Hallux valgus correction utilising a modified short scarf osteotomy with a magnesium biodegradable or titanium compression screws – a comparative study of clinical outcomes

Abstract

Background Biodegradable implants reduce the likelihood of further surgery for hardware removal and reduce the risks of associated infection and allergy. The purpose of this study is to evaluate the clinical efficacy and determine the comparability of biodegradable magnesium alloy MgYREZr (MAGNEZIX® CS) compression screw fixation compared with standard titanium screw fixation in the surgical treatment of hallux valgus deformity. Methods Eleven patients undergoing corrective surgery for hallux valgus utilising biodegradable magnesium screws and a control group of 25 patients undergoing corrective hallux valgus surgery with standard titanium screws were reviewed at a median of 19 months (range 12–30 months). PROM scores (Manchester-Oxford Foot Questionnaire (MOXFQ), Foot and Ankle Outcomes Instrument (FAOI) and the EQ-5D-3 L) were recorded preoperatively and at latest follow-up. Results The results between the two groups were broadly similar, with the Magnesium and Titanium patients showing similar patterns in the various domains in the MOXFQ, the FAOI and the EQ-5D-3 L. Most patients reported a near full shoe comfort score, and EQ-5D-3 L scores were significantly improved in both patient groups (with most patients reporting a full score). Foot pain and foot function improved irrespective of the scoring systems and patients in both groups demonstrated significantly improved scores following the surgery ( p < 0.05). Notably, there were no significant differences when comparing the post-operative scores between the groups for any individual scoring parameter . No impairment to quality of life was recorded. There were no intra or post-operative complications. There were no problems encountered through the use of the bioabsorbable screws. Conclusion Biodegradable magnesium-based compression screws appeared to be safe in this study and are an effective fixation device in the treatment of hallux valgus deformity with clinical outcomes similar to standard titanium screw fixation.

Is There a Role for Absorbable Metals in Surgery? A Systematic Review and Meta-Analysis of Mg/Mg Alloy Based Implants

“…After analysis of the inclusion criteria, eight articles were eligible, which 468 patients were included (control group or experimental group), with 230 screws of Mg. The age of patients included in all studies was 48.14 years [ 7 , 10 , 11 , 21 , 22 , 33 , 34 , 47 ]. The main results are summarized in Table 1 .…”

“…From eight studies selected, three were RCT studies [ 10 , 11 , 33 ], one were retrospective studies [ 34 ], two were case-control studies [ 11 , 22 ], and lastly, two were prospective case series [ 21 , 47 ]. All of these studies were published between 2013–2020.…”

“…The studies analyzed reported various inclusion criteria for patient selection. Inclusion criteria were: age between 18 and 79 years, no medical contraindications, and surgical procedures that require fixation using screws [ 10 , 22 ]. The exclusion criteria included: patients with neurological diseases, surgeries in the same body region operated previously, allergies against the materials used for testing components of the screws [ 33 , 34 ] ( Table 1 ).…”

“…Of the eight studies selected, six studies were related to the hallux region [ 7 , 10 , 21 , 22 , 33 , 34 ], one related to the treatment of necrosis of the femoral head [ 11 ] and last one related to mandibular condyle fracture [ 47 ]. All studies used screws for fixation.…”

“…The concept of absorbable metals has been developed recently to reduce these possible complications [ 21 , 22 , 23 ]. Mg and zinc-based degradable metal alloys were recently developed since these metals possess desirable characteristics such as adequate strength (tensile, bending, and torsional) for bone fracture fixation.…”