Investigación clínica sobre pie y tobillo

Abstracto

Relevancy grading of outcome predicting factors after distal chevron osteotomy for hallux valgus correction

Gerhard Kaufmann, Moritz Wagner, Dietmar Dammerer, Hanno Ulmer, Michael Liebensteiner, Franz Endstrasser, Matthias Braito

Aim: The purpose of this study was to identify radiographic risk factors for loss of correction (LOC) after hallux valgus surgery and to weight their importance for LOC.

Patients and Methods: We retrospectively assessed radiographs of 1082 consecutive chevron osteotomy cases in regard to early LOC from initially postoperative to six and 12 weeks postoperatively. The influence of preoperative and postoperative radiographic parameters on LOC of hallux valgus angle (HVA) and intermetatarsal 1/2 angle (IMA) was evaluated using nonparametric Spearman’s rank correlations and multiple linear regression analyses.

Results: Mean LOC from initially postoperative to six and 12 weeks postoperatively were 1.4 (SD 2.7) and 3.4 (SD 2.6) degrees for IMA and 3.5 (SD 5.4) and 7.6 (SD 5.6) degrees for HVA, respectively. Significant correlations were found between LOC of HVA and IMA for preoperative IMA, HVA, distal metatarsal articular angle (DMAA), proximal to distal phalangeal articular angle (PDPAA) and joint congruity as well as for postoperative IMA, HVA, PDPAA, joint congruity and sesamoid position. Categorization of outcome-predicting postoperative radiographic factors revealed the following parameters to be important in descending order: HVA, sesamoid position, IMA, PDPAA and joint congruity.

Conclusion: Multiple pre- and postoperative radiological parameters correlate with early loss of correction after hallux valgus surgery. Relevancy grading revealed the postoperative HVA and sesamoid position to be the most important parameters, followed by IMA, PDPAA and joint congruity. In consequence total deformity correction, taking all aspects of the hallux valgus deformity into account, seems reasonable.

Take home message: Total deformity correction taking into account all aspects of the hallux valgus deformity (severity of hallux valgus deformity, joint line orientation and joint congruity, hallux valgus interphalangeus, positioning of the sesamoids) may result in reduced early LOC after distal chevron osteotomy for hallux valgus correction.