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Migliorini F, Eschweiler J, Tingart M, Maffulli N. Revision surgeries for failed hallux valgus correction: A systematic review. Surgeon 2021; 19:e497-e506. [PMID: 33423923 DOI: 10.1016/j.surge.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/13/2020] [Accepted: 11/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Failure of hallux valgus (HV) correction is not uncommon, and its management can be challenging. The available literature is not exhaustive. Therefore, we conducted a systematic review to investigate the current evidence on the role of revision surgery for failed HV correction, including clinical presentation, indications, surgical strategies and outcomes. MATERIAL AND METHODS The present systematic review was performed according to the PRISMA guidelines. Pubmed, EMBASE, Google Scholar and Scopus online databases were accessed in November 2020. All the clinical studies on revision for failed HV correction were analysed, and only studies reporting quantitative data under the outcomes of interest were considered for inclusion. RESULTS Data from 20 studies (586 procedures) were retrieved. The HV angle, the intermetatarsal angle and the distal metatarsal articular angle were reduced of 17.8° (P < 0.001), 3.3° (P = 0.05) and 7.3° (P < 0.001) respectively. The American Orthopaedic Foot & Ankle Society score improved of 24.7% (P < 0.001). The visual analogue scale improved by 40.8% (P < 0.001). Dorsiflexion and plantar flexion of the first metatarso-phalangeal joint remained similar to their preoperative values (P = 0.2 and P = 0.4, respectively). After revision surgery the following complications were further detected: recurrences 5.1% (30 of 586 patients), non-unions 4.1% (24/586), additional surgical procedures 8.7% (51 of 586 patients). CONCLUSION Revision surgery for failed primary HV correction can yield satisfying results. Accurate preoperative planning is necessary to try and identify the causes of failure, and address them appropriately.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK.
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2
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Scala A, Cipolla M, Giannini S, Oliva G. The Modified Subcapital Metatarsal Osteotomy in the Treatment of Hallux Valgus Recurrence. Foot Ankle Spec 2020; 13:404-414. [PMID: 31583899 DOI: 10.1177/1938640019875322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The purpose of the present study is to illustrate the use of a modified subcapital metatarsal osteotomy (MSMO) in the treatment of hallux valgus (HV) recurrence. The article reports the clinical and radiological outcomes of a cohort of 52 consecutive patients presenting with recurrent HV, treated with MSMO. A total of 52 patients (54 feet) underwent operations between May 2010 and November 2015. The mean time of follow-up was 2.5 years (range 5.5-1.0 years), and the mean age was 49 years (range 22-76 years). The patient cohort comprised 46 female and 6 male patients. The results of this research show that MSMO is a reliable technique for the correction of HV recurrence. The postoperative radiographic assessments show a statistically significant postoperative improvement of the HV angle (P < .05) and the intermetatarsal angle (P < .05). The postoperative position of the tibial sesamoid was significantly improved (P < .1). The distal metatarsal articular angle was improved (P < .001), though assessment may be affected by the previous operations performed on the first metatarsophalangeal joint. The statistical analysis shows that the postoperative American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale parameters were significantly improved (P < 0.001). Results of this study indicate that the minimally invasive MSMO is effective in restoring anatomical alignment and improving patient outcomes in recurrent cases of HV.Levels of Evidence: Level III: Case-control study.
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Affiliation(s)
- Andrea Scala
- "Ars Medica" Clinic via Cesare Ferrero di Cambiano, Rome, Italy (AS).,Orthopaedic and Traumatology Department State University "La Sapienza," Rome, Italy (MC).,Radiology Department "Foro Italico" University of Rome, Rome, Italy (SG).,Radiology Department Military Police "Carabinieri" Medical Center, Rome, Italy (GO)
| | - Massimo Cipolla
- "Ars Medica" Clinic via Cesare Ferrero di Cambiano, Rome, Italy (AS).,Orthopaedic and Traumatology Department State University "La Sapienza," Rome, Italy (MC).,Radiology Department "Foro Italico" University of Rome, Rome, Italy (SG).,Radiology Department Military Police "Carabinieri" Medical Center, Rome, Italy (GO)
| | - Silvana Giannini
- "Ars Medica" Clinic via Cesare Ferrero di Cambiano, Rome, Italy (AS).,Orthopaedic and Traumatology Department State University "La Sapienza," Rome, Italy (MC).,Radiology Department "Foro Italico" University of Rome, Rome, Italy (SG).,Radiology Department Military Police "Carabinieri" Medical Center, Rome, Italy (GO)
| | - Giulio Oliva
- "Ars Medica" Clinic via Cesare Ferrero di Cambiano, Rome, Italy (AS).,Orthopaedic and Traumatology Department State University "La Sapienza," Rome, Italy (MC).,Radiology Department "Foro Italico" University of Rome, Rome, Italy (SG).,Radiology Department Military Police "Carabinieri" Medical Center, Rome, Italy (GO)
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Castioni D, Fanelli D, Gasparini G, Iannò B, Galasso O. Scarf osteotomy for the treatment of moderate to severe hallux valgus: Analysis of predictors for midterm outcomes and recurrence. Foot Ankle Surg 2020; 26:439-444. [PMID: 31208876 DOI: 10.1016/j.fas.2019.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/25/2019] [Accepted: 05/16/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Controversies remain regarding the predictors for outcomes and recurrence after scarf osteotomy for hallux valgus deformity. METHODS Sixty-two patients (70 feet) underwent scarf osteotomy for hallux valgus deformity. The radiological angles, tibial sesamoid position, articular congruence, demographics, comorbidities, AOFAS, VAS and SF-12 scores, and the postoperative compliance were tested as predictors for outcomes and recurrence. RESULTS After a mean 38±15.4 months follow-up, all of the radiological angles, the total AOFAS, PCS-12 and VAS scores significantly improved (all P<0.001). Preoperative MCS-12 was directly related to the total postoperative AOFAS score (P=0.003). A higher number of cardiovascular risk factors negatively affected the postoperative total AOFAS score, VAS and PCS-12 (β=-3.42, P=0.030; β=0.262, P=0.022; β=-0.181, P=0.025, respectively). The BMI influenced postoperative PCS-12 (β=-0.244, P=0.002). Preoperative HVA was directly related to postoperative DMAA (P=0.002) and tibial sesamoid position (P=0.005). Preoperative joint incongruence and postoperative noncompliance were associated with recurrence (P=0.043 and P=0.035, respectively). CONCLUSIONS Satisfactory results can be expected after scarf osteotomy. Higher BMI and number of cardiovascular risk factors, and low mental status should be carefully considered when counselling patients for this procedure. Adherence to postoperative care instructions influences deformity recurrence.
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Affiliation(s)
- Davide Castioni
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy
| | - Daniele Fanelli
- Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy.
| | - Bruno Iannò
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy
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4
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Magnan B, Negri S, Maluta T, Dall'Oca C, Samaila E. Minimally invasive distal first metatarsal osteotomy can be an option for recurrent hallux valgus. Foot Ankle Surg 2019; 25:332-339. [PMID: 29409172 DOI: 10.1016/j.fas.2017.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/29/2017] [Accepted: 12/29/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recurrence rate of surgical treatment of hallux valgus ranges in the literature from 2.7% to 16%, regardless of used procedure. In this study, long-term results of a minimally invasive distal osteotomy of the first metatarsal bone for treatment of recurrent hallux valgus are described. METHODS 32 consecutive percutaneous distal osteotomies of the first metatarsal were performed in 26 patients for treatment of recurrent hallux valgus. Primary surgery had been soft tissue procedures in 8 cases (25%), first metatarsal or phalangeal osteotomies in 19 cases (59.4%) and Keller procedures in 5 cases (15.6%). RESULTS Patients were assessed with a mean follow-up of 9.8±4.3 years. All patients reported the disappearance or reduction of the pain. The mean overall AOFAS score improved from 46.9±17.8 points to 85.2±14.9 at final follow-up. The mean hallux valgus angle decreased from 26.1±9.1 to 9.7±5.4°, the intermetatarsal angle decreased from 11.5±4.5 to 6.7±4.0°. No major complications were recorded with a re-recurrence rate of 3.1% (1 case). CONCLUSIONS Percutaneous distal osteotomy of the first metatarsal can be a reliable and safe surgical option in the recurrent hallux valgus with low complication rate and the advantages of a minimally invasive surgery. LEVELS OF EVIDENCE IV, Retrospective Case Series.
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Affiliation(s)
- Bruno Magnan
- Department of Orthopaedics and Trauma Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy.
| | - Stefano Negri
- Department of Orthopaedics and Trauma Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Tommaso Maluta
- Department of Orthopaedics and Trauma Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Carlo Dall'Oca
- Department of Orthopaedics and Trauma Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Elena Samaila
- Department of Orthopaedics and Trauma Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
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Lui TH. Correction of Recurred Hallux Valgus Deformity by Endoscopic Distal Soft Tissue Procedure. Arthrosc Tech 2017; 6:e435-e440. [PMID: 28580264 PMCID: PMC5443353 DOI: 10.1016/j.eats.2016.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/25/2016] [Indexed: 02/03/2023] Open
Abstract
The underlying reason for recurrence of hallux valgus deformity after bunion surgery is multifactorial and includes surgeon-based and patient-based factors as well as original components of deformity initially unaddressed at the index procedure. Surgical treatment of a recurred hallux valgus deformity should be undertaken using the same guidelines for correction of a primary hallux valgus deformity. It requires correction of bony alignment, restoration of joint congruity, and achievement of soft tissue balance. The purpose of this Technical Note is to describe the details of endoscopic soft tissue procedure to correct a recurred hallux valgus deformity. To successfully complete this procedure, adequate lateral release to achieve soft tissue balance around the first metatarsophalangeal joint with reduction of the sesamoid bones is mandatory.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung Shui, NTHong Kong SARChina
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6
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Choi JY, Yoon HH, Suh YM, Suh JS. Surgical correction of hallux valgus complicated with adult-type pes plano-valgus. J Orthop Surg (Hong Kong) 2017; 25:2309499016684320. [PMID: 28176606 DOI: 10.1177/2309499016684320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To investigate the efficiency of simultaneous correction of moderate to severe hallux valgus deformity and adult-type pes planus. METHODS Twenty cases of moderate to severe hallux valgus complicated with adult-type pes planus in 19 consecutive patients (15 (79%) women, 4 (11%) men; mean age: 44.50 ± 17.13 years, mean follow-up duration: 31.30 ± 17.02 months) were included. Medial calcaneal sliding osteotomy was performed to correct hindfoot valgus, whereas treatments of hallux valgus were case dependent. RESULTS The mean postoperative hallux valgus angle, intermetatarsal angle, hindfoot alignment angle, and hindfoot alignment ratio were 8.40 ± 5.29°, 4.20 ± 2.54°, 3.09 ± 2.92º and 0.41 ± 0.17, respectively. Although a hallux varus deformity occurred as a postoperative complication in one case (5%), there were no cases of postoperative recurrence. CONCLUSION Simultaneous correction of hallux valgus and pes plano-valgus using medial calcaneal sliding osteotomy is an effective technique that reduces recurrence of hallux valgus and increases satisfaction in patients with moderate to severe hallux valgus deformity complicated with adult-type pes planus accompanying hindfoot valgus.
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Affiliation(s)
- Jun Young Choi
- 1 W Institute for Foot and Ankle Disease and Trauma, W Hospital, Daegu, South Korea
| | - Hyeong Hwa Yoon
- 2 Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Yu Min Suh
- 3 Wesleyan University, Middletown, CT, USA
| | - Jin Soo Suh
- 1 W Institute for Foot and Ankle Disease and Trauma, W Hospital, Daegu, South Korea
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7
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Abstract
The treatment of hallux valgus depends on multiple factors, including clinical examination, patient considerations, clinical findings, radiographic assessment, and surgeon preference. Appropriate procedure selection and proper technique will usually result in good-to-excellent outcomes. Complications following hallux valgus correction include recurrence, transfer metatarsalgia, avascular necrosis, hallux varus, and nonunion and malunion of metatarsal osteotomies. In order to decrease the risks of complication, a precise and meticulous physical examination should be conducted preoperatively. In addition, a surgeon should select appropriate osteotomies to correct complex hallux valgus deformities. As a general principle, the severity of deformity dictates treatment options.
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8
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Abstract
Recurrence of hallux valgus deformity can be a common complication after corrective surgery. The cause of recurrent hallux valgus is usually multifactorial, and includes patient-related factors such as preoperative anatomic predisposition, medical comorbidities, compliance with postcorrection instructions, and surgical factors such as choice of the appropriate procedure and technical competency. For a successful outcome, this cause must be ascertained preoperatively. Although the algorithm to determine which intervention should be used is not unlike that of primary hallux valgus surgery, operative correction of hallux valgus recurrence can be challenging. This article discusses these challenges, complications, causes, and techniques.
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9
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Abstract
INTRODUCTION Although the gold standard to address hallux rigidus that fails conservative treatment is an arthrodesis, some surgeons have attempted to use arthroplasty to improve range of motion and to simulate a normal joint. When these implants do fail, a salvage MTP arthrodesis is the only surgical option for these patients. This research aims to outline various methods to arthrodese the MTP joint in salvage situations. METHODS We retrospectively looked at patients who underwent a first-MTP fusion after failure of an implant arthroplasty. All fusions involved either bone allograft or autograft and internal fixation. The patients were assessed clinically, radiographically, and with the Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS MTP-IP) clinical questionnaire preoperatively and postoperatively. RESULTS In all, 11 patients met the inclusion criteria. The average age of patients at the time of the salvage MTP arthrodesis was 57 years. The interval time between primary surgery and revision arthrodesis was on average 84.2 months. There was a high reoperation rate, with 7 operative procedures occurring per 12 arthrodeses (58%). The average time to radiographic fusion was 6.9 ± 4.8 months; 41.7% of patients had a delayed union (>6 months to fusion). Two patients had symptomatic nonunions (16.7%). All the patients had an improvement in their AOFAS MTP-IP score. CONCLUSION Although salvage arthrodeses for failed arthroplasties generally have favorable satisfaction rates and are a powerful tool in treating this painful condition, they are fraught with complications. They unite slower, have a significantly higher reoperation rate, and have lower AOFAS scores than primary fusions.
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Affiliation(s)
- Christopher E Gross
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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10
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Duan X, Kadakia AR. Salvage of recurrence after failed surgical treatment of hallux valgus. Arch Orthop Trauma Surg 2012; 132:477-85. [PMID: 22205157 DOI: 10.1007/s00402-011-1447-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Indexed: 12/29/2022]
Abstract
Recurrence of the deformity is unfortunately a common occurrence following surgical treatment of hallux valgus. The underlying reason for recurrence is multifactorial and includes surgeon's factor, patient's factor, and deformity components that were not addressed at the index procedure. Salvage of recurrence can be challenging for both the patient and the surgeon. Successful treatment requires understanding the underlying reason for the failure of initial treatment and correcting bony alignment, restoring the joint congruity, and balancing soft tissues. We present an algorithmic approach to revision hallux valgus surgery.
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Affiliation(s)
- Xiaojun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
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11
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Bock P, Lanz U, Kröner A, Grabmeier G, Engel A. The Scarf osteotomy: a salvage procedure for recurrent hallux valgus in selected cases. Clin Orthop Relat Res 2010; 468:2177-87. [PMID: 20496024 PMCID: PMC2895827 DOI: 10.1007/s11999-010-1363-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Accepted: 04/12/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Scarf osteotomy was described as a technique to correct a metatarsus primus varus in primary hallux valgus surgery, but it is unclear whether the technique could correct recurrent hallux valgus when an initial procedure failed to provide any or an adequate lateral displacement of the metatarsal head. QUESTIONS/PURPOSES We asked whether the Scarf osteotomy could reduce pain, improve the AOFAS score, reduce the deformity, and prevent further recurrence when used as a revision procedure. PATIENTS AND METHODS Of 41 patients (45 feet) we treated for failed initial operations, we retrospectively reviewed 35 (39 feet) who underwent a Scarf osteotomy. We administered a VAS for pain and the AOFAS score preoperatively and postoperatively. Preoperative and postoperative radiographs were taken to assess the hallux valgus angle [HVA] and intermetatarsal angle [IMA]. The minimum followup was 24 months (mean, 42 months; range, 24-89 months). RESULTS The mean VAS for pain improved from 5.9 to 0.4 points. The mean AOFAS score improved from 56 to 90 points. The radiographic evaluation showed improvement of the mean HVA from 30 degrees to 8 degrees and improvement of the IMA from 13 degrees to 4 degrees. Complications included one asymptomatic recurrence with a 20 degrees -HVA, one overcorrection with a 3 degrees-varus deformity, and pain attributable to irritation caused by screws in five patients. CONCLUSIONS As a revision procedure the Scarf osteotomy clinically and radiographically corrected recurrent hallux valgus recurrence in most patients. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Peter Bock
- Department of Orthopedic Surgery, Danube Hospital, Vienna, Langobardenstrasse 122, 1220 Vienna, Austria
| | - Ulrich Lanz
- Department of Orthopedic Surgery, Danube Hospital, Vienna, Langobardenstrasse 122, 1220 Vienna, Austria
| | - Andreas Kröner
- Department of Orthopedic Surgery, Danube Hospital, Vienna, Langobardenstrasse 122, 1220 Vienna, Austria
| | - Georg Grabmeier
- Department of Orthopedic Surgery, Danube Hospital, Vienna, Langobardenstrasse 122, 1220 Vienna, Austria
| | - Alfred Engel
- Department of Orthopedic Surgery, Danube Hospital, Vienna, Langobardenstrasse 122, 1220 Vienna, Austria
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12
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Yucel I, Tenekecioglu Y, Ogut T, Kesmezacar H. Treatment of hallux valgus by modified McBride procedure: a 6-year follow-up. J Orthop Traumatol 2010; 11:89-97. [PMID: 20505975 PMCID: PMC2896573 DOI: 10.1007/s10195-010-0092-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Accepted: 04/26/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Surgical decision-making was reevaluated by comparison with an algorithm designed to analyze treatment of hallux valgus deformities. MATERIALS AND METHODS A modified McBride procedure was performed on 52 feet of 35 patients with hallux valgus deformity. From this series, 36 feet of 21 patients were evaluated preoperatively, early postoperatively, and late postoperatively by means of subjective evaluation and clinical and radiological findings. RESULTS The hallux valgus angle preoperatively, early postoperatively, and late postoperatively was 32.7 +/- 8.5 degrees, 10.1 +/- 6.9 degrees, and 20.6 +/- 9.5 degrees, respectively. Hallux valgus recurrence of 72.2% was observed. Subjective results were better and the patients rated their satisfaction with the procedure as excellent or high in 23 cases (63.9%) and moderate, low, or unsatisfactory in 13 cases (36.1%). CONCLUSIONS This level of patient satisfaction demonstrates that the McBride procedure is an efficient approach for eliminating pain due to hallux valgus deformity.
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Affiliation(s)
- Istemi Yucel
- Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Duzce, Duzce, Turkey.
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13
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Abstract
Selecting the appropriate surgical procedure for the treatment of hallux valgus not always is clear. Every procedure has its merits depending on the individual and circumstances. Correcting pain and deformity, avoiding recurrence, and preserving or re-establishing normal foot function should be the goals of bunion surgery. Although radiographic measurements can be helpful, their weight is not as important as understanding the function of the first ray in each patient. This article attempts to guide procedure selection based on re-establishing normal foot function as much as possible while meeting patients' goals and expectations.
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14
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Varner KE, Matt V, Alexander JW, Johnston JD, Younas S, Marymont JV, Noble PC. Screw versus plate fixation of proximal first metatarsal crescentic osteotomy. Foot Ankle Int 2009; 30:142-9. [PMID: 19254509 DOI: 10.3113/fai-2009-0142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus associated with metatarus primus varus is a deformity that disrupts normal foot function. Standard treatment has often included distal or proximal metatarsal osteotomy with or without a distal soft tissue procedure. The intrinsically unstable proximal crescentic osteotomy relies on operative fixation for stability. This study examined the strength of fixation of a single screw versus a plate for stabilization of proximal first metatarsal crescentic osteotomies for correction of hallux valgus. MATERIALS AND METHODS A crescentic osteotomy was performed on nine pairs of fresh/frozen cadaveric feet. The distal fragment was rotated laterally and the osteotomy was temporarily stabilized with a Kirschner wire. The osteotomized metatarsal fragments were fixed with a cancellous screw on one side and single plate on the contralateral side. Each specimen was loaded in a mechanical testing machine, and its response was measured by monitoring the opening of the osteotomy and change in alignment of the fragments. Position and alignment of the proximal and distal fragments were calculated. RESULTS All of the measures of fixation strength were statistically greater in specimens treated with a plate rather than with screw fixation. Plate fixation provided approximately twice the resistance to disruption of the osteotomy under cyclic loading conditions. CONCLUSION The dorsal plate is biomechanically more stable than a single cancellous screw when applied to proximal crescentic osteotomies. CLINICAL RELEVANCE The greater stability of the plate construct may be helpful in selecting the fixation device for these osteotomies.
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Affiliation(s)
- Kevin E Varner
- The Methodist Hospital, Department of Orthopaedic Surgery.
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15
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Uchiyama E, Kitaoka HB, Luo ZP, Grande JP, Kura H, An KN. Pathomechanics of hallux valgus: biomechanical and immunohistochemical study. Foot Ankle Int 2005; 26:732-8. [PMID: 16174504 DOI: 10.1177/107110070502600911] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND One factor believed to contribute to the development of hallux valgus is an abnormality in collagen structure and makeup of the medial collateral ligament (MCL) of the first metatarsophalangeal joint (MTPJ). We hypothesized that the mechanical properties of the MCL in feet with hallux valgus are significantly different from those in normal feet and that these differences may be related to alterations in the type or distribution of collagen fibers at the interface between the MCL and the bone. MATERIALS AND METHODS Seven normal fresh-frozen cadaver feet were compared to four cadaver feet that had hallux valgus deformities. The MCL mechanical properties, structure of collagen fibers, and content proportion of type I and type III collagen were determined. RESULTS The load-deformation and stress-strain curves were curvilinear with three regions: laxity, toe, and linear regions. Laxity of the MCL in feet with hallux valgus was significantly larger than that of normal feet (p = 0.022). Stiffness and tensile modulus in the toe region in feet with hallux valgus were significantly smaller than those in normal feet (p = 0.004); however, stiffness and tensile modulus in the linear region were not significantly different. The MCL collagen fibrils in the feet with hallux valgus had a more wavy distribution than the fibrils in the normal feet. CONCLUSIONS In general, strong staining for collagen III and to a lesser extent, collagen I was observed at the interface between the MCL and bone in the feet with hallux valgus but not in the normal feet. These results indicate that the abnormal mechanical properties of the MCL in feet with hallux valgus may be related to differences in the organization of collagen I and collagen III fibrils.
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Affiliation(s)
- Eiichi Uchiyama
- Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
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16
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Abstract
Complications following hallux valgus surgery can occur and are a frequent source of patient dissatisfaction. The treatment of these complications begins with careful preoperative planning to ensure that the chosen procedure is appropriate for the specific patient. When complications occur, treatment must also be individualized to address the symptoms of the patient. This article presented an overview of the more common complications that are seen following hallux valgus surgery. Nonsurgical and surgical options for treatment were outlined to assist in the management of these complications.
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Affiliation(s)
- Daniel E Lehman
- OrthoIndy, 8450 Northwest Boulevard, Indianapolis, IN 46278, USA.
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de Prado M, Ripoll P, Vaquero J, Golanó P. Tratamiento quirúrgico percutáneo del hallux valgus mediante osteotomías múltiples. Rev Esp Cir Ortop Traumatol (Engl Ed) 2003. [DOI: 10.1016/s1888-4415(03)76145-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Coetzee JC, Resig SG, Kuskowski M, Saleh KJ. The Lapidus procedure as salvage after failed surgical treatment of hallux valgus: a prospective cohort study. J Bone Joint Surg Am 2003; 85:60-5. [PMID: 12533573 DOI: 10.2106/00004623-200301000-00010] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recurrent hallux valgus is a relatively common, yet challenging, condition for both the patient and the surgeon. The literature on the treatment of recurrent hallux valgus is sparse. The purpose of this study was to evaluate prospectively the functional outcome and patient satisfaction following the Lapidus procedure for the treatment of recurrent hallux valgus deformity. METHODS Twenty-four patients with a total of twenty-six symptomatic recurrences of hallux valgus after previous procedures for treatment of the deformity were included in the study. Exclusion criteria included prior fusion procedures on the foot or ankle, a previous Keller or Mayo procedure, insulin-dependent diabetes, peripheral vascular disease, or peripheral neuropathy. A visual analog pain scale and the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale were administered preoperatively, at six months postoperatively, and yearly thereafter. Weight-bearing radiographs were also made preoperatively; at six weeks, three months, six months, and one year postoperatively; and yearly thereafter. Patient satisfaction was assessed at the latest follow-up evaluation. RESULTS At twenty-four months, the mean score according to the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale had increased from 47.6 to 87.9 points, the mean score according to the visual analog pain scale had improved from 6.2 to 1.4, the mean hallux valgus angle had improved from 37.1 degrees to 17.1 degrees, and the mean intermetatarsal angle had improved from 18 degrees to 8.6 degrees. The patients were very satisfied after 77% of the twenty-six procedures, satisfied after 4%, and somewhat satisfied after 19%; no patient was dissatisfied. There were no cases of hallux varus. Complications included three nonunions, all of which occurred in smokers, and two superficial wound infections. CONCLUSION In appropriately selected patients, the Lapidus procedure is a reliable and effective operation after failed surgical treatment of hallux valgus. LEVEL OF EVIDENCE Therapeutic study, Level IV (case series [no, or historical, control group]). See p. 2 for complete description of levels of evidence.
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Affiliation(s)
- J Chris Coetzee
- Department of Orthopaedic Surgery, University of Minnesota School of Medicine, Minneapolis 55455, USA.
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Abstract
The great toe is affected by many congenital and acquired conditions including arthritis, hallux valgus, and hallux rigidus and disease of the hallucal sesamoids. Many surgical procedures have been described for the treatment of these conditions. With the increased popularity of forefoot surgery comes the potential for complications even when the surgery is done meticulously by an experienced surgeon under well-planned conditions. When a complication occurs, it can present difficult and challenging problems. It is, therefore, important to recognize a complication early so it may be analyzed and treated successfully. When recognized, a plan should be developed to identify, quantify, control, and resolve the problem. The current review defines some common complications and treatment options. Several problems may exist at the same time. A solution addressing all aspects of the problem must be designed so as not to augment the presenting complications. Salvage operations and long-term treatment are included to provide a perspective on treatment of residual deformity. It is important to realize that there often are several solutions to a difficult problem. Many factors influence the surgeon's choice and implementation of a solution, but the ultimate outcome always depends on a well thought out plan.
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Affiliation(s)
- G J Sammarco
- Department of Orthopaedics, University of Cincinnati School of Medicine, the Center for Orthopaedic Care, Inc, OH 45219, USA
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