Outcomes of Minimally Invasive Surgery for Severe Hallux Valgus Deformity: A Systematic Review and Meta-Analysis

Abstract

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The use of minimally invasive (MIS) techniques in hallux valgus correction has been established in mild to moderate hallux valgus. However, there has been no clear consensus on the outcomes of MIS techniques in severe hallux valgus. This paper presents a systematic review and meta-analysis to determine the clinical and radiological outcomes of patients with severe hallux valgus who underwent MIS corrective osteotomy. Methods: The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies that presented patients with severe hallux valgus, defined as Hallux Valgus Angle (HVA) ≥ 40 ° and/or Intermetatarsal Angle (IMA) ≥ 16 °, with clinical and/or radiological outcomes after MIS surgery were included. Results: 16 studies were included with 1170 feet. The average preoperative HVA was 36.0° and IMA was 16.9°. Post-operatively, all studies reported significant improvement in AOFAS score with a mean difference of 41.1 (95% CI 33.58, 48.67). All studies reported improvement in radiological parameters: HVA mean improvement of 23.8° (95% CI 19.73, 27.86), IMA mean improvement of 8.22° (95% CI 6.14, 10.29).4 studies reported patient satisfaction postoperatively with a pooled average of 92.3% over 415 patients. 11 studies reported superficial and/or deep infection postoperatively with a pooled average of 2.3% over 798 patients. 13 studies reported malunion, delayed union or non-union with a pooled average of 2.9% over 981 patients. 6 studies reported loss of correction postoperatively with a pooled average of 8.8% over 531 patients. Conclusion: In the treatment of severe hallux valgus, the use of minimally invasive surgical techniques provides significant improvement in clinical and radiological parameters with low rates of complications.