Assessment of the Learning Curve of Minimally Invasive Surgery for Hallux Valgus: A Systematic Review

Abstract

Category: Bunion; Other Introduction/Purpose: Hallux valgus (HV) is a common orthopedic foot and ankle condition involving deformity with subsequent pain and dysfunction of the first ray. Surgical interventions, such as open and minimally invasive surgery (MIS), are frequently utilized if conservative management is insufficient. In recent years, MIS has been increasingly used and has been regarded as one of the most innovative surgical interventions for HV. However, insufficient and/or delayed mastery of MIS for HV has the potential to affect patient outcomes and complication rates. The purpose of this study is to examine the learning curve associated with MIS for the treatment of HV. Methods: A systematic review was performed using PubMed, ScienceDirect, Web of Science, CINAHL and MEDLINE databases from database inception to February 16th, 2023. Inclusion criteria was articles with level of evidence I-III, any outcomes associated with learning curve, MIS, full-text articles in English, and diagnosis of HV in adult patients. Exclusion criteria was articles not containing data on learning curves, non-English full-text, and level IV studies. Results: A total of 165 articles were found with 6 articles meeting final article selection. For all six articles, 368 total patients (422 total feet) were included in the study with an average age of 55.69 years (range 15 - 84). Three studies reported the number of surgeries needed to reach the plateau phase of the learning curve of MIS for HV, with a frequency weighted mean of 35.5 surgeries (range 27 – 40). In the selected articles, significant results were found for increased OR time and fluoroscopy shots in the learning phase. There was no significant increase in complications in the learning phase. There was no significant decrease in patient outcomes, or the quality of correction performed during the learning phase for MIS for HV. Conclusion: An average of 35.5 surgeries (range 27 – 40) are needed to reach the plateau phase for MIS for HV. The learning phase of the learning curve of MIS for HV has a significant increase in OR time and fluoroscopy usage. However, the learning phase of the learning curve of MIS for HIV is not associated with decreased outcomes, decreased corrections, or higher complication rates. More research with higher quality studies is needed to determine the impact of the learning curve of MIS for HV on patient outcomes.