Functional and Radiographic Outcomes of Hallux Valgus Correction by Mini-invasive Surgery With Reverdin-Isham Percutaneous Osteotomy
Condition: Hallux Valgus
MeSH terms: Hallux Valgus; Bunion
Study type: Interventional

Summary: 
      Minimally invasive surgery (MIS) represents one of the most innovative surgical treatments of
      Hallux Valgus (HV). However, long-term outcomes still remain a matter of discussion within
      the orthopaedic community. The purpose of this longitudinal prospective study was to evaluate
      radiographic and functional outcomes in patients with mild-to-severe HV who underwent
      Reverdin-Isham and Akin percutaneous osteotomy, following exostosectomy and lateral release.
    

Detailed description: 
      One hundred and eighty patients with mild-to-severe symptomatic HV were treated by MIS.
      Clinical evaluation was assessed pre-operatively, as well as at 3 and 12 months after surgery
      and at final follow-up of 48 months, using the American Orthopaedic Foot and Ankle Society
      (AOFAS) Hallux grading system. Patient satisfaction and complications were recorded.Further
      parameters assessed were postoperative pain at rest and during movement by the numerical
      rating scale (NRS), patient satisfaction using the Visual Analogue Scale (VAS), quality of
      life, and return to daily activities. Incidence of Chronic Pain Syndrome (CPS), Type of
      anesthesia and ASA were evaluated and recorded.

      Computer-assisted measurement of antero-posterior radiographs was taken pre-operatively, as
      well as at 3 and 12 months after surgery and at 48-month follow-up, analysing the
      intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular
      angle (DMAA), and the tibial sesamoid position. Also, the bridging bone/callus formation was
      evaluated at the different radiographic follow-ups, while the articular surface congruency
      and the metatarsal index were calculated only preoperatively and at last follow-up.
      Statistical analysis was carried out using the paired t-test. Statistical significance was
      set at p < 0.05.
    

Intervention name(s): Reverdin-Isham Osteotomy
Intervention type(s): Procedure
Intervention description(s): Incision on the medial part of the foot, a Shannon Isham burr was introduced at the junction of metaphysis and epiphysis. It was applied to the flat bone surface achieved previously at approximately 45°, keeping the articular cartilage surface of the first metatarsal head as reference point on the superior cortex. In this position, under fluoroscopic control, the osteotomy was started following a distal-dorsal and proximal-plantar direction. At this point, the burr was slightly withdrawn in order to preserve a few millimetres of the lateral cortex, and the osteotomy of the plantar cortex was performed completely. Then, a Wedge burr was used to create a wedge with a medially oriented base. At the point of closing the wedge, osteoclasis of the preserved lateral cortex was achieved, modifying the orientation of the articular surface, normalizing the DMAA value, and adding an intrinsic stability to the osteotomy by producing contact of the trabecular bone.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Hallux Valgus; Reverdin-Isham Osteotomy; Minimally Invasive Surgery; Percutaneous Distal Osteotomy; First Ray; Forefoot