Two Year Follow-Up of 334 Third-Generation Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery

Category: Bunion Introduction/Purpose: The aim of this study was to explore the 2 year results of third generation (using screw fixation) Minimally Invasive Chevron and Akin osteotomies (MICA) for hallux valgus correction. There is a paucity of published data regarding the outcomes of this relatively new technique. We present the largest series in the literature, using three separate validated patient-reported outcome measures (EQ-5DL, VAS Pain and Manchester Oxford Foot Questionnaire (MOXFQ), for this time point. Methods: A single surgeon case series of patients with hallux valgus underwent primary third generation minimally invasive chevron and akin osteotomies for hallux valgus correction. Between August 2015 and January 2018, 290 MICAs were performed in 203 patients that were eligible for 2 year follow up. Baseline and 2 year post-operative patient reported outcomes were collected for 164 feet in 130 patients (124 females; 6 males). Paired t-tests were used to determine the statistical significance of the difference between pre- and post-operative scores. Results: The mean age was 56.6 (range 29.5-81.0, standard deviation (s.d.) 10.9). At two year follow up, mean MOXFQ scores improved for each domain: Pain; baseline 40.6 (range 0-100, s.d. 22.8), reduced to 11.3 (range 0-75, s.d. 16.0, p<0.001); Walking; 36.0 (range 0-100, s.d. 25.9) reduced to 8.2 (range 0-75.0, s.d. 16.0, p<0.001); Social interaction; 46.7 (range 0-100, s.d. 24.3), reduced to 7.7 (range 0-75.0, s.d. 13.9, p<0.001). Mean VAS Pain score improved from 30.4 (range 0.0-90.0, s.d. 23.6) to 9.4 (range 0.00-70.0, s.d. 15.6, p<0.001). Mean EQ-5D index score improved from 0.750 (range 0.066-1.000, s.d. 0.148) to 0.892 (range 0.410-1.000, s.d. 0.135, p<0.001). Mean EQ-5D VAS score did not significantly improve from 81.9 (range 0-100, s.d. 17.1) to 83.0 (range 0-100, s.d. 18.0, p=0.559). Conclusion: This is the largest prospective case series of short-term patient reported outcomes using a validated assessment method for hallux valgus, following third generation MICA to date. These data show that this technique is effective at improving foot and ankle specific patient reported outcomes at 2 years. This cohort is being followed over the longer term.

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One Year Follow-Up of Patient Reported Outcomes Following Third Generation Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00328 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0032

Author(s):

Thomas L. Lewis ◽

Robbie Ray ◽

David Gordon

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Patient Reported Outcomes ◽

Case Series ◽

Third Generation ◽

Short Term ◽

Patient Reported ◽

The Mean ◽

One Year

Category: Bunion Introduction/Purpose: The aim of this study was to explore the short-term results of third generation (using screw fixation) Minimally Invasive Chevron and Akin osteotomies (MICA) for hallux valgus correction. There is a paucity of published data regarding the outcomes of this relatively new technique. We present the largest series in the literature, using three separate validated patient-reported outcome measures (EQ-5DL, VAS Pain and Manchester Oxford Foot Questionnaire (MOXFQ), for this time point. Methods: A single surgeon case series of patients with hallux valgus underwent primary third generation minimally invasive chevron and akin osteotomies (MICA) for hallux valgus correction. Between August 2015 and January 2019, 430 MICAs were performed in 295 patients that were eligible for 1 year follow up. Baseline and 1 year post-operative patient reported outcomes were collected for 242 feet in 194 patients (182 females; 12 males). Paired t-tests were used to determine the statistical significance of the difference between pre- and post-operative scores. Results: The mean age was 55.9 (range 16.3-84.9, standard deviation (s.d.) 12.5). At one year follow up, the mean MOXFQ scores had improved for each domain: Pain; baseline 41.9 (range 0-100, s.d. 21.8), reduced to 13.8 (range 0-90, s.d. 17.7, p<0.001); Walking; baseline 34.6 (range 0-100, s.d. 24.3) reduced to 9.8 (range 0-89.0, s.d. 18.0, p<0.001); Social interaction; baseline 45.4 (range 0-100, s.d. 22.8), reduced to 8.2 (range 0-75.0, s.d. 14.7, p<0.001). Mean VAS Pain score improved from 29.8 (range 0.0-90.0, s.d. 22.1) to 8.2 (range 0.00-64.0, s.d. 12.8, p<0.001). Mean EQ-5D index score improved from 0.755 (range 0.066-1.000, s.d. 0.136) to 0.891 (range 0.350-1.000, s.d. 0.124, p<0.001). Mean EQ-5D VAS score improved from 83.4 (range 28- 100, s.d. 12.4) to 85.6 (range 0-100, s.d. 14.2, p=0.047). Conclusion: This is the largest prospective case series of short-term patient reported outcomes using a validated assessment method for hallux valgus, following third generation MICA to date. These data show that this technique is effective at improving foot and ankle specific patient reported outcomes at 1 year. This cohort is being followed over the longer term.

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Six Month Follow-Up of Patient Reported Outcomes Following Third Generation Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00330 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0033

Author(s):

Thomas L. Lewis ◽

Robbie Ray ◽

David Gordon

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Patient Reported Outcomes ◽

Case Series ◽

Third Generation ◽

Short Term ◽

Specific Patient ◽

Patient Reported ◽

The Mean

Category: Bunion Introduction/Purpose: The aim of this study was to explore the short-term results of third generation (using screw fixation) Minimally Invasive Chevron and Akin osteotomies (MICA) for hallux valgus correction. There is a paucity of published data regarding the outcomes of this relatively new technique. We present the largest series in the literature, using three separate validated patient-reported outcome measures (EQ-5DL, VAS Pain and Manchester Oxford Foot Questionnaire (MOXFQ), for this time point. Methods: A single surgeon case series of patients with hallux valgus underwent primary third generation minimally invasive chevron and akin osteotomies for hallux valgus correction. Between August 2015 and July 2019, 478 MICAs were performed in 328 patients that were eligible for 6 month follow up. Baseline and 6 month post-operative patient reported outcomes were collected for 340 feet in 267 patients (247 females; 20 males). Paired t-tests were used to determine the statistical significance of the difference between pre- and post-operative scores. Results: The mean age was 54.9 (range 16.3-84.9, standard deviation (s.d.) 12.8). At 6 month follow up, the mean MOXFQ scores had improved for each domain: Pain; baseline 42.5 (range 0-100, s.d. 22.6), reduced to 16.3 (range 0-100, s.d. 18.4, p<0.001); Walking; baseline 35.5 (range 0-100, s.d. 24.8), reduced to 12.2 (range s.d. 19.1, p<0.001); Social interaction; baseline 45.4 (range 0- 100, s.d. 22.6), reduced to 10.9 (range 0-100.0, s.d. 16.9, p<0.001). Mean VAS Pain score improved from 30.5 (range 0.0-90.0, s.d. 22.1) to 10.5 (range 0.00-78.0, s.d. 14.8, p<0.001). Mean EQ-5D index score improved from 0.752 (range 0.066-1.000, s.d. 0.133) to 0.872 (range 0.122-1.000, s.d. 0.133, p<0.001). Mean EQ-5D VAS score remained static from 82.7 (range 0-100, s.d. 13.3) to 83.7 (range 0-100, s.d. 17.8, p=0.386). Conclusion: This is the largest prospective case series of short-term patient reported outcomes using a validated assessment method for hallux valgus, following third generation MICA to date. These data show that this technique is effective at improving foot and ankle specific patient reported outcomes at 6 months. This cohort is being followed over the longer term.

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Radiological Outcomes of Third Generation Minimally Invasive Chevron Akin Osteotomies (MICA) for Hallux Valgus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00329 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0032

Author(s):

Thomas L. Lewis ◽

Robbie Ray; David Gordon

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Weight Bearing ◽

Case Series ◽

Deformity Correction ◽

Third Generation ◽

Radiographic Measurements ◽

Significant Difference ◽

Patient Reported ◽

The Mean

Category: Bunion Introduction/Purpose: Minimally invasive surgery for hallux valgus has significantly increased in popularity recently due to smaller incisions, reduced soft tissue trauma, and the ability to achieve large deformity corrections compared to traditional treatments. This study aimed to investigate the radiological outcomes and degree of deformity correction of the intermetatarsal angle (IMA) and the hallux valgus angle (HVA) following third generation (using screw fixation) Minimally Invasive Chevron and Akin Osteotomies (MICA) for hallux valgus. Methods: A single surgeon case series of patients with hallux valgus underwent primary, third generation MICA for hallux valgus. Pre- and post-operative (6 weeks after surgery) radiological assessments of the IMA and HVA were based on weight-bearing dorso-plantar radiographs. Radiographic measurements were conducted by two foot & ankle fellowship trained consultant surgeons (RR, DG). Paired t-tests were used to determine the statistically significant difference between pre- and post-operative measurements. Results: Between January 2017 and December 2019, 401 MICAs were performed in 274 patients. Pre- and post-operative radiograph measurements were collected for 348 feet in 232 patients (219 female; 13 male). The mean age was 54.4 years (range 16.3-84.9, standard deviation (s.d.) 13.2). Mean pre-operative IMA was 15.3° (range 6.5°-27.0°, s.d. 3.4°) and HVA was 33.8° (range 9.3°-63.9°, s.d. 9.7°). Post-operatively, there was a statistically significant improvement in radiological deformity correction; mean IMA was 5.3° (range -1.2°-16.5°, s.d. 2.7°, p<0.001) and mean HVA was 8.8° (range -5.2°-24.0°, s.d. 4.5°, p<0.001). The mean post-operative reduction in IMA and HVA was 10.0° and 25.0° respectively. Conclusion: This is the largest case series demonstrating radiological outcomes following third generation Minimally Invasive Chevron and Akin Osteotomies (MICA) for hallux valgus to date. These data show that this is an effective approach at correcting both mild and severe hallux valgus deformities. Longer term radiological outcome studies are needed to investigate whether there is any change in radiological outcomes. Correlation with patient reported outcomes is planned.

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Distal Chevron Osteotomy vs The Simple, Effective, Rapid, Inexpensive Technique (SERI) for Mild to Moderate Isolated Hallux Valgus: A Randomized Controlled Study

10.21203/rs.3.rs-17170/v1 ◽

2020 ◽

Author(s):

Ezequiel Palmanovich ◽

Nissiom Ohana* - equal first author contribution ◽

Ilan Small ◽

Iftach Hetsroni ◽

Eyal Amar ◽

...

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Controlled Study ◽

Wound Complications ◽

Invasive Technique ◽

Control Group ◽

Chevron Osteotomy ◽

The Mean ◽

One Year

Abstract Background Hallux valgus is a common foot deformity that leads to functional disability with serious sequelae. Minimally invasive surgery is often used to treat hallux valgus in order to reduce wound complications and improve recovery time. The objective of this study was to compare a Simple, Effective, Rapid, Inexpensive (SERI) technique with a simple Chevron technique in patients with minimum of one-year follow. Methods and Materials Between the years 2014-2015 we performed a prospective study comparing the SERI minimally invasive technique to treat symptomatic hallux valgus with a standard chevron osteotomy technique. All procedures were performed by a single fellowship trained foot and ankle surgeon. Twenty-one patients were randomized to the SERI cohort and 15 to the standard Chevron technique. Results The mean pre-operative intermetatarsal angle (IMA) of the SERI group was 14.8 ± 1.9 (11.9 - 22.9). The mean pre-operative IMA of the Chevron control group was 13.3 ± 2.3 (10.4 -18.2) (p = 0.038). The mean IMA two weeks after surgery was 6.0 ± 2.3 (2.4-12) in the SERI group, and 6.1 ± 3 (2.6-13.1) in the control group. At the two week and one year follow up, there was no significant difference found in the IMA between the two groups (p = 0.871). Neither groups reported symptomatic transfer metatarsalgia throughout the follow up period. The SERI group had increased metatarsophalangeal joint (MTPJ) motion (p < 0.001) however, all other parameters with similar. Conclusion The SERI technique provided comparable outcomes at up to one year follow up when compared to a standard Chevron osteotomy for moderate hallux valgus. This study demonstrated good reproducible results using the SERI technique for moderate hallux valgus.

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Percutaneous, MIS and open hallux valgus surgery

EFORT Open Reviews ◽

10.1302/2058-5241.6.210029 ◽

2021 ◽

Vol 6 (6) ◽

pp. 432-438

Author(s):

Hans-Jörg Trnka

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

First Generation ◽

Second Generation ◽

Surgical Techniques ◽

Metatarsal Head ◽

Medullary Canal ◽

Third Generation ◽

First Metatarsal ◽

Minimal Incision

There is some confusion in the terminology used when referring to MIS (Minimal invasive surgery) or percutaneous surgery. The correct term to describe these procedures should be percutaneous (made through the skin) and MIS should be reserved for procedures whose extent is between percutaneous and open surgery (e.g. osteosynthesis). Minimal incision surgery may be distinguished in first, second and third generation minimal incision surgery techniques. First generation MIS hallux valgus surgery is mainly connected with the Isham procedure; an intraarticular oblique and incomplete osteotomy of the head of the first metatarsal without fixation. The Bösch osteotomy and the SERI are classified as second generation MIS hallux surgery. They are both transverse subcapital osteotomies fixed with a percutaneous medial K-wire inserted into the medullary canal. For all these procedures, intraoperative fluoroscopic control is necessary. Open hallux valgus surgery can be divided into proximal, diaphyseal and distal osteotomies of the first metatarsal. Reviewing the available literature suggests minimally invasive and percutaneous hallux valgus correction leads to similar clinical and radiological results to those for open chevron or SCARF osteotomies. First generation minimally invasive techniques are primarily recommended for minor deformities. In second generation minimally invasive hallux valgus surgery, up to 61% malunion of the metatarsal head is reported. Once surgeons are past the learning curve, third generation minimally invasive chevron osteotomies can present similar clinical and radiological outcomes to open surgeries. Specific cadaveric training is mandatory for any surgeon considering performing minimally invasive surgical techniques. Cite this article: EFORT Open Rev 2021;6:432-438. DOI: 10.1302/2058-5241.6.210029

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A New Minimally Invasive Surgery of Hallux Valgus: Technique and Preliminary Outcomes

10.21203/rs.3.rs-54804/v1 ◽

2020 ◽

Author(s):

Changjun Guo ◽

Xingchen Li ◽

Chunguang Li ◽

Yang Xu ◽

Ming Cai ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Hallux Valgus ◽

Invasive Surgery ◽

Valgus Deformity ◽

Safe Procedure ◽

First Metatarsal ◽

Hallux Valgus Deformity ◽

Valgus Angle

Abstract PurposeThis study aimed to present a new minimally invasive surgery (MIS) technique and evaluate the safety and efficacy for correction of hallux valgus deformity at a preliminary follow-up.Methods48 consecutive feet that underwent a new MIS of hallux valgus with a mean 17.6 months follow-up (range 9 to 28 months). This technique uses a new osteotomy of the first metatarsal with screw fixation and percutaneous Weil osteotomy of lesser metatarsal without fixation. All patients were clinically evaluated using the Manchester-Oxford Foot Questionnaire (MOXFQ), American Orthopedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal score (AOFAS HMI) and visual analogue scale (VAS). Radiographic measures included hallux valgus angle (HVA), intermetatarsal angle (IMA) and the length of the first metatarsal. ResultsThere was significant improvement in the radiographic parameters(P<0.001). The IMA decreased from 13.3° to 9.8°, the HVA improved from 35.9° to 17.9° and the mean MT length decreased by 4 mm. There was significant improvement of VAS in the postoperative 2 weeks (P < .001). There were significant improvements in the MOXFQ scores and AOFAS HMI scores, respectively. The total rate of complication was 10.4%.ConclusionThe preliminary radiographic and clinical outcomes of this new minimally invasive surgery show that it is a safe procedure and had significantly less pain in the first 2 weeks following surgery.

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Third-Generation Minimally Invasive Chevron and Akin Osteotomies (MICA) in Hallux Valgus Surgery

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.20.01178 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Thomas L. Lewis ◽

Robbie Ray ◽

George Miller ◽

David J. Gordon

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Third Generation

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Minimally invasive Chevron-Akin osteotomy

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1208 ◽

2020 ◽

Vol 14 (3) ◽

pp. 264-268

Author(s):

Gustavo Nunes ◽

João Magalhães ◽

Tiago Baumfeld ◽

Roberto Pinto

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Case Series ◽

Preoperative Assessment ◽

Foot And Ankle ◽

Level Of Evidence ◽

Intermetatarsal Angle ◽

Akin Osteotomy ◽

Severe Hallux Valgus

Objective: To present the clinical and radiographic results of surgical treatment of patients with moderate to severe hallux valgus (HV) by minimally invasive Chevron - Akin osteotomy (MICA). Methods: The case series comprises 25 patients (30 feet) with diagnoses of moderate to severe HV treated surgically with the MICA technique. All patients answered the American Orthopedic Foot and Ankle Score (AOFAS) and rated pain on visual analogue scale (VAS) at preoperative assessment and at the last follow-up consultation. Radiological assessment included measurement of the valgus angles of the hallux (HVA) and the 1st and 2nd ray intermetatarsal angle (IMA). Complications and satisfaction ratings were also documented. Results: Mean follow-up was 14.6 months. Mean AOFAS increased from 42.8 to 90 and VAS reduced from 8.6 to 1.7. Mean HVA reduced from 31.7o to 8.4o and IMA from 14o to 5o. All these improvements were statistically significant (p<0.001). The most common complication observed was discomfort caused by hardware, affecting five feet (16.6%). Two patients (6.6%) had transitory neurapraxia and one patient (3.3%) developed reflex sympathetic dystrophy. There were no cases of infection, relapse, pseudarthrosis, or malunion of osteotomies. Subjective satisfaction ratings classified 93.3% of results as good or excellent. Conclusion: Minimally invasive Chevron-Akin osteotomy is a safe and reproducible technique that achieves good clinical and radiographic results for treatment of moderate to severe hallux valgus. Level of Evidence IV; Therapeutic Studies; Case Series.

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