Clinical and Radiographic Outcomes of Percutaneous Chevron-Akin Osteotomies for the Correction of Hallux Valgus Deformity

Mikhail, Christopher; Markowitz, Jonathan; Lenarda, Luca Di; Guzman, Javier Z.; Vulcano, Ettore

doi:10.1177/10711007211031218

Cited by 33 publications

(45 citation statements)

References 43 publications

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“…Most report high satisfaction (greater than 90%) and low complication rates. 14 , 16 , 20 , 22 The most common reason for reoperation has been for removal of hardware. 19 Rates of nonunion are variably reported, but range from 0% to 2.8%.…”

Section: Discussionmentioning

confidence: 99%

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Early Radiographic Outcomes of Minimally Invasive Chevron Bunionectomy Compared to the Modified Lapidus Procedure

Cody

Caolo

Ellis

et al. 2022

Foot & Ankle Orthopaedics

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Background: Minimally invasive (MIS) bunion surgery has become increasingly popular. Although early reports on outcomes have been encouraging, no study to date has compared outcomes from the MIS chevron and Akin procedures to the modified Lapidus procedure. Our primary aim was to compare early radiographic outcomes of the MIS chevron and Akin osteotomies to those of the modified Lapidus procedure in patients with comparable deformities, and secondarily to compare clinical outcomes. Methods: Patients were retrospectively reviewed for inclusion from a prospectively collected foot and ankle registry. Patients were eligible if they underwent either the MIS bunionectomy or modified Lapidus procedure and had preoperative and minimum 5-month postoperative weightbearing radiographs. Forty-one patients who underwent MIS bunionectomy were matched to 41 patients who underwent Lapidus bunionectomy based on radiographic parameters. Demographics, radiographic parameters, complications, reoperations, and PROMIS scores were compared between groups. Results: Both groups achieved similar radiographic correction. There was no significant difference in pre- or postoperative PROMIS scores between groups. Procedure duration was significantly faster in the MIS group ( P < .001). Bunion recurrence (hallux valgus angle ≥20 degrees) occurred in 1 MIS patient and 2 Lapidus patients, with all patients asymptomatic. The most common reason for reoperation was removal of hardware (4 patients in the MIS group, 2 patients in the Lapidus group). Conclusion: This is the first study to our knowledge to compare early radiographic outcomes between MIS bunionectomy and the modified Lapidus procedure in patients matched for bunion severity. We found that patients with similar preoperative deformities experience similar radiographic correction following MIS chevron and Akin osteotomies vs modified Lapidus bunionectomy. Further research is needed to investigate satisfaction differences between the procedures, longer-term outcomes, and which deformities are best suited to each procedure. Level of Evidence: Level III, Retrospective case control study.

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Section: Discussionmentioning

confidence: 99%

“… 14 , 15 , 19 , 20 Studies comparing the MIS chevron and Akin bunionectomy to open metatarsal osteotomies have generally found less pain in the early postoperative period for patients undergoing MIS surgery and no difference in clinical or radiographic outcomes between groups. 2 , 10 , 18 , 22 , 28 …”

Section: Introductionmentioning

confidence: 99%

Early Radiographic Outcomes of Minimally Invasive Chevron Bunionectomy Compared to the Modified Lapidus Procedure

Cody

Caolo

Ellis

et al. 2022

Foot & Ankle Orthopaedics

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“…[ 20 ] In a study evaluating percutaneous osteotomies for hallux valgus operation, it was reported that tourniquets were not used to prevent the development of heat necrosis. [ 21 ] In the light of this information, we think that not using a tourniquet is among the advantages of this technique.…”

Section: Discussionmentioning

confidence: 99%

Metatarsal osteotomy for hallux valgus under wide-awake local anesthesia with no tourniquet technique

Pamuk¹

2022

Jt Dis Relat Surg

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Objectives The issue of performing a hallux valgus operation with the wide-awake local anesthesia with no tourniquet (WALANT) technique has not been evaluated before. The objective of this study was to compare the clinical results of patients who underwent the WALANT technique during hallux valgus operation and patients who underwent the procedure with traditional anesthesia (TA). Patients and methods In this cross-sectional, retrospective study, 34 patients (17 males, 17 females; mean age: 46.1±8.3 years; range, 36 to 62 years) who underwent first metatarsal osteotomy with the diagnosis of hallux valgus disease at the orthopedics and traumatology department of the Private Silivri Anadolu Hospital between November 1, 2018, and June 1, 2020, were divided into two groups according to the surgical approach determined by patient choice: the WALANT group and the TA group. Demographic characteristics, Visual Analog Scale (VAS) scores for pain and anxiety, postoperative satisfaction levels, and complications were recorded. Results There was no significant difference between the groups in terms of demographic characteristics. The VAS pain score during needle insertion was significantly higher in the WALANT group compared to the TA group (p<0.001). Conversely, the VAS anxiety score was significantly higher in the WALANT group compared to the TA group (p<0.001). The median follow-up time was 5.4 months (interquartile range, 5-6 months). Conclusion This is the first study demonstrating that adequate anesthetic efficacy can be achieved with the WALANT technique for the hallux valgus operation. Acceptable pain scores can be achieved with this technique, and costs are reduced.

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“…Inherently, MIS surgery leads to less soft tissue trauma and dissection compared with open techniques and is often associated with lower levels of postoperative pain, improved wound healing, and quicker patient recovery. [12][13][14] The MIS Shannon burr in foot and ankle surgery is one component of an expanding MIS field. It may be combined with other MIS techniques such as arthroscopy and percutaneous surgery that also aim to decrease the operative insult to the delicate soft tissue envelope of the foot and ankle.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quality of MIS vs Open Joint Preparations of the Foot and Ankle

et al. 2022

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Background: Minimally invasive surgery (MIS) is growing in the field of foot and ankle, and the MIS burr is an emerging tool. Although commonly used to perform osteotomies, the burr can also be used for arthrodesis joint preparation that traditionally would be performed through open incisions. To date, there is no study comparing the quality of joint preparation between using a fluoroscopy-guided MIS technique compared to traditional open techniques. The goal of this cadaveric study is to compare the percentage of joint surfaces prepared between MIS and open techniques for the most common joints that are fused in foot and ankle surgery. Methods: Open joint preparation was performed under direct visualization with open incisions. MIS joint preparation was performed percutaneously using fluoroscopic guidance alone, without arthroscopy. After joint preparation, cadaveric samples were disarticulated, and joint surfaces were analyzed for percentage of cartilaginous surface removed. The percentage of joint surface prepared was compared between the open and MIS techniques. Results: Ten cadaveric samples were used for the MIS technique and 5 samples for the open technique. Percentage of joint surface prepared was similar for all joint surfaces. Conclusion: The MIS technique in the hands of experienced surgeons was found to provide overall similar percentages of surface area prepared compared to traditional open techniques. Clinical Relevance: MIS joint preparation may be useful for specific patient populations. This study suggests that MIS joint preparation is a reasonable, and possibly advantageous, alternative to open preparation in arthrodesis surgery when performed by experienced MIS surgeons.

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Clinical and Radiographic Outcomes of Percutaneous Chevron-Akin Osteotomies for the Correction of Hallux Valgus Deformity

Cited by 33 publications

References 43 publications

Early Radiographic Outcomes of Minimally Invasive Chevron Bunionectomy Compared to the Modified Lapidus Procedure

Early Radiographic Outcomes of Minimally Invasive Chevron Bunionectomy Compared to the Modified Lapidus Procedure

Metatarsal osteotomy for hallux valgus under wide-awake local anesthesia with no tourniquet technique

Quality of MIS vs Open Joint Preparations of the Foot and Ankle

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