MIBA Osteotomy vs Open Technique in Hallux Valgus Surgery: Results of a Randomized Prospective Study

Abstract

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: In Hallux Valgus (HV) surgery, the open technique has traditionally been used, which implies aggressive and extensive approaches, not without complications. The goal of surgical treatment of HV is to correct the anatomical deformity and achieve a satisfactory long-term result, without interrupting the biomechanics and weight-bearing function of the first metatarsophalangeal joint complex. In recent years, the use of minimally invasive techniques (MIS) has been a valid alternative due to less soft tissue trauma. The purpose of this study is to compare short-medium term clinical results of the MIBA technique versus the traditional open technique in patients with mild-moderate HV. Methods: A randomized, multicenter clinical trial of patients with HV, operated between January 2019 - January 2022, with a minimum of 1-year follow-up. A total of 39 patients were included; 20 MIBA and 19 with the open technique (Chevron osteotomy). It was evaluated if there were statistically significant differences between: demographic variables; radiologic measurements: Intermetatarsal Angle (IMA); Metatarsal Length (ML); visual analog scale (VAS); Foot and Ankle Ability Measure (FAAM), 36-Item Short-Form Health Survey (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) metatarsophalangeal- interphalangeal (MTP-IP) and operative wound healing through Photographic Wound Assessment Tool (PWAT) and ASEPSIS score were analyzed. The radiologic measurements and functional scores were collected preoperatively, at 2-6 weeks and 1-year follow-up, while wound scores were at 3 weeks, 3 months, and 1-year follow-up. Results: There were no significant differences concerning age, hypertension, diabetes mellitus, or smoking between both groups. The average follow-up time of the MIBA group was 14 months and the open technique group 12.9 months. In relation of postoperative soft tissue, MIBA group showed significant differences at 6 weeks in PWAT score (0.06 ± 0.24) but no statistically significant differences at 3 weeks and 1 year of follow-up. There were no significant differences in IMA and ML values at 6 months (p=0.57 vs 0.40) and 1 year (p=0.35 vs 0.11). Regarding functional scores, no significant differences were found preoperatively, at 6 months, and 1-year follow-up. Complications in both groups did not have significant differences either. Conclusion: The MIBA technique is a reliable alternative to the classical technique, with significant differences at 6 weeks in a better evolution of postoperative soft tissue according to the PWAT score, but correcting in the medium term. Concerning radiological, functional outcomes and complications, no significant differences were found at 1-year follow-up. Further follow-up and casuistry are necessary to obtain definitive results.