Radiologic Recurrence of Hallux Valgus Deformity after Scarf and Akin Osteotomy in Patients with High Distal Metatarsal Articular Angle

Abstract

Category: Bunion Introduction/Purpose: The most frequent complication after hallux valgus corrective surgery is recurrence of deformity. Many factors have been identified previously as risk factors for recurrence. Especially, inadequate correction of the distal metatarsal articular angle (DMAA) has been reported one of the surgical risk factors for recurrence. This study aimed to investigate the recurrence rate after hallux valgus correction using Scarf and Akin osteotomy and to identify the significance of postoperative DMAA as a risk factor of recurrence. Methods: We reviewed 87 hallux valgus patients (122 feet) who received Scarf and Akin osteotomy from January 2007 to August 2015. Clinical outcomes were evaluated using VAS and the AOFAS score. Radiological outcome measures included hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) in serial weight bearing radiograph. Recurrence was defined as more than 20 degrees of HVA in final follow-up radiograph. Radiological factors associated with recurrence including high DMAA were evaluated and analyzed. Results: Mean follow-up duration was 20.6 months (range, 12.0-46.5 months) and mean age was 44 years (13-80 years). The VAS and AOFAS scores were significantly improved at the final follow-up (7.0 to 2.0, p<0.001, 78.0 to 92.0, p<0.001). Significant corrections in the HVA, IMA and DMAA were obtained(p<0.001). Eleven (9.0%, 11/122) cases recurred hallux valgus deformity. Postoperative IMA, DMAA and HVA showed significant moderate to strong correlation with HVA at final follow-up (rho: Spearman correlation coefficient, 0.42, 0.71, 0.87, p<0.001). There was no recurrence in cases of postoperative DMAA less than 11.3 degree (fisher exact test, p<0.001). Conclusion: High DMAA is one of numerous risk factor for hallux valgus recurrence after scarf and akin osteotomy. To avoid recurrence, we suggest that surgical correctional goal of DMAA should be considered less than 11.3 degrees.