Hallux valgus: effectiveness and safety of minimally invasive surgery. A systematic review

Abstract

Minimally invasive techniques for hallux valgus correction include arthroscopy, percutaneous and minimum incision surgery. In the last few decades, several techniques have been increasingly used. We performed a comprehensive search of CINAHL, Embase, Medline, HealthSTAR and the Cochrane Central Registry of Controlled Trials, from inception of the database to 4 January 2010, using various combinations of the keywords terms 'Bosch', 'PDO', 'percutaneous distal osteotomy', 'SERI', 'percutaneous', 'minimal incision', 'minimum incision', 'minimally invasive', 'less invasive', 'mini-invasive', 'hallux valgus', 'bunion', 'surgery', 'arthroscopy', 'metatarsal' 'forefoot'. Only articles published in peer reviewed journals were included in this systematic review. Several new techniques are available for minimally invasive correction of the hallux valgus. Minimally invasive correction of the hallux valgus may provide better outcome for patients who would not recover well from traditional open approaches, because of decreasing recovery and rehabilitation times, as surgical exposure and deep tissue dissection are smaller and gentler to the soft tissues. Data are lacking to allow definitive conclusions on the use of these techniques for routine management of patients with hallux valgus. Given the limitations of the current case series, especially the extensive clinical heterogeneity, it is not possible to determine clear recommendations regarding the systematic use of minimally invasive surgery for hallux valgus correction, even though preliminary results are encouraging. Studies of higher levels of evidence, concentrating on large adequately powered randomized trials, should be conducted to help answer these questions.

Minimally invasive hallux valgus surgery: a critical review of the evidence

“…This can certainly be achieved using minimally invasive hallux valgus surgery. Comparisons of minimally invasive and open techniques revealed similar results of both techniques [17,31,32,34,44,45].…”

“…Shortening on an average of 2.2±2.8 mm was noted. The HVA was corrected from an average of 27.7°(18-37) to 14.6° (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)) and the IMA from 11.2! (10-18) to 5.8°(4-12).…”

“…One may distinguish between minimal incision surgery, percutaneous surgery and arthroscopic surgery [17]. Arthroscopic hallux valgus surgery is certainly not a standard procedure [18].…”

“…Based on the systemic reviews by Mafulli et al [17] and Roukis [21] the literature search was organised by two independent investigators. MEDLINE was systematically searched for available studies.…”

Osteotomías en el tratamiento quirúrgico del hallux abductus valgus

“…Los defensores de unas y otras técnicas tienen argumentos en su favor para el uso de una u otra. Aquellos que defienden el uso de la cirugía de mínima invasión citan como ventajas teóricas la disminución de los tiempos de recuperación y rehabilitación, reducción del tiempo quirúrgico, un menor estrés para el paciente y un supuesto menor coste de la cirugía 46,47 . Como puntos negativos tiene la desventaja de que se realiza sin visualización directa de los tejidos, y según la técnica, la fluoroscopia es obligatoria.…”