Minimally Invasive vs. Open Surgery for Hallux Valgus: A Meta-Analysis

Abstract

PurposeIn recent years, minimally invasive surgery (MIS) for hallux valgus has emerged and gained popularity. To date, evidence on the benefits of MIS for hallux valgus is still controversial. This updated meta-analysis aimed to comprehensively evaluate the efficiency of MIS vs. open surgery for hallux valgus.MethodsA systematic literature search of PubMed, Embase, and the Cochrane Library was performed. Two independent reviewers conducted data extraction and analyzed data with R software. Data were presented with risk ratio (RR) and standardized mean difference (SMD) along with 95% confidence interval (CI).ResultsA total of 22 studies in which there were 790 ft treated with the MIS procedure and 838 ft treated with an open procedure were included. The correction of sesamoid position was better in the MIS group. The post-operative distal metatarsal articular angle (DMAA) of the MIS group was lower. There was less pain at the early phase in the MIS group. The MIS group had a shorter surgery time and shorter hospitalization time compared with the open group. Our meta-analysis revealed no statistically significant difference in hallux valgus angle (HVA), first intermetatarsal angle (IMA), the first metatarsal shortening, the American Orthopedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS) score at the final follow-up or complication rate (when all studies were considered). When taking into consideration only randomized controlled trial (RCT), the AOFAS score was higher in the MIS group while HVA, IMA, DMAA, and complication rate remained no significance. Post-operative IMA of the MIS group was significantly lower when only studies reporting the second-generation (2G) MIS were included. When just studies adopting the third-generation (3G) MIS were included, the HVA and DMAA were lower in the MIS group.ConclusionThe MIS procedures were more effective than open surgeries in the treatment of hallux valgus. Moreover, the MIS group achieved better radiologic and clinical outcomes compared with the open group.

Clinical and Radiographic Outcomes of Percutaneous Third-Generation Double First Metatarsal Osteotomy Combined With Closing-Wedge Proximal Phalangeal Osteotomy for Moderate and Severe Hallux Valgus

“…In contrast, Holme et al 14 included 9 severe cases, and Tay et al 32 reported moderate cases. Ji et al 16 showed comparable outcomes with open and MIS in a meta-analysis. In the present study, the overall complication rate was 16.8% and 26.8% in moderate and severe cases respectively, including the learning curve period of this specific technique for an experienced surgeon.…”

“…Okuda et al 26 in 2009 found an association between postoperative TSP and recurrence; a similar finding was observed in our study. Ji et al 16 only found 4 studies reporting this measurement. The roundness type of the first metatarsal head (Round Sign) has been associated with recurrence.…”

“…9,14 In the last 5 years, there has been an increase in publications related to third-generation MIS techniques for correction of severe deformities of HV with results comparable with open techniques, and likewise with complication repo rts. 13,16,19,32,33 With respect to the third-generation percutaneous double first metatarsal osteotomy (PEDO) plus first phalanx osteotomy (Akin percutaneous), the literature is still scarce to date. 6,8,10 Percutaneous and minimally invasive procedures will require ideally cadaveric and saw-bones prior training using high-torque and low-speed micromotor, small blades, rasps, and burrs.…”

“…In the last 5 years, there has been an increase in publications related to third-generation MIS techniques for correction of severe deformities of HV with results comparable with open techniques, and likewise with complication reports. 13,16,19,32,33…”

Current status and trends in Hallux valgus research from 2004 to 2021: A Bibliometric Analysis

“…Another meta-analysis noted that treatment of HV was more effective with minimally invasive surgery than open surgery. Additionally, the minimally invasive surgery group had a better radiologic and clinical outcome than the open group (59). A retrospective comparative study investigated that while open osteotomies performed better than minimally invasive surgery in HVA and IMA, minimally invasive surgery performed better in DMAA.…”