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Functional and radiographic outcomes of hallux valgus correction by mini-invasive surgery with Reverdin-Isham and Akin percutaneous osteotomies: a longitudinal prospective study with a 48-month follow-up.
J Orthop Surg Res 2016; 11(1):157JO

Abstract

BACKGROUND

Minimally invasive surgery (MIS) represents one of the most innovative surgical treatments of hallux valgus (HV). However, long-term outcomes still remain a matter of discussion within the orthopaedic community. The purpose of this longitudinal prospective study was to evaluate radiographic and functional outcomes in patients with mild-to-severe HV who underwent Reverdin-Isham and Akin percutaneous osteotomy, following exostosectomy and lateral release.

METHODS

Eighty patients with mild-to-severe symptomatic HV were treated by MIS. Clinical evaluation was assessed preoperatively, as well as at 3 and 12 months after surgery and at final follow-up of 48 months, using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux grading system. Patient satisfaction and complications were recorded. Computer-assisted measurement of antero-posterior radiographs was taken preoperatively, as well as at 3 and 12 months after surgery and at 48-month follow-up, analysing the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA) and the tibial sesamoid position. Also, the bridging bone/callus formation was evaluated at the different radiographic follow-ups, while the articular surface congruency and the metatarsal index were calculated only preoperatively and at the last follow-up. Patient satisfaction was assessed using the visual analogue score (VAS). Statistical analysis was carried out using the paired t test. Statistical significance was set at p < 0.05.

RESULTS

The mean AOFAS score was 87.15 points at the final follow-up of 48 months, and the VAS score was 8.35/10. The post-operative radiographic assessments showed a statistically significant improvement compared with preoperative values. The mean corrections of each angular value at the last follow-up were as follows: IMA 3.90°, HVA 12.50°, DMAA 4.72° and a tibial sesamoid position of 1.10. The articular surface was congruent in 77 (96.25%) cases and incongruent only in 3 (3.75%). The complete healing of the osteotomies was achieved in all series at 3-month follow-up. However, the results obtained in the correction of the severe HV deformities were less encouraging.

CONCLUSIONS

Minimally invasive surgery with Reverdin-Isham and Akin percutaneous osteotomy, in combination with previous exostosectomy and subsequent lateral soft-tissue release, is a safe, effective and reliable procedure for correction of mild-to-moderate HV. However, it requires a long learning curve because of the inherent difficulty of the mixed different surgical procedures.

TRIAL REGISTRATION

ClinicalTrials.gov PRS Protocol Registration and Results System: NCT02886221.

Authors+Show Affiliations

Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy. carlo.biz@unipd.it.Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy.Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, Barcelona, Spain. Health Sciences Faculty of Manresa, University of Vic-Central University of Catalunya, Barcelona, Spain.Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy.Orthopaedic and Trauma Unit, Padua Hospital, via Giustiniani 2, Padova, Italy.Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy.Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27919259

Citation

Biz, Carlo, et al. "Functional and Radiographic Outcomes of Hallux Valgus Correction By Mini-invasive Surgery With Reverdin-Isham and Akin Percutaneous Osteotomies: a Longitudinal Prospective Study With a 48-month Follow-up." Journal of Orthopaedic Surgery and Research, vol. 11, no. 1, 2016, p. 157.
Biz C, Fosser M, Dalmau-Pastor M, et al. Functional and radiographic outcomes of hallux valgus correction by mini-invasive surgery with Reverdin-Isham and Akin percutaneous osteotomies: a longitudinal prospective study with a 48-month follow-up. J Orthop Surg Res. 2016;11(1):157.
Biz, C., Fosser, M., Dalmau-Pastor, M., Corradin, M., Rodà, M. G., Aldegheri, R., & Ruggieri, P. (2016). Functional and radiographic outcomes of hallux valgus correction by mini-invasive surgery with Reverdin-Isham and Akin percutaneous osteotomies: a longitudinal prospective study with a 48-month follow-up. Journal of Orthopaedic Surgery and Research, 11(1), p. 157.
Biz C, et al. Functional and Radiographic Outcomes of Hallux Valgus Correction By Mini-invasive Surgery With Reverdin-Isham and Akin Percutaneous Osteotomies: a Longitudinal Prospective Study With a 48-month Follow-up. J Orthop Surg Res. 2016 Dec 5;11(1):157. PubMed PMID: 27919259.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional and radiographic outcomes of hallux valgus correction by mini-invasive surgery with Reverdin-Isham and Akin percutaneous osteotomies: a longitudinal prospective study with a 48-month follow-up. AU - Biz,Carlo, AU - Fosser,Michele, AU - Dalmau-Pastor,Miki, AU - Corradin,Marco, AU - Rodà,Maria Grazia, AU - Aldegheri,Roberto, AU - Ruggieri,Pietro, Y1 - 2016/12/05/ PY - 2016/09/06/received PY - 2016/11/18/accepted PY - 2016/12/7/entrez PY - 2016/12/7/pubmed PY - 2017/5/2/medline KW - Akin osteotomy KW - First ray KW - Forefoot KW - Hallux valgus KW - Minimally invasive surgery KW - Percutaneous distal osteotomy KW - Reverdin-Isham osteotomy SP - 157 EP - 157 JF - Journal of orthopaedic surgery and research JO - J Orthop Surg Res VL - 11 IS - 1 N2 - BACKGROUND: Minimally invasive surgery (MIS) represents one of the most innovative surgical treatments of hallux valgus (HV). However, long-term outcomes still remain a matter of discussion within the orthopaedic community. The purpose of this longitudinal prospective study was to evaluate radiographic and functional outcomes in patients with mild-to-severe HV who underwent Reverdin-Isham and Akin percutaneous osteotomy, following exostosectomy and lateral release. METHODS: Eighty patients with mild-to-severe symptomatic HV were treated by MIS. Clinical evaluation was assessed preoperatively, as well as at 3 and 12 months after surgery and at final follow-up of 48 months, using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux grading system. Patient satisfaction and complications were recorded. Computer-assisted measurement of antero-posterior radiographs was taken preoperatively, as well as at 3 and 12 months after surgery and at 48-month follow-up, analysing the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA) and the tibial sesamoid position. Also, the bridging bone/callus formation was evaluated at the different radiographic follow-ups, while the articular surface congruency and the metatarsal index were calculated only preoperatively and at the last follow-up. Patient satisfaction was assessed using the visual analogue score (VAS). Statistical analysis was carried out using the paired t test. Statistical significance was set at p < 0.05. RESULTS: The mean AOFAS score was 87.15 points at the final follow-up of 48 months, and the VAS score was 8.35/10. The post-operative radiographic assessments showed a statistically significant improvement compared with preoperative values. The mean corrections of each angular value at the last follow-up were as follows: IMA 3.90°, HVA 12.50°, DMAA 4.72° and a tibial sesamoid position of 1.10. The articular surface was congruent in 77 (96.25%) cases and incongruent only in 3 (3.75%). The complete healing of the osteotomies was achieved in all series at 3-month follow-up. However, the results obtained in the correction of the severe HV deformities were less encouraging. CONCLUSIONS: Minimally invasive surgery with Reverdin-Isham and Akin percutaneous osteotomy, in combination with previous exostosectomy and subsequent lateral soft-tissue release, is a safe, effective and reliable procedure for correction of mild-to-moderate HV. However, it requires a long learning curve because of the inherent difficulty of the mixed different surgical procedures. TRIAL REGISTRATION: ClinicalTrials.gov PRS Protocol Registration and Results System: NCT02886221. SN - 1749-799X UR - https://www.unboundmedicine.com/medline/citation/27919259/Functional_and_radiographic_outcomes_of_hallux_valgus_correction_by_mini_invasive_surgery_with_Reverdin_Isham_and_Akin_percutaneous_osteotomies:_a_longitudinal_prospective_study_with_a_48_month_follow_up_ L2 - https://josr-online.biomedcentral.com/articles/10.1186/s13018-016-0491-x DB - PRIME DP - Unbound Medicine ER -