Woo Jin Choi, MD, Ihsan Oesman, MD, Hyun Kook Youn, MD, Jin Woo Lee, MD, PhD
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1 Woo Jin Choi, MD, Ihsan Oesman, MD, Hyun Kook Youn, MD, Jin Woo Lee, MD, PhD Department of Orthopaedic Surgery Yonsei University College of Medicine, Seoul, Korea
2 < Presentation Title > The effect of combined procedures on the outcomes and recurrence of hallux valgus after the Ludloff osteotomy < Presenter s Name > Woo Jin Choi My disclosure is in the Final AOFAS Program Book. I have no potential conflicts with this presentation.
3 Postoperative recurrence of hallux valgus deformity ranges from 3% to 25% following proximal metatarsal osteotomy, although there are various definitions of recurrence in the literature and some investiga tors do not even mention it 1-8. Additional procedures combined with first metatarsal osteotomy, incl uding distal soft tissue procedures (DSTPs), Akin osteotomy, and su pplementary axial Kirschner wire, are widely used for the treatment of hallux valgus deformity We investigated the effect of such combined procedures on the outc omes and recurrence of hallux valgus after Ludloff osteotomy.
4 84 patients (103 feet) had received Ludloff osteotomy combined wit h additional procedures between June 2005 and May A DSTP was performed using the first web space incision or transart icular soft tissue release. According to the combined procedures, pa tients were divided into group I (31 feet; first web space soft tissue r elease), group II (35 feet; Akin osteotomy and transarticular soft tiss ue release), and group III (37 feet; Akin osteotomy, supplementary a xial K-wire fixation, and transarticular soft tissue release). Each grou p was subdivided into severe and moderate deformities. We compared group I with group II to evaluate the effect of Akin ost eotomy, group II with group III to analyze the effect of additional Kirs chner wire fixation, and identified the postoperative incongruency of the metatarsophalangeal (MTP) joint in the three groups to evaluate the effect of DSTPs according to two methods.
5 AOFAS score p=0.231 p= I VAS Preop p=0.123 Follow-up p= I Preop Follow-up
6 Effect of Akin osteotomy - vs II HVA correction( ) IMA correction( ) Moderate Severe Moderate Severe (P=0.015) (P=0.019) (P=0.935) (P=0.495) Effect of additional K-wire - vs III HVA correction( ) I IMA correction( ) I Moderate Severe Moderate Severe (P=0.854) (P=0.039) (P=0.016) (P=0.001)
7 First web space vs Trans-articular release Postoperative Incongruency 31.3% 31.6% 6.3% 15.8% 11.1% 6.7% GrouP II I Moderate (P=0.863) Severe (P=0.026)
8 Recurrence Total (n=103) (n=31) (n=35) I (n=37) p Value Total 16(15.5%) 8(25.8%) 5(14.3%) 3(8.1%) Moderate 7(6.8%) 4(12.9%) 2(5.7%) 1(2.7%) Severe 9(8.7%) 4(12.9%) 3(8.6%) 2(5.4%) Predictors for recurrence OR p Value 95% CI preop. HVA additional K-wire
9 The Akin osteotomy can significantly increase the reduction of HVA i n both moderate and severe deformities. Supplementary axial Kirschner wire can significantly reduce the loss of IMA correction in both deformity groups. In severe deformities, first web space soft tissue release can preven t postoperative recurrence of first MTP incongruency more efficientl y than transarticular soft tissue release. Preoperative HVA and additional axial Kirschner wire could be facto rs which affect recurrence of hallux valgus after Ludloff osteotomy. We believe that these findings can be applied in other proximal oste otomies besides the Ludloff osteotomy.
10 1. Mann RA, Rudicel S, Graves SC. Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. A long-term follow-up. J Bone Joint Surg Am. 1992;74: Dreeben S, Mann RA. Advanced hallux valgus deformity: long-term results utilizing the distal soft tissue procedure a nd proximal metatarsal osteotomy. Foot Ankle Int. 1996;17: Easley ME, Kiebzak GM, Davis WH, Anderson RB. Prospective, randomized comparison of proximal crescentic and proximal chevron osteotomies for correction of hallux valgus deformity. Foot Ankle Int. 1996;17: Veri JP, Pirani SP, Claridge R. Crescentic proximal metatarsal osteotomy for moderate to severe hallux valgus: a me an 12.2 year follow-up study. Foot Ankle Int. 2001;22: Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. The shape of the lateral edge of the first metatarsal h ead as a risk factor for recurrence of hallux valgus. Journal of bone and joint surgery American volume. 2007;89: Trnka HJ, Hofstaetter SG, Easley ME. Intermediate-term results of the Ludloff osteotomy in one hundred and eleven feet. Surgical technique. J Bone Joint Surg Am. 2009;91 Suppl 2 Pt 1: Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2009;91: Crevoisier X, Mouhsine E, Ortolano V, Udin B, Dutoit M. The scarf osteotomy for the treatment of hallux valgus defor mity: a review of 84 cases. Foot Ankle Int. 2001;22: Lechler P, Feldmann C, Kock FX, Schaumburger J, Grifka J, Handel M. Clinical outcome after Chevron-Akin double osteotomy versus isolated Chevron procedure: a prospective matched group analysis. Arch Orthop Trauma Surg. 2012;132: Garrido IM, Rubio ER, Bosch MN, Gonzalez MS, Paz GB, Llabres AJ. Scarf and Akin osteotomies for moderate an d severe hallux valgus: clinical and radiographic results. Foot Ankle Surg. 2008;14: Schneider W, Aigner N, Pinggera O, Knahr K. Chevron osteotomy in hallux valgus. Ten-year results of 112 cases. J Bone Joint Surg Br. 2004;86: Lee K, Seo C, Hur C, Moon E, Lee J. Outcome of proximal chevron osteotomy for hallux valgus with and without tr ansverse Kirschner wire fixation. Foot & ankle international. 2008;29:
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