The Learning Curve of Third-Generation Percutaneous Chevron and Akin Osteotomy (PECA) for Hallux Valgus

Lewis, Thomas; Robinson, Peter; Ray, Robbie; Goff, Thomas; Dearden, Paul; Whitehouse, Michael; Lam, Peter; Dracopoulos, G.

doi:10.1053/j.jfas.2022.06.005

Cited by 13 publications

(17 citation statements)

References 28 publications

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“…In the same group the mean HVA improved from 27.2 (16-42) degrees preoperatively to 10.7 degrees (4-12) postoperatively. The mean IPA in the unfractured group improved from 13.9 (11)(12)(13)(14)(15)(16)(17) degrees to 3.9 (3-8) degrees postoperatively. In the group with lateral cortex fracture, the mean first-to-second IMA angle preoperatively was 13.3 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) degrees and improved postoperatively to 3.8 (1-6) degrees.…”

Section: Primary Outcomesmentioning

confidence: 87%

“…Overall, studies have reported similar outcomes with effective deformity correction, short learning curve, low complication rate, low symptomatic recurrence, low postoperative opioid use, and high patient satisfaction. 3,9,11-15,17,18,22…”

Section: Discussionmentioning

confidence: 99%

“…The preoperative HVA was 29.3 degrees and improved to 7.1 (4-12) degrees postoperatively. The mean IPA improved from 13.5 (9)(10)(11)(12)(13)(14)(15)(16) degrees to 4.7 (3-8) degrees postoperatively. The preoperative IMA, HVA, and IPA differences between the fracture and nonfracture group were not significant (P > .05).…”

Section: Primary Outcomesmentioning

confidence: 90%

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Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy

Marciano,

Ashinsky,

Mysore

et al. 2023

Foot Ankle Int.

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Background: Intraoperative fracture of the lateral cortex is common during Akin osteotomy. In a recent study, lateral cortex fracture did not impede healing or result in loss of correction in a combined cohort of open and percutaneous osteotomies stabilized by K-wire fixation. We hypothesize that undesired lateral cortex fracture will not affect radiographic correction and patient-reported outcomes in a percutaneous cohort stabilized by permanent, rigid screw fixation. Methods: Consecutive patients with hallux valgus who underwent first metatarsal osteotomy and percutaneous Akin osteotomy stabilized by permanent, rigid screw fixation between May 2020 and January 2022 were retrospectively reviewed. Patients were stratified based on fractured lateral cortex (FC) or its absence (nonfractured cortex [NFC]). Visual analog scale (VAS) and Foot Function Index (FFI) were used to assess pain and patient-reported outcomes at 1-year follow-up. Patients were polled for satisfaction at 1-year follow-up by yes/no survey. Results: Ninety-eight patients (89% female) were reviewed (98 feet; 43 NFC, 55 FC). Mean age was 48.3 years (range, 18-83 years). Mean preoperative VAS score was 7.5 and 7.7 in NFC and FC groups, which significantly decreased to 0.6 ( P < .01) and 0.6 ( P < .01), respectively. Mean total FFI was 53.9 and 54.2 and decreased to 17.9 ( P < .01) and 17.2 ( P < .01) in the NFC group and FC group, respectively. Overall, 97.8% of the NFC group and 96.4% of the FC group reported satisfaction. Mean HVA improved from 27.2 (16-42) degrees to 10.7 degrees (4-12) postoperatively in the NFC group. And in the FC group, HVA improved from 29.3 (19-39) degrees to 7.1 (4-12) degrees postoperatively. Postoperative HVA was significantly lower in the FC group ( P < .05). Conclusion: In an exclusively percutaneous surgical cohort with correction maintained by rigid screw fixation, fracture of the lateral cortex is associated with improved postoperative radiologic alignment without detriment to patient-reported outcomes. Level of Evidence: Level III, retrospective cohort study.

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Section: Primary Outcomesmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy

Marciano,

Ashinsky,

Mysore

et al. 2023

Foot Ankle Int.

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“…Surgeons may be intrigued by emerging techniques but need to carefully evaluate their risks. In particular, the learning curve and its associated risks and complications are important when considering adopting minimally invasive techniques [27]. We are unable to recommend the MIS approach over traditional approaches, in light of the absence of any clinically important benefits to MIS identified in this meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, nine of the 13 patients experienced dorsal malunion [22]. However, these complications may have been a function of the learning curve associated with MIS for hallux valgus deformities, because the authors had little experience in MIS [27,53]. This should not be dismissed-any surgeon adopting a new technique might find him or herself in this same situation, and the risk of novelty and potential harms arising in patients when the surgeon is surmounting a learning curve must be considered [26].…”

Section: Complicationsmentioning

confidence: 99%

Does Minimally Invasive Surgery Provide Better Clinical or Radiographic Outcomes Than Open Surgery in the Treatment of Hallux Valgus Deformity? A Systematic Review and Meta-analysis

Polzer

Ocokoljic

Ray

et al. 2022

Clin Orthop Relat Res

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BackgroundHallux valgus is the most common foot deformity and affects 23% to 35% of the general population. More than 150 different techniques have been described for surgical correction. Recently, there has been increasing interest in the use of minimally invasive surgery to correct hallux valgus deformities. A variety of studies have been published with differing outcomes regarding minimally invasive surgery. However, most studies lack sufficient power and are small, making it difficult to draw adequate conclusions. A meta-analysis can therefore be helpful to evaluate and compare minimally invasive and open surgery.Questions/purposesWe performed a systematic review and meta-analysis of randomized controlled trials and prospective controlled studies to answer the following question: Compared with open surgery, does minimally invasive surgery for hallux valgus result in (1) improved American Orthopaedic Foot and Ankle Society (AOFAS) scores and VAS scores for pain, (2) improved radiologic outcomes, (3) fewer complications, or (4) a shorter duration of surgery?MethodsThe systematic review and meta-analysis was conducted according to the guidelines of the Cochrane Handbook for Systematic Reviews of Intervention and the Preferred Reporting Items for Systematic Reviews and Meta-analyses. A search was performed in the PubMed, Embase, Scopus, CINAHL, and CENTRAL databases on May 3, 2022. Studies were eligible if they were randomized controlled or prospective controlled studies that compared minimally invasive surgery and open surgery to treat patients with hallux valgus. We defined minimally invasive surgery as surgery performed through the smallest incision required to perform the procedure accurately, with an incision length of approximately 2 cm at maximum. Open surgery, on the other hand, involves a larger incision and direct visualization of deeper structures. Seven studies (395 feet), consisting of six randomized controlled studies and one prospective comparative study, were included in the qualitative and quantitative data synthesis. There were no differences between the minimally invasive and open surgery groups regarding age, gender, or severity of hallux valgus deformity. Each included study was assessed for the risk of bias using the second version of the Cochrane tool for assessing the risk of bias in randomized trials or by using the Newcastle-Ottawa Scale for comparative studies. Most of the included studies had intermediate quality regarding the risk of bias. We excluded one study from our analysis because of its high risk of bias to avoid serious distortions in the meta-analysis. We performed a sensitivity analysis to confirm that our meta-analysis was robust by including only studies with a low risk of bias. The analyzed endpoints included the AOFAS score (range 0 to 100), where higher scores represent less pain and better function; the minimum clinically important difference on this scale was 29 points. In addition, the VAS score was analyzed, which is based on a pain rating scale (range 0 to 1...

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The surgical learning curve for percutaneous Zadek osteotomy for treatment of insertional achilles tendinopathy

Hall,

Kaplan,

Phillips

et al. 2024

Arch Orthop Trauma Surg

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Introduction The Zadek Osteotomy has been described as an effective technique for the treatment of insertional Achilles tendinopathy. Recently, this strategy has been modified using minimally invasive techniques. A learning curve has been observed in many minimally invasive procedures in foot and ankle surgery. This retrospective study first intended to evaluate if there is a learning curve associated with the percutaneous Zadek Osteotomy. Further, if a learning curve was observed, we planned to assess the data for associated changes in complications and postoperative outcomes. Methods A retrospective analysis of 98 patients who underwent percutaneous Zadek Osteotomy was performed. Patient charts were reviewed for operative times, complications, union rates, and Foot Function Index (FFI) and Visual Analogue Scale (VAS) scores. Analysis of variance was utilized to assess for differences between groups of cases. Results Patients included 61 females and 37 males. Mean age was 51.28 ± 11.12 (range 28–81) years. Mean follow-up time was 42.07 ± 12.99 (range 24–65) months. Significant increases in operative times were observed in cases 1–14 when compared to cases 15–98 (p < 0.001). Improvements in FFI and VAS scores were observed at final follow-up within each case group (p < 0.001); there were no differences detected in FFI or VAS scores between groups of cases. There was no difference detected in number of complications between intervals of cases. Conclusion A learning curve was observed for the percutaneous Zadek Osteotomy, which was overcome around case 14. This learning curve was only observed in terms of procedure length. A surgeon’s level of inexperience with the technique does not appear to affect functional outcomes, nonunion, or need for revision. Level of evidence IV Data will not be deposited in a repository.

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The Learning Curve of Third-Generation Percutaneous Chevron and Akin Osteotomy (PECA) for Hallux Valgus

Cited by 13 publications

References 28 publications

Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy

Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy

Does Minimally Invasive Surgery Provide Better Clinical or Radiographic Outcomes Than Open Surgery in the Treatment of Hallux Valgus Deformity? A Systematic Review and Meta-analysis

The surgical learning curve for percutaneous Zadek osteotomy for treatment of insertional achilles tendinopathy

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