Rates of revision for different HAV procedures

NewsBot · Jul 2, 2008

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Rates of revision surgery using chevron-austin osteotomy, lapidus arthrodesis, and closing base wedge osteotomy for correction of hallux valgus deformity.
Lagaay PM, Hamilton GA, Ford LA, Williams ME, Rush SM, Schuberth JM.
J Foot Ankle Surg. 2008 Jul-Aug;47(4):267-72.

To identify complications that necessitated revision surgery after the primary operation, a multicenter retrospective chart review was conducted for 646 patients who received either a modified chevron-Austin osteotomy (270 patients), modified Lapidus arthrodesis (342 patients), or closing base wedge osteotomy (34 patients) to correct hallux valgus deformity. Revision surgery for complications was calculated and compared. All surgery was performed by 1 of 5 staff foot and ankle surgeons at Kaiser Permanente medical centers. Complications included recurrent hallux valgus, iatrogenic hallux varus, painful retained hardware, nonunion, postoperative infection, and capital fragment dislocation. The rates of revision surgery after Lapidus arthrodesis, closing base wedge osteotomy and chevron-Austin osteotomy were similar with no statistical difference between them. The total rate for re-operation was 5.56% among patients who received chevron-Austin osteotomy, 8.82% among those who had a closing base wedge osteotomy, and 8.19% for patients who received modified Lapidus arthrodesis. Among patients who had the chevron-Austin osteotomy procedure, rates of re-operation were 1.85% for recurrent hallux valgus and 1.48% for hallux varus. Among patients who had the modified Lapidus arthrodesis, rates of re-operation were 2.92% for recurrent hallux valgus and 0.29% for hallux varus. Among patients who had the closing base wedge osteotomy, rates of reoperation were 2.94% for recurrent hallux valgus and 2.94% for hallux varus. The collected comparative complication rates should serve to provide adjunctive information for foot and ankle surgeons and patients regarding hallux valgus surgery.
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Admin2 · Jul 2, 2008

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NewsBot · Jun 4, 2016

Serious sequellae of the hallux valgus surgery: More options for its surgical treatment.
Nunez-Samper M et al
Revista Espanola de Cirugia Ortopedica y Traumatologia [2016]

The purpose of this study is to present a method for treating the serious consequences that result from failure of corrective techniques used for hallux valgus, which produces severe shortening of the first ray, and makes it difficult to perform the third rocker.In this study, conducted in 2 hospitals in Madrid and Barcelona, an assessment was made of the clinical and radiological results of 40 cases, of which 97.5% were female. Technically it involves making a metatarsophalangeal arthrodesis after bone distraction with an external mini-fixation, and then inserting an iliac crest bone graft, stabilising it with a plate or the mini-fixator.The pre-operative shortening was 2.5cm. and elongation obtained was between 1.5 and 3.0cm. Clinical and radiological bone graft integration was achieved at 2-4 months, although full integration occurred after one year. Falliner and Blauth criteria were used to evaluate the results at 6 and 12 months follow-up, and using Visual Analogue Scale (VAS score/pain, scale 1-10), being favourable in 80%, and not changing over time. The failure rate was 7.5%, which included the non-integration of the graft and infection, requiring additional surgery.There are not many publications on the number and type of complication for hallux valgus surgery, or guidelines established, only the treatment by conventional fusion. The problem arises when the patient presents a severe shortening of the ray, and direct fusion would aggravate the insufficiency of the first ray and the transference metatarsalgia. In these cases, these procedures would be indicated.
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NewsBot · Jul 29, 2016

Techniques for First Metatarsophalangeal Joint Salvage Associated With Failed Hallux Valgus Surgery.
Lundeen, Gregory A. MD, MPH; Daws, Snow B. MD; Dunaway, Linda APRN, NP-C
Techniques in Foot & Ankle Surgery: July 21, 2016

The surgical correction of hallux valgus (HV) is one of the most common procedures performed by orthopedic foot and ankle surgeons. There are >100 different operations described in the literature for the management of HV, yet patient dissatisfaction following HV surgery can occur in 4% to 41% of cases. The most common outcomes leading to patient complaints include recurrence of HV, hallux varus, malunion, nonunion, osteonecrosis of the first metatarsal head, first metatarsophalangeal joint stiffness, and pain. This manuscript will present and discuss 4 cases of failed HV treated with joint-sparing secondary procedures. The goal is to use these cases as examples of treatment options available in the management of revision surgery related to previous HV reconstruction. The evaluation of patients with failed HV surgery is discussed, and an overview of the various joint-sparing surgical treatment options is presented.
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NewsBot · Jan 12, 2021

Revision surgeries for failed hallux valgus correction: A systematic review
FilippoMiglioriniaJörgEschweileraMarkusTingartaNicolaMaffullibcd
The Surgeon; 7 January 2021

Background
Failure of hallux valgus (HV) correction is not uncommon, and its management can be challenging. The available literature is not exhaustive. Therefore, we conducted a systematic review to investigate the current evidence on the role of revision surgery for failed HV correction, including clinical presentation, indications, surgical strategies and outcomes.

Material and methods
The present systematic review was performed according to the PRISMA guidelines. Pubmed, EMBASE, Google Scholar and Scopus online databases were accessed in November 2020. All the clinical studies on revision for failed HV correction were analysed, and only studies reporting quantitative data under the outcomes of interest were considered for inclusion.

Results
Data from 20 studies (586 procedures) were retrieved. The HV angle, the intermetatarsal angle and the distal metatarsal articular angle were reduced of 17.8° (P < 0.001), 3.3° (P = 0.05) and 7.3° (P < 0.001) respectively. The American Orthopaedic Foot & Ankle Society score improved of 24.7% (P < 0.001). The visual analogue scale improved by 40.8% (P < 0.001). Dorsiflexion and plantar flexion of the first metatarso-phalangeal joint remained similar to their preoperative values (P = 0.2 and P = 0.4, respectively). After revision surgery the following complications were further detected: recurrences 5.1% (30 of 586 patients), non-unions 4.1% (24/586), additional surgical procedures 8.7% (51 of 586 patients).

Conclusion
Revision surgery for failed primary HV correction can yield satisfying results. Accurate preoperative planning is necessary to try and identify the causes of failure, and address them appropriately.
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NewsBot · Jan 14, 2021

Percutaneous basal closing wedge osteotomy for hallux valgus deformity
Joel Vernois et al
Oper Orthop Traumatol. 2021 Jan 13

Objective: This article describes the percutaneous technique of a minimally invasive basal closing wedge osteotomy for correction of hallux valgus.

Indications: This procedure allows correction of severe deformity with a minimally invasive approach.

Contraindications: No specific contraindication; a fusion would be preferred for an arthritic tarsometatarsal or metatarsophalangeal joint.

Surgical technique: The surgical technique is based on the use of burrs specifically adapted for foot surgery. A basal closing wedge osteotomy is performed and fixed percutaneously. Each step is controlled under fluoroscopy.

Postoperative management: A postoperative heel shoe is prescribed for 6 weeks with crutches. The foot is elevated during the first 2 weeks. Impact is forbidden for 3 months.

Results: The authors report good and excellent results with an average correction of the hallux valgus angle of 26° and an intermetatarsal angle of 8.2°.
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