Assessment of the Efficacy of SERI Osteotomy for Hallux Valgus Correction

SLR - April 2019 - Nina Argade

Podiatric Relevance: In recent years, the SERI (Simple, Effective, Rapid, Inexpensive) procedure has become an acceptable minimally invasive technique to correct mild to moderate hallux valgus. It is a distal first metatarsal osteotomy similar to a Bosch procedure that involves lateral soft-tissue manipulation and release of lateral structures to reposition the sesamoids. Its advantages include percutaneous technique, minimal soft-tissue dissection, temporary hardware, nonspecific instrumentation, cost-effectiveness, decreased operative time and direct visualization under fluoroscopy. The purpose of this study was to compare radiographic measurements obtained preoperatively and at one year postoperatively and to evaluate complications of the SERI osteotomy.

Methods: This was a retrospective study reviewing patient data from August 2013 to September 2016 at the Department of Orthopedic Surgery at the Security Forces Hospital in Riyadh, Saudi Arabia. All surgeries were performed using the same technique, by the same surgeon. Twenty-nine patients met the inclusion criteria [age 20 to 60 years, mild or moderate reducible hallux valgus (HV), hallux valgus angle (HVA) ≤ 40° and intermetatarsal angle (IMA) ≤ 20°, arthritis of the first metatarsophalangeal joint (MTPJ) up to Regnauld Grade 2 and postsurgical follow-up of at least one year]. Patients with stiffness or severe arthritis of the first MTPJ, history of rheumatoid arthritis or another inflammatory disease, diabetes or neurological disorder, and patients who had undergone a previous hallux surgery were excluded from the study. Patient demographics, operative characteristics, preoperative and postoperative (one year) radiographic measurements and complications were recorded.

Results: The mean age of patients was 34.9 ± 13.6 years. Six patients (20.7 percent) were treated for severe HV. Mean operation time was 11.1 ± 2.3 minutes. Four patients (13.8 percent) reported postoperative pain. No revision surgery was performed. Congruency of the hallux MTPJ increased significantly, documented in only four patients (13.8 percent) preoperatively but in 17 (58.6 percent) at one year. The mean HVA , IMA and distal metatarsal articular angle (DMAA) were significantly decreased at one year. The HVA normalized to <15° in 20 patients (69.0 percent), and the IMA normalized to <9° in 25 patients (86.2 percent), but the DMAA normalized in only four patients (13.8 percent). The number of patients with sesamoid subluxation decreased from 29 (100 percent) to 13 (44.8 percent). There were three patients (10.3 percent) in whom the degenerative arthritis of the first MTPJ progressed from Regnauld Grade 1 to Regnauld Grade 2.

Conclusions: Radiographically measured angles were significantly improved one year after surgery, no complications developed during the one-year follow-up period and there was no recurrence. The results of this study concur with those of previous studies that show reliability of the SERI technique in cases of mild to moderate hallux valgus deformity. This study goes a step further in showing reliability of the SERI technique in cases of severe HV, defined as an IMA >40 and HVA>20 (n=6). The merits of the SERI technique are promising; however, studies with larger sample size and longer follow-up (10 to 20 years) should be performed to evaluate the true complication and recurrence rates of hallux valgus deformity in patients undergoing this procedure.