Open vs Minimally Invasive Scarf Osteotomy for Hallux Valgus Correction: A Randomized Controlled Trial

Abstract

Background: Minimally invasive (MI) surgery is becoming increasingly popular in the treatment of hallux valgus (HV). The scarf osteotomy is an effective procedure with a track record in open HV surgery. We adapted this effective osteotomy to MI surgery as a novel technique never reported before. The aim of this study was to compare the clinical and radiologic outcomes of patients who underwent open or MI scarf. Methods: Between 2017 and 2018, 58 patients were randomized to either open or MI scarf to treat HV deformity. Prospective patient-reported outcome measures and weightbearing radiographs were obtained. Data included the AOFAS score, radiologic angular correction, operative time, fluoroscopy radiation dose, and postoperative pain on visual analog scale (VAS). Results: The mean follow-up was of 21 (range, 12-38) months. Radiologic measurements (postoperative hallux valgus angle, first-to-second intermetatarsal angle, and distal metaphyseal articular angle) were similar in both groups and showed statistically significant improvement from preoperative measures. The mean operative time for the MI group was 16.7 vs 26.1 minutes in the open group, a statistically significant difference. Radiation exposure was 14 times higher in the MI group when compared to the open group (mean: 34 vs 2.4 mGy/cm2, P < .001). There were no major complications in either group. Conclusions: The MI scarf provides a clinically and radiologically equivalent outcome to open scarf for the treatment of HV with reduced operative time and immediate postoperative VAS for pain but is associated with a small increase in radiation exposure. Level of Evidence: Level I, randomized controlled trial.

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

“…Follow-up times were highly variable, ranging from 6 months to 7 years. Among the included studies, 8 studies ( 15 , 17 , 24 , 26 , 28 , 29 , 31 , 35 ) were RCTs, 2 studies ( 4 , 14 ) were prospective comparative studies, and 12 studies ( 5 , 13 , 16 , 18 , 22 , 23 , 25 , 27 , 30 , 32 – 34 ) were retrospective comparative studies. A total of 10 studies ( 13 , 17 , 22 – 28 , 32 ) reported on the 2G percutaneous hallux valgus surgery, in which 7 studies ( 13 , 22 – 25 , 28 ) involved Bösch osteotomy and 3 studies ( 17 , 26 , 27 ) involved a simple, an effective, a rapid, and an inexpensive (SERI) technique.…”

“…Tay et al ( 34 ) performed a retrospective study to compare between the MICA and scarf/akin surgery. Two studies ( 4 , 31 ) performed a comparison of the mini-scarf with open scarf osteotomy. Guo et al ( 33 ) conducted a retrospective comparative study for a comparison of percutaneous oblique osteotomy (POO) with open chevron osteotomy.…”

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

“…Surgery duration and the time using fluoroscopy was not measured in the present study; nevertheless, the amount of radiation and surgical time decrease while surgeon experience increases. 33 Tay et al 32 reported significant improvements in VAS score 1 week after surgery with third-generation MIS, and these results could explain the differences between the first, second, and third generations of MIS. Similar results were reported by Neufeld et al 24 with MICA.…”

“…Tay et al 32 reported similar results comparing MICA with scarf + Akin at 6 and 24 months, although the preoperative HVA values were smaller than those in the present study. 14,21,32 Torrent et al 33 compared open to MIS scarf osteotomy with similar clinical and radiographic results between both techniques. The MIS technique was faster than open although with more fluoroscopic radiation.…”

“…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.…”