Loss of Correction After Chevron Osteotomy for Hallux Valgus as a Function of Preoperative Deformity

Kaufmann, Gerhard; Sinz, Stefanie; Giesinger, Johannes; Braito, Matthias; Biedermann, R.; Dammerer, Dietmar

doi:10.1177/1071100718807699

Cited by 27 publications

(19 citation statements)

References 32 publications

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“…There was a significant increase (mean, 4.1 degrees, P < .001) in the a1-2 IMA from a mean of 10.9 degrees (range, 8-14) preoperatively to 15.0 degrees (range, [9][10][11][12][13][14][15][16][17][18][19] postoperatively. For the m1-2IMA, there was a significant decrease (mean, 4.6 degrees, P < .001) from a mean of 10.9 degrees (range, 8-14) preoperatively to 6.4 degrees (range, 1-11) postoperatively.…”

Section: Resultsmentioning

confidence: 90%

“…The mean improvement of the m1-2IMA (4.6 degrees) and the mean postoperative m1-2IMA (6.4 degrees) is comparable to multiple prior studies evaluating DCO. 3,5,9,10,12,13,16,20,28,32 Similarly, the HVA was also noted to have significant improvement with a final average measurement of 8.5 degrees. This is consistent with the existing literature, 3,5,9,10,12,13,16,20,28,32 and expected given that the mechanical axis of the first metatarsal was used for the HVA measurement.…”

Section: Discussionmentioning

confidence: 91%

“…The increase in a1-2IMA is also concerning as a potential mechanism for HV recurrence. Loss of correction of the intermetatarsal angle as well as HVA has been demonstrated in short-term follow-up within 3 months following DCO, 13 whereas the rate of HV recurrence has been reported to be as high as 73% in one series with 14-year follow-up. 10 The cause of recurrent HV is likely multifactorial but the described radiologic risk factors include greater preoperative deformity, incomplete reduction of the sesamoids, metatarsophalangeal joint incongruency, as well as first ray hypermobility.…”

Section: Discussionmentioning

confidence: 99%

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Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

Chan

Noori

Chen

et al. 2020

Foot & Ankle Orthopaedics

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Background: Distal chevron metatarsal osteotomy (DCO) is a common technique to address hallux valgus (HV), which involves coronal translation of the capital fragment resulting in a nonanatomic first metatarsal. The purpose of this study was to evaluate the radiographic effect of the DCO on the anatomic vs the mechanical axis of the first metatarsal. Our hypothesis was that patients undergoing DCO would have improvement in the mechanical metatarsal axis but worsening of the anatomic axis. Methods: This was a retrospective case series of consecutive patients who underwent DCO for HV. The primary outcomes were the change in anatomic first–second intermetatarsal angle (a1-2IMA) vs mechanical first–second intermetatarsal angle (m1-2IMA). Secondary outcomes included the change in hallux valgus angle (HVA) and medial sesamoid position. Results: 40 feet were analyzed with a mean follow-up of 21.2 weeks. The a1-2IMA increased significantly (mean, 4.1 degrees) whereas the m1-2IMA decreased significantly (mean, 4.6 degrees) following DCO. There was a significant improvement in HVA (mean, 12.5 degrees). Medial sesamoid position was improved in 21 feet (52.5%). Patients with no improvement in sesamoid position were found to have a larger increase in a1-2IMA (mean, 4.7 vs 3.5 degrees, P = .03) and less improvement in m1-2IMA (mean, 3.8 vs 5.2 degrees, P = .02) compared to patients with improvement in sesamoid position. Conclusion: Distal chevron osteotomy for HV was associated with worsening of the anatomic axis of the first metatarsal despite improvements in the mechanical metatarsal axis, HVA, and medial sesamoid position. Greater worsening of the anatomic axis was associated with less improvement of sesamoid position. Our findings may suggest the presence of intermetatarsal instability, which could limit the power of DCO in HV correction for more severe deformities and provide a mechanism for HV recurrence. Level of Evidence: Level IV, retrospective case series.

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Section: Resultsmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

Chan

Noori

Chen

et al. 2020

Foot & Ankle Orthopaedics

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“…A common complication after distal I-MTT osteotomy is HV recurrence, mainly due to undercorrection, 28,37 with rates reported to be as high as 16%. 43 Often, the recurrences have been described in connection with different operative methods, independent from the implementation of an Akin osteotomy.…”

Section: Discussionmentioning

confidence: 99%

Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus

et al. 2020

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Background: This study was aimed at assessing clinical and radiographic outcomes of the Minimally Invasive Intramedullary Nail Device (MIIND) to correct moderate to severe hallux valgus (HV) and the long-term persistence of its effects. Methods: This case series study involved 100 patients, 84 women and 16 men (mean age, 59 years), who underwent the MIIND procedure with a mean follow-up of 97 months. Assessment was performed preoperatively, postoperatively, at 6 and 12 months, and at last follow-up. Clinical outcomes were evaluated with American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and patient satisfaction. Intermetatarsal angle (IMA), metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and tibial sesamoid position were assessed. Statistical analysis was performed. Results: The mean AOFAS score improved from 57.9 to 90.5 points, VAS scale was 1.5 ± 2.0, and patients’ satisfaction was 8.7 ± 1.4. The mean correction of the HVA and IMA showed a significant correction; however, the effect of time was not statistically significant on DMAA. Sex ( P = .047), severity ( P = .050), associated procedures ( P = .000), and preoperative angle ( P = .000) showed significant association with HVA correction and its persistence over time. Age was not statistically significant. Complications were 9 cases of superficial wound infection and 6 recurrences. Conclusions: The MIIND technique proved a viable procedure to correct moderate to severe HV with a low rate of complications and recurrence, producing significant correction of most radiographic parameters assessed and their persistence, even at long term. Level of Evidence: Level IV, case series study.

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“…21,29 In a recently published study, a correlation of loss of correction with preoperative intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and sesamoid position could be found in a chevron cohort. 16 However, little is known about initial postoperative radiologic parameters on loss of correction after hallux valgus surgery. Although the initial postoperative radiograph has been shown to not be truly weight-bearing, it remains the surgeon's tool for evaluating operative outcome after hallux valgus correction.…”

Section: Introductionmentioning

confidence: 99%

Effect of Akin Osteotomy on Hallux Valgus Correction After Scarf Osteotomy With Hallux Valgus Interphalangeus

Kaufmann¹,

Hofer

Braito

et al. 2019

Foot Ankle Int.

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Background: Recurrence after hallux valgus correction is a relatively frequent occurrence. Little is known about the importance of initial correction on radiologic outcome. The objective of our study was to determine postoperative radiologic parameters correlating with loss of correction after scarf osteotomy and the combined scarf/akin osteotomy, respectively. Methods: Loss of correction was evaluated based on a group of 53 feet with isolated scarf osteotomy (S group) and a group of 17 feet with combined scarf and akin osteotomy (SA group) in a retrospective analysis. The intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), the proximal to distal phalangeal articular angle (PDPAA), the position of the sesamoids, and joint congruity were measured in weight-bearing radiographs preoperatively and postoperatively throughout a mean follow-up of 44.8 ± 23.6 months. Results: Loss of correction was comparable between the S and the SA group ( P > .05). In contrast, we found higher loss of HVA correction in the S subgroup with a preoperative PDPAA above 8 degrees ( P = .011), whereas loss of correction in the S subgroup below 8 degrees of PDPAA was comparable to the SA group. In the S group, loss of correction showed significant correlation with postoperative IMA ( P = .015) and PDPAA ( P = .008), whereas in the SA group a correlation could be detected for IMA only ( P = .045). Conclusion: In cases with a PDPAA above 8 degrees, we recommend a combined scarf/akin osteotomy to diminish the potential for loss of correction. Level of Evidence: Level III, therapeutic, retrospective comparative series.

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Loss of Correction After Chevron Osteotomy for Hallux Valgus as a Function of Preoperative Deformity

Cited by 27 publications

References 32 publications

Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus

Effect of Akin Osteotomy on Hallux Valgus Correction After Scarf Osteotomy With Hallux Valgus Interphalangeus

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