The influence of the number of screws and additional surgical procedures on outcome in hallux valgus treatment

Abstract

BackgroundSurgical treatment of hallux valgus (HV) is one of the major flagships of orthopedic surgeons. Due to relatively unsatisfactory radiological and clinical outcomes, the search for the best surgical technique and causes for unsatisfactory outcomes continues. The objective was to investigate associations of the number of screws and additional surgical techniques for HV with radiological and clinical outcome after reversed L-shaped osteotomy (ReveL).MethodsA retrospective cohort study of adults from a single University Hospital between 2004 and 2013 was performed. The primary exposure was the number of screws (one vs two) used for osseous fixation after ReveL. The secondary exposure was an additional surgical technique for HV (e.g., Akin osteotomy). The primary outcome was a radiological recurrence of HV (HV angle (HVA) > 15°) at last follow-up. The secondary outcomes were limited patient satisfaction, complication, revision surgery, and elective hardware removal. Odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression adjusting for confounders.ResultsThe recurrence was 45% less likely with the use of one screw, independent of age, sex, additional technique, and preoperative HVA (odds ratio (ORadjusted) = 0.55 [95% CI 0.30–0.98], p = 0.043). The recurrence was 162% more likely with an additional surgical technique for HV (ORadjusted = 2.62 [1.24–5.52], p = 0.011).ConclusionIn ReveL for HV, a single screw (instead of two screws) may be sufficient enough for a similar or even better outcome, which may also reduce costs. Additional surgical procedures for HV may be refrained from if possible. Due to limitations of a retrospective study, results may need validation with clinical trials.

Comparison of Bioabsorbable Magnesium versus Titanium Screw Fixation for Modified Distal Chevron Osteotomy in Hallux Valgus

“…Prominent screw heads or plates may irritate the skin and cause pain and discomfort when wearing shoes. In literature, implant removal rates in chevron osteotomy operations vary between 2.3% and 23.6% [7, 24, 25]. In the current series, one patient in the Ti group required removal of the screws, which corresponds to a 5.8% implant removal rate and is in line with the current literature.…”

“…Metallic screw fixation is now the most frequently used fixation method for modified chevron osteotomies [6]. However, elective implant removal due to irritation of metallic screws has been reported in up to 26.9% of patients in reported series [7]. A second operation decreases patient satisfaction and increases the overall cost of the treatment.…”

Mitchell Osteotomy for Hallux Valgus Using Trans-Osseous Capsulorrhaphy for Stabilization

“…The average amount of correction of hallux abductus with the Mitchell's osteotomy is dependent on the surgeon performing the operation. Averages of correction have been stated in the literature, but they have appeared very sporadically [1][2][3][4][5][6][7][8][9][10][11][12][13].…”

“…Although the metatarsal head is often intrinsically stable with step-cut Mitchell's osteotomy, secure existence of new techniques, Mitchell's osteotomy in the treatment of Hallux valgus remains to be used in our era and indications has expanded from mild to moderate hallux valgus surgery, to moderate and severe hallux valgus surgery [1,9] this partly is because of the simplicity of the technique and relative stability of the osteotomy regardless of whether internal fixation or suture fixation, is used.…”

“…reported in up to 26.9% of patients in reported series [1]. A second operation decreases patient satisfaction and increases the overall cost of the treatment.…”