Early outcomes of Minimally Invasive Percutaneous Chevron/Akin Osteotomy for Symptomatic Hallux Valgus Deformity

Abstract

Category:Midfoot/Forefoot; BunionIntroduction/Purpose:Hallux Valgus (HV) is a common progressive forefoot deformity. Although traditional open techniques have shown good outcomes, no technique has been shown to be superior to other techniques and 15% of patients have procedure related complications. This has significant functional restrictions, pain, and reduced quality of life. Minimally Invasive (MIS) percutaneous techniques became more popular in Orthopaedics. The current third generation of hallux valgus MIS technique developed by Vernois and Redfern features a percutaneous procedure with a stable internal fixation. The purpose of this study is to review the early outcomes of MIS hallux valgus operation by a single surgeon.Methods:Electronic health records were queried from January 1, 2015, through February 01, 2021, for patients who underwent MIS to treat HV deformity. Patients were treated by a single surgeon. The primary clinical outcomes assessed were visual analog pain score (VAS), rate of revision surgery, and recurrence. Additionally, radiographic outcomes were assessed including pre-and postoperative hallux valgus angle (HVA), inter-metatarsal angle (IMA), and foot width. The secondary outcomes included postoperative complications: infection, scar hypersensitivity, hardware irritation, hardware loosening, removal of hardware, and metatarsal fracture.Results:A total of 91 feet underwent MIS to correct symptomatic HV deformity. The mean age of this cohort was 53.63 +- 15.42 years, mean BMI of 26.81 +- 6.21, mean follow-up of 6.33 +- 6.39 months and 87 feet belonged to female patients. Patients showed a statistically significant (P < 0.001) improvement in VAS score after surgery. The radiographic outcomes showed significant (P < 0.001) improvement for all three variables at final follow up, with a mean improvement of 10.70° +- 6.42, 2.39° +- 3.55, and 5.30 mm +- 4.23 for the HVA, IMA, and foot width respectively. Two patients (2.2%) required revision surgery, one due to nonunion and one due to persistent pain. One patient had a hardware irritation that did not require hardware removal and one patient had a second metatarsal fracture. No feet had HV recurrence, hardware loosening, infection, or scar hypersensitivity.Conclusion:The current study showed that minimally invasive percutaneous Chevron/Akin for symptomatic hallux valgus correction is an effective and safe technique. In addition to a low complication rate, significant improvement in pain score and radiographic parameters at final follow up were demonstrated. Future randomized trials with long term follow up are needed to validate the outcomes of minimally invasive techniques.