Do Patient-Reported Outcomes Differ Between Open and Minimally Invasive Hallux Cheilectomy?
Authors: Zona Nathaniel , Stark Samuel D. , Villarreal Eric , Hunt Kenneth 
Published: December 2024

Category:

Midfoot/Forefoot; Arthroscopy

Introduction/Purpose:

Newer arthroscopic and minimally invasive (MIS) surgical techniques and instrumentation have made it increasingly easier to perform small-joint diagnostic arthroscopy and procedures that have been generally performed in an open fashion. These newer techniques have now been used for long enough that sufficient patient populations with long-term follow-data data are becoming available for comparison to traditional open cheilectomy. Our study sought to determine whether there is a difference in patient-reported outcomes (PRO) between MIS and open hallux cheilectomy as the number of patients undergoing the MIS version of the procedure increases and more long-term follow-up data becomes available. Our hypothesis was that patient-reported outcomes would be better for MIS cheilectomy at short-term follow-up but would even out over time with longer term follow-up.

Methods:

A retrospective chart review of all hallux MTP cheilectomies (CPT 28289) between 2015 and 2023 was performed within a single academic healthcare system. Chart review was then undertaken to collect basic demographics and determine if the patients had an open or minimally invasive cheilectomy. PROs were collected in a prospective fashion as part of the institution’s PRO registry starting in 2018. Patients with a completed measure of PROMIS Physical Function (PF), Pain Interference (PI) and/or Foot and Ankle Single Assessment Numeric Evaluation (FA SANE) at baseline, 3-, 6-, 12-, and/or 24-month postoperative timepoints were included in analysis. Differences in average PROs at each timepoint, both within and between cheilectomy type, were determined non-parametrically using Wilcoxon Rank Sum Tests. The average improvement of patients with a preoperative and at least one postoperative measure for each group were compared using an unpaired t-test. A p-value of < 0.05 was considered statistically significant.

Results:

In total, 172 patients with completed PROs were included in analysis. Average age was 53.2±11.4 and 111 (65%) of patients were female. The open approach was performed in 118 (69%) patients and 54 (31%) patients had a minimally invasive approach, consisting of hallux MTP arthroscopy followed by bone resection with an MIS burr under fluoroscopic guidance. For all PROs, the open and arthroscopic approaches demonstrated similar averages at each time point, and improvements in both techniques reached statistical significance (figure 1). There was no statistically significant difference in overall improvement by procedure type for PF (p=0.257), PI (p=0.544), or FA SANE (p=0.723). These corresponding improvements for the open approach were 5.18±8.67, -5.99±8.33 and 17.83±30.5 while the arthroscopic approach improvements were 3.33±7.69, -5.03±7.33, and 15.66±28.34 respectively.

Conclusion:

Arthroscopic and open approaches to hallux MTP cheilectomies have similar postoperative PRO improvements, and both techniques ultimately result in significant improvement. The magnitude of these improvements are not different based on technique at longest follow up. Thus, arthroscopic approaches are non-inferior to the traditional open approach. Further work is needed to determine if additional surgeries performed in parallel with cheilectomies may be affecting the observed PROs. Additionally, current work is being done to assess how functional, clinical, and radiographic outcomes align with PROs following MIS or open cheilectomy.