Mid-term outcome of distal osteotomy and first tarsometatarsal joint fusion for hallux valgus.

Abstract

Objectives: Many surgical methods have been described for correction of hallux valgus (HV), in general dictated by the severity of the deformity. The aim of the study was to evaluate mid-term outcome of patients with distal chevron osteotomy and Lapidus arthrodesis. Methods: A retrospective study of patients operated in the hospital from January 2017 to December 2018, was conducted. Two groups were identified: distal chevron osteotomy (group A) and Lapidus arthrodesis (group B). Pre-operative and mid-term postoperative radiological examination results and patients' satisfaction were analyzed. Results: Mid-term outcome was evaluated in 49 patients (48 female, 1 male), mean age 55.8 (31-77) years, mean 63 (45-81) months after operation. Eighteen patients (24 feet) were in the group A, 31 patient (35 feet) in group B. In the group A pre-operative mean hallux valgus angle (HVA) was 32.40, intermetatarsal angle (IMA) 11.50, distal metatarsal articular angle (DMAA) 29.50; postoperative mean HVA was 19.80, IMA 90, DMAA 160 (p<0.05). Mean grade of the medial sesamoid position pre-operatively was 2, postoperatively-1. In the Lapidus arthrodesis group pre-operative mean HVA was 38.10, IMA 150, DMAA 34.10; postoperative mean HVA was 160, IMA 8.60, DMAA 14.10 (p<0.05). Mean grade of the medial sesamoid position pre-operatively was 2, postoperatively-2. No significant difference among mean postoperative HVA, IMA, DMAA in group A and group B was identified (p˃0.05). In group A 14 patients (77.8%) were satisfied, 4 patients (22.2%) were unsatisfied; in group B 23 patients (74.2%) were satisfied, 8 patients were unsatisfied (25.8 %) with outcome. Two patients had superficial postoperative infection, one – hypertrophic scar, one – metatarsalgia, one stiffness. Discussion/conclusions: Both HV patients' groups demonstrated improvement of HVA, IMA, DMAA postoperatively. Two thirds of patients were satisfied with outcome in both groups. Patients are suggested to be informed about possible complications and risks after surgery.