Functional and radiographic outcomes of hallux valgus correction by mini-invasive surgery with Reverdin-Isham and Akin percutaneous osteotomies: a longitudinal prospective study with a 48-month follow-up

Carlo Biz, Michele Fosser, Miki Dalmau-Pastor, Marco Corradin, Maria Grazia Rodà, Roberto Aldegheri, Pietro Ruggieri, Carlo Biz, Michele Fosser, Miki Dalmau-Pastor, Marco Corradin, Maria Grazia Rodà, Roberto Aldegheri, Pietro Ruggieri

Abstract

Background: Minimally invasive surgery (MIS) represents one of the most innovative surgical treatments of hallux valgus (HV). However, long-term outcomes still remain a matter of discussion within the orthopaedic community. The purpose of this longitudinal prospective study was to evaluate radiographic and functional outcomes in patients with mild-to-severe HV who underwent Reverdin-Isham and Akin percutaneous osteotomy, following exostosectomy and lateral release.

Methods: Eighty patients with mild-to-severe symptomatic HV were treated by MIS. Clinical evaluation was assessed preoperatively, as well as at 3 and 12 months after surgery and at final follow-up of 48 months, using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux grading system. Patient satisfaction and complications were recorded. Computer-assisted measurement of antero-posterior radiographs was taken preoperatively, as well as at 3 and 12 months after surgery and at 48-month follow-up, analysing the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA) and the tibial sesamoid position. Also, the bridging bone/callus formation was evaluated at the different radiographic follow-ups, while the articular surface congruency and the metatarsal index were calculated only preoperatively and at the last follow-up. Patient satisfaction was assessed using the visual analogue score (VAS). Statistical analysis was carried out using the paired t test. Statistical significance was set at p < 0.05.

Results: The mean AOFAS score was 87.15 points at the final follow-up of 48 months, and the VAS score was 8.35/10. The post-operative radiographic assessments showed a statistically significant improvement compared with preoperative values. The mean corrections of each angular value at the last follow-up were as follows: IMA 3.90°, HVA 12.50°, DMAA 4.72° and a tibial sesamoid position of 1.10. The articular surface was congruent in 77 (96.25%) cases and incongruent only in 3 (3.75%). The complete healing of the osteotomies was achieved in all series at 3-month follow-up. However, the results obtained in the correction of the severe HV deformities were less encouraging.

Conclusions: Minimally invasive surgery with Reverdin-Isham and Akin percutaneous osteotomy, in combination with previous exostosectomy and subsequent lateral soft-tissue release, is a safe, effective and reliable procedure for correction of mild-to-moderate HV. However, it requires a long learning curve because of the inherent difficulty of the mixed different surgical procedures.

Trial registration: ClinicalTrials.gov PRS Protocol Registration and Results System: NCT02886221.

Keywords: Akin osteotomy; First ray; Forefoot; Hallux valgus; Minimally invasive surgery; Percutaneous distal osteotomy; Reverdin-Isham osteotomy.

Figures

Fig. 1
Fig. 1
Portal placement (a) and rasp introduction (b). The protocolised incision protects the dorsomedial cutaneous nerve of the hallux (c): 1 dorsomedial cutaneous nerve of the hallux, 2 point of incision for Reverdin-Isham osteotomy
Fig. 2
Fig. 2
Reverdin-Isham osteotomy: intraoperative fluoroscopic imagine shoving the proper position and inclination of the burr to respect the distal first metatarsal bone (a). The final result of an ideal closing wedge osteotomy with a medial base that corrects also the DMAA (b)
Fig. 3
Fig. 3
Example of post-operative bandage (a) and rigid flat-soled orthopaedic shoe (b)
Fig. 4
Fig. 4
Pre-op (a) and at 48-month last follow-up (b) clinical images of a 36-year-old woman after having undergone percutaneous Reverdin-Isham osteotomy, lateral release and Akin osteotomy for mild HV correction
Fig. 5
Fig. 5
Graph of statistical analysis of preoperative and post-operative AOFAS scores (P ≤ 0.05)
Fig. 6
Fig. 6
A 36-year-old woman with mild HV: 1 antero-posterior radiographic images, 2 sesamoid and 3 lateral view at preoperative period (a), 1-month follow-up (b), 3-month follow-up (c), 12-month follow-up (d) and 48-month follow-up (e), showing the maintained correction of the deformity
Fig. 7
Fig. 7
Graph of statistical analysis of preoperative and post-operative different angular values (p ≤ 0.05): IMA (a), HVA (b), DMAA (c) and tibial sesamoid position (d)

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