Outcomes after scarf osteotomy with and without Akin osteotomy a retrospective comparative study

Abstract

Background The scarf osteotomy is a well-established surgical method for correcting a hallux valgus deformity. It is often combined with an Akin osteotomy. However, clear guidelines defining indication criteria are missing. The purpose of this study was to analyze the radiological outcome after scarf osteotomy in dependence of additional Akin osteotomy. Methods This study included 184 patients in whom a hallux valgus deformity was corrected with a scarf osteotomy (group S), and 63 patients in whom an additional Akin osteotomy was performed (group SA). Weight-bearing radiographs were evaluated preoperatively, postoperatively, after 6 weeks, after 3 months and at a follow-up with a mean of 45.4 months. Analysis was made for the following radiological parameters: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), the proximal to distal phalangeal articular angle (PDPAA), and the position of the sesamoids as well as the joint congruity. Results Radiographic recurrence (HVA > 20°) was detected in 1 patient (1.6% of recurrence) in the SA group, and in 27 patients in the S group (14.7% of recurrence) at follow-up. Outcome between the two groups differed significantly showing reduced loss of HVA correction in the SA group ( p < 0.001). The subgroup with a preoperative PDPAA above eight degrees showed significant inferiority of outcome for the S group compared to the SA group. Conclusion Radiological outcome after scarf osteotomy is superior with concomitant Akin osteotomy. A preoperative PDPAA above eight degrees makes additional Akin osteotomy recommendable. Level of evidence Therapeutic, Level III, retrospective comparative series

Minimally Invasive vs Open Akin Osteotomy

“…This finding was confirmed by another study of this group comparing isolated Scarf osteotomy with combined Scarf and Akin osteotomy (recurrence isolated Scarf 14.7% [n = 184] vs combined procedure 1.6% [n = 63]). 13 Hence, the authors recommend a combined procedure if a preoperative proximal to distal phalangeal articular angle of 8 degrees is present. 12,13…”

“…13 Hence, the authors recommend a combined procedure if a preoperative proximal to distal phalangeal articular angle of 8 degrees is present. 12,13…”

Outcomes after Rotation Scarf with Akin Osteotomy for Severe Hallux Valgus

“…(5) Akin osteotomy can effectively correct the enlargement of DMAA, and effectively assist metatarsal osteotomy, which signi cantly improves the e cacy and satisfaction rate and fully compensates for the de ciencies exhibited by rotation scarf osteotomy. [22] Rotation scarf osteotomy was among the most common operative procedures for hallux valgus deformity. Common complications of rotation scarf osteotomy include rst metatarsal fracture, metastatic metatarsalgia, infection, medial dorsal cutaneous nerve injury of the hallux, and recurrence of deformity.…”

Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy

“…7,21,38 Factors linked to hallux valgus recurrence after scarf osteotomy include surgical experience, first ray instability, preoperative joint incongruence, preoperative HVA, preoperative IMA, preoperative distal metatarsal articular angle, incomplete metatarsal head reduction over the sesamoids, and postoperative noncompliance. 7,9,21,24,38,41 The definition of recurrence in the literature is variable, some report it as an HVA greater than 15 degrees and some an HVA greater than 20 degrees. 7,21 In addition, the postoperative time frame reported for a recurrence is also ill defined.…”