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Minimally invasive osteotomy for hallux valgus improved AOFAS scores 41 points
Although 2% of cases experienced delayed consolidation, all feet healed by 4 months.
An investigator has found a simple, minimally invasive surgical technique effective for hallux valgus correction based on 1,000 feet he treated.
The procedure was less expensive and almost twice as fast to do than other hallux valgus osteotomies, according to Sandro Giannini, MD.
He reported his results at a mean follow-up of 5 years at the American Orthopaedic Foot and Ankle Society (AOFAS) 22nd Annual Summer Meeting, calling the technique a SERI osteotomy, for simple, effective, rapid, inexpensive.
Giannini, director of orthopedic surgery and traumatology at Istituto Orthopedici Rizzoli, Bologna, Italy, told Orthopedics Today he could complete the surgeries in 5 minutes vs. 13 minutes for scarf and 10 minutes for Chevron osteotomies.
Done under direct visualization without any intraoperative radiographs, the procedure involves a complete distal metatarsal osteotomy performed through a 1-cm medial incision at the metatarsal neck. Giannini fixes the osteotomy with 2-mm Kirschner wire, which costs less than the screws and plates needed to stabilize other types of hallux valgus osteotomies.
Outcomes were 85% good or excellent. The mean AOFAS scores improved from 48 + 15 preoperatively to 89 + 13 at 37 months follow-up, average.
Images: Giannini S |
Observable correction
Giannini found he could use the technique in up to 90% of cases.
Intraoperatively, he plainly saw how well the displacement of the metatarsal head corrected different aspects of the deformity like hallux valgus angle (HVA), intermetatarsal angle (IMA), proximal articular set angle (PASA), and dorsal or plantar displacement. PASA is similar to the distal metatarsal articular angle.
Patients treated were 20 to 65 years old and did not have arthritis. Preoperatively their overall deformity or HVA was less than 40°, with the IMA no greater than 18°.
Giannini compared the technique to others: “We obtained the same results regarding the correction of the deformity; however, we had more stiffness in the metatarsophalangeal joint (MPJ) using the osteotomy associated with intra-articular procedures, more complications regarding wound healing, painful scar, and necessity of hardware removal.”
Complications surmountable
Patients could bear weight immediately postop and continued that for 4 weeks wearing just a bandage and talus shoe.
Giannini reported a few minor complications, some of which resolved. Thirty-one feet exhibited slight stiffness.
There was delayed consolidation in 25 feet, which he thought was from walking or standing too much postoperatively. “It is usually asymptomatic and complete radiographic consolidation with remodeling of the diaphysis occurs after four months.”
Giannini said the learning curve consists of about 30 cases. “Very important for obtaining better results is the respect of the indications: IMA less than 18°, arthritis no more than 1°, no MPJ stiffness.”
The procedure is contraindicated for severe instability, more than 1° of arthritis, IMA greater than 18° and MPJ stiffness.
For more information:
- Giannini S, Faldini C, Vannini F, et al. Minimally invasive distal metatarsal osteotomy for surgical treatment of hallux valgus: Clinical study of the first 1,000 consecutive cases at mean 5 year follow-up. Presented at the American Orthopaedic Foot and Ankle Society 22nd Annual Summer Meeting. July 14-16, 2006. La Jolla, Calif.