Re: Chevron Osteotomy
Minimally Invasive Chevron Osteotomy; Functional Outcome and Comparison with Open Chevron Osteotomy
Samer S. Morgan, Ibrahim Roushdi, Simon Palmer
Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
Symptomatic hallux valgus is a common clinical problem, current trend is towards minimally invasive procedures. The goal of this study is to evaluate the outcome of minimally invasive chevron ostoetomy, comparing it with a matched group who had open chevron osteotomy.
Prospective study with 54 patients. MIS group 25 patients between October 2009 and November 2010. Open group 29 patients between February 2008 and October 2010. Inclusion criteria included mild to moderate hallux valgus, no previous history of foot surgery, no history of inflammatory arthritis, or metatasophalangeal joint (MTPJ) arthritis. All the operations were peformed by the senior author. Functional outcome and pain were evaluated using pre and post operative Manchester Oxford Foot and ankle questionnaire (MOXFQ). It is a 16 item questionnaire assessing three domains, walking, footpain and social interaction, the lower the score the better. Radiologically, pre and post operative intermetatarsal angle (IMA) and hallux valgus angle (HVA), avascular necrosis and union were assessed. Complications and satisfaction were recorded.
In the MIS group (25 patients) two patients lost to follow up, 23 were available for analysis. Mean age at operation was 55 (23-79). Twenty-four patients were female and the operation was on the left side in 14 patients. The MIS group showed significant improvement in all the domains of the MOXFQ. Walking (preop. 48/100 (SD 26), postop 28 (SD 32) <0.018), foot pain (preop. 54(SD 24), postop. 33(SD 29) <0.013), social interaction (preop. 56 (SD 26), postop 22 (SD 32) <0.001). Radiologically the mean HVA and IMA corrections were 11.8° and 6.3°, respectively, which is statistically significant (p < 0.001). There were no cases with nonunion, malunion, overcorrection, transfer metatarsalgia or osteonecrosis. In the open group (29 patients) four patients lost to follow up, 25 patients were available for analysis. Mean age at operation was 55 years (34-75). Twenty-three patients were female and the operation was on the left side in 16 patients. The open group showed significant improvement in all domains of the MOXFQ, walking (pre 52(SD 23), post. 27 (SD 22) <0.0001), foot pain (pre. 52 (SD22). Post 33(SD23) <0.002) , social interaction (pre. 56 (SD17), post 22 (SD17) <0.0001). The HVA and IMA were 10.5 and 5.9 degrees respectively and was statistically significant. The improvement in MOXFQ and HVA and IMA corrections were not statistically significant between the MIS and open groups.
DISCUSSION AND CONCLUSION
Recently chevron osteotomy is being performed using minimally invasive techniques. It has the advantage of minimal soft tissue dissection and consequently less risk of avascular necrosis, less pain and faster recovery. Our results showed that the MIS chevron osteotomy is an effective procedure with minimal complications and satisfactory functional outcome and comparable to the open standard chevron osteotomy. Larger sample size is required to confirm our findings. The results of our randomized controlled trial are awaited.