The Effect of Gender on Hallux Valgus Surgery

Abstract

Category: Bunion Introduction/Purpose: Men are recognized to possess higher pain thresholds, report less pain and have a greater tolerance for pain. With increasing numbers of males seeking hallux valgus (HV) surgery, there is a paucity of literature comparing health-related quality-of-life (HRQoL) outcomes and satisfaction between males and females undergoing HV surgery. Methods: Prospectively collected registry data of 439 patients who underwent HV surgery at a single institution from 2007-2015 were reviewed. Propensity scores generated using logistic regression was used to match males (n=26) to females (n=52) in a 1:2 ratio. Hallux visual analogue scale (VAS) scores, American Orthopaedic Foot and Ankle Society scores (AOFAS), proportion attaining AOFAS minimal clinically important difference (MCID), Short-form 36 (SF-36), satisfaction and expectation scores were analyzed. Hallux valgus (HVA) and inter-metatarsal (IMA) angles were recorded pre- and postoperatively. Results: Before PSM, there were significant differences in age (49.8±17.4 vs 55.2±11.8, p=0.03) and SF-36 role-physical (37.5±43.7 vs 59.2±42.6, p=0.01)(Table 1). After PSM, there were no significant pre-operative differences in hallux VAS, AOFAS and SF-36 HRQoL scores between groups (Table 1). At two-years, males had significantly lower SF-36 general health scores (68.7±20.6 vs 79.3±17.8, p=0.02) (Table 2). In addition, lower proportion of males reported good/excellent satisfaction (73.1% vs 78.8%) and expectation fulfilment (80.8% vs 94.2%) at two-years (Table 3). Similar proportion of males attained MCID for AOFAS (53.8% vs 46.2%, p=0.63) (Table 4). Males and females presented with similar pre-operative HVA (29.3±8.4 vs 28.2±9.3, p=0.63) and IMA (14.4±3.2 vs 13.9±3.4, p=0.53), with successful correction of HVA (14.7±6.5 vs 12.5±7.8, p=0.25) and IMA (9.4±3.3 vs 8.3±3.1, p=0.17) post-operatively (Table 5). Conclusion: Our findings suggest that males may experience lower expectation fulfilment when compared to females after HV surgery, despite resolution of hallux pain, satisfactory radiological correction and attainment of similar proportion of MCID in AOFAS scores. These findings highlight that males may possess higher expectations towards hallux valgus surgery. Future research should focus on factors affecting expectation fulfilment in males undergoing HV surgery.