Comparison of Minimally Invasive and Open Bunion Surgery in Older Patients
Authors: Boden Allison L. , DiGiovanni Grace , Masry Seif El , Ellis Scott J. , Johnson A. Holly , Conti Matthew S. 
Published: December 2024

Category: Bunion Introduction/ Purpose: Hallux valgus deformity affects more than 35% of people over 65 years old. Surgical correction in this population can be more complicated due to the likelihood of poor bone quality, worse deformity, and post-operative recovery challenges associated with weight bearing restrictions. There is no consensus on which surgical option is the best in this age-group. Minimally invasive bunionectomy (MIS) has gained popularity, namely due to evidence showing reduced recovery time, earlier weight-bearing, and less post-operative pain which can eliminate the need for opioids, all of which are beneficial to older surgical patients. The purpose of this study was to compare the radiographic and clinical outcomes of patients age 65 and older who underwent either open Lapidus or minimally invasive chevron akin osteotomy for bunion correction. Methods: A retrospective review of prospectively collected data within an institutional registry was performed. We identified 62 patients age 65 or older who were treated surgically for hallux valgus (open Lapidus or minimally invasive chevron akin osteotomy) between January 2017 and August 2022 with at least 1-year post-operative PROMIS scores. Chart review was performed to obtain demographic information and to confirm the surgical procedures completed. Pre- and at least 6-month post-operative radiographs were measured to obtain the hallux valgus angle (HVA) and intermetatarsal angle (IMA). PROMIS scores were obtained pre-operatively and at one and/or two years post-operatively. Differences in demographic, clinical, and radiographic outcomes between cohorts were assessed using the Mann Whitney U test and p-values were adjusted for a false discovery rate of 5%. Results: Both the MIS and open cohorts showed significant improvement in radiographic measurements between pre- and post-operative radiographs (p < 0.001), though there was no significant difference between groups (p > 0.05). There was a clinically and statistically significant improvement within the PROMIS domain of Pain Interference for the open and MIS groups and Physical Function for the MIS group at 1 and 2-years post-operatively, however, there was only a significant difference at 2-years for the PROMIS Physical Function domain in the open group. No difference was noted in Physical Function at 1-year post-operatively for the open group or between groups (Table 1). Within the MIS and open groups, there was an overall complication rate of 26% in each group (p > 0.05). Conclusion: Patients in both the MIS and open surgical groups had improvement in radiographic measurements and PROMIS scores, though there was no clinical or statistical difference found between groups. Additionally, patients in the open group may take longer to improve as there was not a significant improvement in the PROMIS Physical Function domain until the 2-year post-operative time point. Further investigation of recovery metrics between techniques in the earlier post-operative time-point is warranted. Given the results, both MIS and open surgical techniques appear to be safe and effective in correcting hallux valgus in older patients.