Effectiveness of Hallux Valgus Surgery on Post-Operative Outcomes in Skeletally Mature Patients

Abstract

Category: Bunion Introduction/Purpose: To evaluate the outcomes of 1st MTP motion preserving hallux valgus surgery using Patient Reported Outcomes (PROMs) in the literature since 2001. This paper also tries to eliminate some of the heterogeneity in reporting by using the effect size of the treatment using Minimally Important Clinical Differences (MCIDs). Methods: For this systematic review, we searched for peer-reviewed English-language articles published in 2001 or later, using the electronic databases Medline, Embase, SCOPUS, PEDro, CINAHL, Global Index Medicus, Web of Science, and World Wide Science. There were a total of 5,544 articles published on bunions. We reviewed all the abstracts and 1,200 papers were selected for full text evaluation. Finally, we analyzed 310 of the articles for this review. In total, there were 21,109 patients in 401 cohorts that underwent surgery on a total of 24,231 feet. Results: Our primary endpoint was patient reported outcomes measures (PROMs) and was stratified based on location of the osteotomy on the metatarsal shaft as well as follow up time. AOFAS was the most common PROM used and was included in 83.5% of the articles. We found that double osteotomies had the greatest overall change score in PROMs with an overall mean improvement of 1.69 MCIDs (CI +/- 0.7), compared to 1.23 (CI +/-0.46) for distal osteotomies; shaft and proximal osteotomies were similar to the distal subgroup. Although it had the highest positive change, double osteotomies were associated with the highest complication rates of recurrence (11.2%), malunion (4.8%), and avascular necrosis (3.2%). Minimally invasive vs open techniques had similar changes in HVA, IMA, and PROMs. There was a slightly higher satisfaction rate in the Open group at 91.6% vs 89.6% in the MIS group. Conclusion: Bony correction of bunions demonstrated a clinically significant improvement in patient reported outcomes with an aggregate MCID between 1.26-1.69. They performed significantly better than soft tissue procedures +/- proximal phalanx osteotomy. Although double osteotomy did perform better than the other bony osteotomies it did have a higher complication rate and the group was a much smaller cohort which makes it more susceptible to bias. MIS vs Open bunion correction demonstrated similar correction and AOFAS scores, the satisfaction rate was about 2% higher in open which was statistically significant but may not have clinical significance