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
< 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.
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 9-12. We investigated the effect of such combined procedures on the outc omes and recurrence of hallux valgus after Ludloff osteotomy.
84 patients (103 feet) had received Ludloff osteotomy combined wit h additional procedures between June 2005 and May 2010. 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.
AOFAS score p=0.231 p=0.212 89.7 88.4 91.6 53.1 51.6 52.4 I VAS Preop p=0.123 Follow-up 5.6 5.8 6.1 p=0.312 0.7 0.9 0.8 I Preop Follow-up
Effect of Akin osteotomy - vs II HVA correction( ) 27.6 22.7 21.8 16.8 IMA correction( ) 6.8 6 8.6 7.8 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( ) 31.7 27.6 22.7 23.3 I IMA correction( ) 11.9 8.7 7.8 6 I Moderate Severe Moderate Severe (P=0.854) (P=0.039) (P=0.016) (P=0.001)
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)
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%) 0.129 Moderate 7(6.8%) 4(12.9%) 2(5.7%) 1(2.7%) 0.264 Severe 9(8.7%) 4(12.9%) 3(8.6%) 2(5.4%) 0.474 Predictors for recurrence OR p Value 95% CI preop. HVA 2.20 0.001 1.11 4.73 additional K-wire 5.05 0.032 1.21 24.39
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.
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