheckler, DPM
Title: Radiographic and clinical outcomes of minimally invasive surgery versus open osteotomies for the correction of hallux valgusReference: Xu Y, Guo CJ, Li XC, Xu XY. Radiographic and clinical outcomes of minimally invasive surgery versus open osteotomies for the correction of hallux valgus. Int Orthop. 2022 Aug;46(8):1767-1774.
Level of Evidence: III
Scientific Literature
Reviewed by: Robert Sheckler, DPM
Residency Program: MedStar Health Podiatric Surgery Residency (Washington, D.C)
Podiatric Relevance: Hallux valgus is a progressive deformity that can lead to pain, discomfort, difficulty walking and other deformities, such as overlapping digits. As the deformity worsens, that can lead to increased pressure to other parts of the foot as well as arthritic changes in joints. As new surgical techniques are discovered, or altered, it is important to compare new and old techniques. The purpose of this study was to evaluate radiographic and clinical effectiveness of the open bunion procedure
(Chevron-Akin) vs the new minimally invasive surgery (MIS).
Methods: This study was a retrospective comparative study which collected data from May, 2018 to January, 2020. There were 27 patients (31 feet) that underwent the MIS procedure and 30 patients (31 feet) that underwent the open procedure. The mean follow up was 26.1 months. Pre-operative and post-operative radiographs were obtained and the measurements that were included were HVA, IMA, DMAA, the Sgarlato's angle, the length of the first metatarsal, and distance between the dorsal cortex of first and second metatarsal necks. AOFAS and VAS were used to assess the foot function pre- and post-operative.
Results: The pre-operative HVA in the MIS group and open group were 34.8° and 33.1° respectively; whereas, the post-operative HVA were 20.4° and 13.7°. The pre-operative IMA in the MIS group and open group were 13.0° and 12.1, respectively, and the
post-operative IMA were 11.4° and 5.5°. The pre-operative DMAA in the MIS group and open group were 14.8° and 15.1°, respectively, and the post-operative DMAA were 6.3° and 8.7°. The AOFAS increased from 44.0 to 90.2 in the MIS group and 47.6 to 89.5 in the open group. The VAS decreased from 7.3 to 1.3 in the MIS group and 7.1 to 1.2 in the open group.
Conclusions: This retrospective comparative study evaluated the radiographic and clinical outcomes of MIS versus open bunion correction procedures. What it found was that the open bunion procedures had better outcomes in the HVA and IMA radiographic findings; whereas, the MIS bunion procedures showed advantages in correcting DMAA. When it came to functional outcomes, the MIS bunion group was equivalent to the open bunion group. It is important to note that both procedures have some advantages over the other, so when choosing the procedure, it is crucial to choose the right patient for that procedure.