Percutaneous Osteotomies in Hallux Valgus: A Systematic Review

Abstract

Percutaneous and minimally invasive surgery is one of the greatest advances in the operating field of orthopedic since the late 1990s. The potential advantages include a shorter operative time, quicker recovery, and reduced hospital stay compared with traditional open surgery. However, scientific validation of the safety and efficacy of hallux valgus (HV) percutaneous surgery remains inconclusive. The objective of the present study was to systematically review the published data and clinical evidence for percutaneous HV surgery, evaluate the scientific method of the reports, and clarify the indications, safety, efficacy, and potential risks of these surgical techniques. Two reviewers independently identified the studies using a PubMed search, with the keywords "hallux valgus," "osteotomy," "minimally invasive," and "percutaneous." Quality assessment was performed using the Coleman methodology scale, and each study was assigned a level of evidence and grade of recommendation. Eighteen studies were included and reported a total of 1534 procedures for percutaneous HV surgery on 1397 patients. Of the 18 studies, 14 (77.8%) were level IV, 2 (11.1%) were level III, and 2 (11.1%) were level II. Overall, the average angle correction of the HV deformity improved postoperatively. Regarding the complications, although some investigators revealed no major complications, others described deformity recurrence in 7.8%, stiffness of the first metatarsophalangeal joint in 9.8%, malunion in 4% to 8.7%, and infection rates ranging from 1.9% to 14.3%. The main indication for percutaneous HV surgery is the correction of mild deformities. The complication rate was elevated even in experienced surgeons. In conclusion, future research in percutaneous techniques should include adequately sized randomized control trials, standardization of treatment protocols, and the use of validated tools for the measurement of clinical outcomes.

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

“…We can both rotate the distal osteotomy block and correct distal metatarsal articular angle (DMAA) simultaneously after osteotomy. DMAA has not been measured in our cases, because there is a poor interobserver reliability [17]and is not frequently used in research due to this reason [1].…”

“…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].…”

“…To date, many studies have evaluated the results of MIS techniques and open therapeutic surgeries for hallux valgus [8,11]. Meanwhile, systematic reviews have been reported to estimate the results of MIS techniques for treating the hallux valgus [1,12]. Those reviews pinpointed limitations of the achievable evidence to determine clear proposals for MIS in hallux valgus correction.…”

Third-Generation Percutaneous Forefoot Surgery

“…The second-generation technique was a distal transverse osteotomy of the 1MT stabilized with an axial wire [40,41]. Recently, some comparative studies evaluating these procedures received a degree of recommendation C (poor-quality evidence for or against recommending intervention), although these results are being reviewed due to the omission of relevant studies [41][42][43][44].…”

“…Additionally, cadaveric results [51,52], technique reports [53], and radiological validations [54,55] have been described. Despite the fact that for some authors percutaneous surgery of the forefoot lacks scientific support [56][57][58], recently two systematic reviews published support its indication in hallux valgus surgery [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59].…”