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Open Access 01-02-2019 | Original Paper

Minimally invasive versus open chevron osteotomy for hallux valgus correction: a randomized controlled trial

Authors: Gerhard Kaufmann, Dietmar Dammerer, Felix Heyenbrock, Matthias Braito, Lorenz Moertlbauer, Michael Liebensteiner

Published in: International Orthopaedics | Issue 2/2019

Abstract

Purpose

The purpose of this study was to compare a minimally invasive chevron osteotomy technique (MIS group) and the well-established open chevron technique (OC group) for correction of hallux valgus deformity.

Methods

Patients who were scheduled to undergo a hallux valgus surgery by means of a distal chevron osteotomy were randomly assigned to one of the two groups. Pre-operatively, six weeks, 12 weeks, and nine months post-operatively the following outcome parameters were determined: Visual Analog Scores (VAS) of pain, the American Orthopedic Foot and Ankle Society (AOFAS) forefoot score, radiographic outcome measures, range of motion (ROM), and patient satisfaction.

Results

Forty-seven cases were analyzed (25 MIS group; 22 OC group). Both operative techniques achieved significant correction of the hallux deformity. The intermetatarsal angle (IMA) improved from 15.1° to 5.8° in the OC and from 14° to 6.8°in the MIS group, whereas the hallux valgus angle (HVA) improved from 28.3° to 8.5° in the OC versus 26.4° to 6.9° in the MIS group. No significant differences were observed between the groups by any of the determined outcome parameters. Regarding patient satisfaction, statistically significant differences were found between MIS and open surgery 12 weeks post-operatively in favour of the MIS group (p = 0.022).

Conclusion

With the minimally invasive chevron osteotomy, radiological and clinical outcome is comparable to the open technique.

Austin DW, Leventen EO (1981) A new osteotomy for hallux valgus: a horizontally directed “V” displacement osteotomy of the metatarsal head for hallux valgus and primus varus. Clin Orthop Relat Res (157):25–30

Trnka HJ, Zembsch A, Easley ME, Salzer M, Ritschl P, Myerson MS (2000) The chevron osteotomy for correction of hallux valgus. Comparison of findings after two and five years of follow-up. J Bone Joint Surg Am 82-A(10):1373–1378CrossRef

Oh IS, Choi SW, Kim MK, Lee SY, Lee JS (2008) Clinical and radiological results after modified distal metatarsal osteotomy for hallux valgus. Foot Ankle Int 29(5):473–477. https://doi.org/10.3113/FAI.2008.0473 10.3113/FAI-2008-0473

Choi WJ, Yoon HK, Yoon HS, Kim BS, Lee JW (2009) Comparison of the proximal chevron and Ludloff osteotomies for the correction of hallux valgus. Foot Ankle Int 30(12):1154–1160. https://doi.org/10.3113/FAI.2009.1154 CrossRefPubMed

Thordarson D, Ebramzadeh E, Moorthy M, Lee J, Rudicel S (2005) Correlation of hallux valgus surgical outcome with AOFAS forefoot score and radiological parameters. Foot Ankle Int 26(2):122–127. https://doi.org/10.1177/107110070502600202 CrossRefPubMed

Park CH, Jang JH, Lee SH, Lee WC (2013) A comparison of proximal and distal chevron osteotomy for the correction of moderate hallux valgus deformity. Bone Joint J 95-B(5):649–656. https://doi.org/10.1302/0301-620X.95B5.30181 CrossRefPubMed

Vopat BG, Lareau CR, Johnson J, Reinert SE, DiGiovanni CW (2013) Comparative study of scarf and extended chevron osteotomies for correction of hallux valgus. Foot Ankle Spec 6(6):409–416. https://doi.org/10.1177/1938640013508431 CrossRefPubMed

Brogan K, Voller T, Gee C, Borbely T, Palmer S (2014) Third-generation minimally invasive correction of hallux valgus: technique and early outcomes. Int Orthop 38(10):2115–2121. https://doi.org/10.1007/s00264-014-2500-1 CrossRefPubMed

Jowett CRJ, Bedi HS (2017) Preliminary results and learning curve of the minimally invasive chevron akin operation for hallux valgus. J Foot Ankle Surg 56(3):445–452. https://doi.org/10.1053/j.jfas.2017.01.002 CrossRefPubMed

10.

Lee M, Walsh J, Smith MM, Ling J, Wines A, Lam P (2017) Hallux valgus correction comparing percutaneous chevron/akin (PECA) and open scarf/akin osteotomies. Foot Ankle Int 38(8):838–846. https://doi.org/10.1177/1071100717704941 CrossRefPubMed

11.

Redfern D, Perera AM (2014) Minimally invasive osteotomies. Foot Ankle Clin 19(2):181–189. https://doi.org/10.1016/j.fcl.2014.02.002 CrossRefPubMed

12.

Brogan K, Lindisfarne E, Akehurst H, Farook U, Shrier W, Palmer S (2016) Minimally invasive and open distal chevron osteotomy for mild to moderate hallux valgus. Foot Ankle Int 37(11):1197–1204. https://doi.org/10.1177/1071100716656440 CrossRefPubMed

13.

Crespo Romero E, Penuela Candel R, Gomez Gomez S, Arias Arias A, Arcas Ordono A, Galvez Gonzalez J, Crespo Romero R (2017) Percutaneous forefoot surgery for treatment of hallux valgus deformity: an intermediate prospective study. Musculoskelet Surg 101(2):167–172. https://doi.org/10.1007/s12306-017-0464-1 CrossRefPubMed

14.

Maffulli N, Longo UG, Marinozzi A, Denaro V (2011) Hallux valgus: effectiveness and safety of minimally invasive surgery. A systematic review. Br Med Bull 97:149–167. https://doi.org/10.1093/bmb/ldq027 CrossRefPubMed

15.

Hardy RH, Clapham JC (1951) Observations on hallux valgus; based on a controlled series. J Bone Joint Surg Br 33-B(3):376–391CrossRefPubMed

16.

Venning P (1951) Sources of error in the production and measurement of standard radiographs of the foot. Br J Radiol 24(277):18–26. https://doi.org/10.1259/0007-1285-24-277-18 CrossRefPubMed

17.

Wulker N (1997) Hallux valgus. Orthopade 26(7):654–664CrossRefPubMed

18.

Smith RW, Reynolds JC, Stewart MJ (1984) Hallux valgus assessment: report of research committee of American Orthopaedic Foot and Ankle Society. Foot Ankle 5(2):92–103CrossRefPubMed

19.

Miller JW (1974) Distal first metatarsal displacement osteotomy. Its place in the schema of bunion surgery. J Bone Joint Surg Am 56(5):923–931CrossRefPubMed

20.

Mitchell CL, Fleming JL, Allen R, Glenney C, Sanford GA (1958) Osteotomy-bunionectomy for hallux valgus. J Bone Joint Surg Am 40-A(1):41–58 discussion 59-60 CrossRefPubMed

21.

Chan HY, Chen JY, Zainul-Abidin S, Ying H, Koo K, Rikhraj IS (2017) Minimal clinically important differences for American Orthopaedic Foot & Ankle Society Score in hallux valgus surgery. Foot Ankle Int 38(5):551–557. https://doi.org/10.1177/1071100716688724 CrossRefPubMed

22.

Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191CrossRef

23.

Giannini S, Faldini C, Nanni M, Di Martino A, Luciani D, Vannini F (2013) A minimally invasive technique for surgical treatment of hallux valgus: simple, effective, rapid, inexpensive (SERI). Int Orthop 37(9):1805–1813. https://doi.org/10.1007/s00264-013-1980-8 CrossRefPubMedPubMedCentral

24.

Faour-Martin O, Martin-Ferrero MA, Valverde Garcia JA, Vega-Castrillo A, de la Red-Gallego MA (2013) Long-term results of the retrocapital metatarsal percutaneous osteotomy for hallux valgus. Int Orthop 37(9):1799–1803. https://doi.org/10.1007/s00264-013-1934-1 CrossRefPubMedPubMedCentral

25.

Trnka HJ, Krenn S, Schuh R (2013) Minimally invasive hallux valgus surgery: a critical review of the evidence. Int Orthop 37(9):1731–1735. https://doi.org/10.1007/s00264-013-2077-0 CrossRefPubMedPubMedCentral

26.

Iyer S, Demetracopoulos CA, Sofka CM, Ellis SJ (2015) High rate of recurrence following proximal medial opening wedge osteotomy for correction of moderate hallux valgus. Foot Ankle Int 36(7):756–763. https://doi.org/10.1177/1071100715577195 CrossRefPubMed

27.

Rodriguez-Reyes G, Lopez-Gavito E, Perez-Sanpablo AI, Galvan Duque-Gastelum C, Alvarez-Camacho M, Mendoza-Cruz F, Parra-Tellez P, Vazquez-Escamilla J, Quinones-Uriostegui I (2014) Dynamic plantar pressure distribution after percutaneous hallux valgus correction using the Reverdin-Isham osteotomy. Rev Invest Clin 66 Suppl 1:S79–S84

28.

Agrawal Y, Desai A, Mehta J (2011) Lateral sesamoid position in hallux valgus: correlation with the conventional radiological assessment. Foot Ankle Surg 17(4):308–311. https://doi.org/10.1016/j.fas.2011.01.001 CrossRefPubMed

29.

Mahadevan D, Lines S, Hepple S, Winson I, Harries W (2016) Extended plantar limb (modified) chevron osteotomy versus scarf osteotomy for hallux valgus correction: a randomised controlled trial. Foot Ankle Surg 22(2):109–113. https://doi.org/10.1016/j.fas.2015.05.012 CrossRefPubMed

30.

Saro C, Jensen I, Lindgren U, Fellander-Tsai L (2007) Quality-of-life outcome after hallux valgus surgery. Qual Life Res 16(5):731–738. https://doi.org/10.1007/s11136-007-9192-6 CrossRefPubMed

31.

Jeuken RM, Schotanus MG, Kort NP, Deenik A, Jong B, Hendrickx RP (2016) Long-term follow-up of a randomized controlled trial comparing scarf to chevron osteotomy in hallux valgus correction. Foot Ankle Int 37(7):687–695. https://doi.org/10.1177/1071100716639574 CrossRefPubMed

32.

Giotis D, Paschos NK, Zampeli F, Giannoulis D, Gantsos A, Mantellos G (2016) Modified Chevron osteotomy for hallux valgus deformity in female athletes. A 2-year follow-up study. Foot Ankle Surg 22(3):181–185. https://doi.org/10.1016/j.fas.2015.07.004 CrossRefPubMed

33.

Chen JY, Ang BF, Jiang L, Yeo NE, Koo K, Singh Rikhraj I (2016) Pain resolution after hallux valgus surgery. Foot Ankle Int 37(10):1071–1075. https://doi.org/10.1177/1071100716653084 CrossRefPubMed

Title: Minimally invasive versus open chevron osteotomy for hallux valgus correction: a randomized controlled trial
Authors: Gerhard Kaufmann
Dietmar Dammerer
Felix Heyenbrock
Matthias Braito
Lorenz Moertlbauer
Michael Liebensteiner
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 2/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-4006-8

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Springer Medicine

Minimally invasive versus open chevron osteotomy for hallux valgus correction: a randomized controlled trial

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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