SLR - January 2020 - Shivang M. Shah
Reference: Kaufmann G, Dammerer D, Heyenbrock F, Braito M, Moertlbauer L, Liebensteiner M. Minimally Invasive Versus Open Chevron Osteotomy for Hallux Valgus Correction: A Randomized Controlled Trial. Int Orthop. 2019;43(2):343–350. doi:10.1007/s00264-018-4006-8Scientific Literature Review
Reviewed By: Shivang M. Shah, DPM
Residency Program: AMITA Health, St. Joseph Hospital – Chicago, IL
Podiatric Relevance: There are more than 100 different type of procedures in order to treat hallux valgus deformity. Open distal chevron osteotomy was first described by Austin et al in 1981 and has since been used to treat a great number of hallux valgus deformities. Common issues following an open chevron (OC) to the joint is scarring and decreased range of motion. This has resulted in the advent of a number of different minimally invasive surgery (MIS) to treat this deformity. Common claims of MIS are to have minor soft tissue damage, reduction in surgical time, a faster recovery while at the same time have the same stability and clinical outcomes. Purpose is to compare OC procedure to a MIS chevron osteotomy looking at clinical score outcome, radiographic outcomes, range of motion at the first metatarsophalangeal joint as well as patient satisfaction.
Methods: This is a prospective randomized control trial. Patient were selected from a waiting list of patients waiting for a distal chevron osteotomy. Exclusion criteria were age <16, prior first metatarsal osteotomy or soft tissue intervention, instability at the first TMTJ, osteoarthritis at first MTPJ, preoperative HVA <20 degrees or IM angle less than 10 degrees. Patients randomized into either OC group or MIS group. The article provides the surgical technique for both the OC and MIS group discussing incision, osteotomy, and fixation. Post-operative treatment was standardized over both groups. Measurements were taken at preoperatively, six weeks, 12 weeks and nine months looking at visual analogue scale, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, radiographic outcomes, range of motion and patient satisfaction.
Results: Twenty-two cases in the OC group and 25 cases in the MIS groups. No significant difference between the two groups with regards to VAS or AOFAS score. No significant difference was noted in the radiographic outcomes. Post-operative HVA and IMA were similar in both groups. No significant difference in ROM were observed at any of the three post-operative intervals. A significant difference was found with patient satisfaction at the 12 week post-operative mark in favor of the MIS group with a p value of 0.022. In both groups there was one patient with a poor satisfaction result.
Conclusions: The MIS was found to be comparable to the classical OC surgical technique. There were no significant difference with regards to post-operative pain levels, AOFAS scores, radiographic measurements, or range of motion. Patients were more satisfied of the MIS procedure at the 12 week post-operative point. There was no significant loss of correction in the first nine months post operatively in either group. It was also found that the K wire fixation in the MIS group required higher need for hardware removal over the screw fixation in the OC group. The authors have since altered their procedure and no longer recommend K wire fixation for the MIS procedure. The advances in the various types of MIS procedures may make it a more viable option when treat mild to moderate hallux valgus deformities.