Outcomes in chevron osteotomy for Hallux Valgus in a large cohort

Abstract

Clinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient's point of view has mostly been conducted by means of more physician-based outcome measures. The goal of this study was to evaluate the effect of the Chevron osteotomy for hallux valgus on patients' daily lives using the Foot and Ankle Outcome Score (FAOS) as a validated and a hallux valgus specific patient reported outcome measure (PROM). Secondary outcome measures were radiological correction, complication rate, and re-operations. All 438 Chevron procedures (336 patients), at two surgical hospital sites in the period between January 2010 and October 2014, were retrospectively evaluated with a follow-up of at least 6 months. Patients were invited to fill in a cross-sectional online FAOS. For the FAOS, a total response of 60% was achieved. The FAOS ranged between 71 and 88 with a follow-up of on average 36 months. Patients with an undercorrection of their hallux valgus (11.6% of the procedures) scored significantly lower on three subscales of the FAOS (range between 61 and 77 versus 72-84). Patients who had a reoperation (12.6% of the procedures) also scored significantly lower on four subscales: 58-100 versus 73-89. Postoperative radiological measurements improved significantly with a mean difference of 6.1 (5.9; 6.4) degrees for the intermetatarsal angle and 13.7 (13.0; 14.5) degrees for the hallux valgus angle. In this large study cohort, Chevron osteotomy for hallux valgus offers good PROM scores on FAOS. These scores were significantly lower in patients with radiological undercorrection or with a reoperation. Results of the FAOS appear to modulate with physician based outcomes and therapeutic incidents. Improvement of outcome may therefore well be possible by increased attention on these surgical details.

Need for concomitant Akin osteotomy in patients undergoing Chevron osteotomy can be determined preoperatively: a retrospective comparative study of 859 cases

“…The mean correction at follow-up in our study population was 14.6° for HVA, 7.0 for IMA, and 5.1 for DMAA in the Chevron group and 19.5, 8.5, and 4.2 in the AC group. The achieved correction of both groups was higher, but still comparable to other studies [22, 23]. In regard to the fact that 81 cases of our study cohort had a moderate to severe deformity in terms of the IMA (> 16°), this finding might be a consequence of stretching the surgical Chevron technique to its technical limit.…”

“…Preoperative deformity in our study population was comparable to published literature [22]. Our cohort experienced significant pre- to postoperative correction of the hallux valgus deformity to all points of survey, in terms of IMA, HVA, DMAA, joint congruity, and positioning of the sesamoids with superiority of the AC cohort.…”

Surgical treatment of mild to moderate hallux valgus

“…Recently, there has been a tendency to increase the number of publications devoted to the treatment of mild and moderate hallux valgus using corrective diaphyseal (Scarf, Mau) and distal (Chevron, Mitchell) osteotomies of the first metatarsal bone 3,[7][8][9] . Each of the variants of osteotomy has certain possibilities in terms of correction of the components of the first metatarsal bone deformation, which is due to the localization of osteotomy, its shape and the need to preserve the contact of bone fragments for the fusion of the osteotomy zone.…”

Surgical treatment of moderate and severe hallux valgus: 30 cases undergoing surgery using the percutaneous Chevron technique

“…O hálux valgo é a deformidade ortopédica mais prevalente no antepé. Estima-se que 23% da população adulta entre 23 e 65 anos de idade sejam portadores da deformidade e na faixa etária acima dos 65 anos, a prevalência sobe para 35% (1) . A doença é multifatorial e a hereditariedade é o principal fator associado, visto que aproximadamente 68% dos pacientes têm antecedente familiar.…”

“…A doença é multifatorial e a hereditariedade é o principal fator associado, visto que aproximadamente 68% dos pacientes têm antecedente familiar. A dor e o desconforto para o uso de calçados fechados estão presentes em muitos casos, acarretando limitações para as atividades cotidianas e impactando nos índices de qualidade de vida (1)(2)(3)(4)(5)(6) .…”