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

Abstract

Purpose The purpose of this study was to compare a minimally invasive chevron osteotomy technique (MIS group) and the wellestablished 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.

Percutaneous, Intra-articular, Chevron Osteotomy (PeICO) for the Treatment of Hallux Valgus: A Cadaveric Study

“…Minimally invasive surgery (MIS), also known as percutaneous surgery, has experienced a sustained growth for the treatment of foot and ankle problems, especially over the last decade. This is supported by numerous studies including clinical series, 3,5,6,8,11,15,18,20,28,33 comparative studies, 7,22,23,38 technical reports 27,41 and radiologic validations. 17…”

“…Nevertheless, the distance between P2 (portal for osteosynthesis) and the DMDN showed the lowest average distance, 4.1 mm. Recently, in a cadaveric study that was divided into 2 surgical groups (experienced surgeons and untrained residents at 10% to 40%, respectively), Kaipel et al 22 found a 20% instance of traumatic nerve lesions when performing a percutaneous Bosch osteotomy; this seems to be considerably higher than that of open surgeries and PeICO. However, the authors did not relate this complication to the location of the K-wire.…”

PROSPECT guideline for hallux valgus repair surgery: a systematic review and procedure‐specific postoperative pain management recommendations

“… 10 11 21 24 25 27 32 33 36 37 44–46 58 None was associated with a reduction in pain scores, except one (n=50) that showed a reduction on POD1 to postoperative week 6, without difference at 6 postoperative months, in favor of percutaneous chevron/Akin osteotomy when compared with an open scarf/Akin osteotomy. 37 In contrast, Kaufmann et al 33 (n=47) investigated a percutaneous approach versus an open chevron osteotomy, but did not find any difference. Of note, 2 out of these 14 trials (n=96 and n=55) specifically compared a scarf versus a chevron osteotomy and did not find any difference in postoperative pain scores.…”

A New Minimally Invasive Surgery of Hallux Valgus: Technique and Preliminary Outcomes

“…Percutaneous and minimally invasive surgery (MIS) for hallux valgus is increasingly common in orthopedics by reason of the inherent for smaller scars, lesser postoperative pain, rapid recovery, reduced rehabilitation times, and decreased risk of infection [1,2].…”