Outcomes in chevron osteotomy for Hallux Valgus in a large cohort

Bart van Groningen; M C Marieke van der Steen; Max Reijman; Janneke Bos; Johannes G E Hendriks

doi:10.1016/j.foot.2016.09.002

Outcomes in chevron osteotomy for Hallux Valgus in a large cohort

Foot (Edinb). 2016 Dec:29:18-24. doi: 10.1016/j.foot.2016.09.002. Epub 2016 Sep 19.

Authors

Bart van Groningen¹, M C Marieke van der Steen², Max Reijman³, Janneke Bos², Johannes G E Hendriks⁴

Affiliations

¹ Orthopaedic Center Máxima, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, The Netherlands. Electronic address: b.vangroningen@mmc.nl.
² Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, The Netherlands.
³ Orthopaedic Center Máxima, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, The Netherlands.
⁴ Orthopaedic Center Máxima, Máxima Medical Center, Postbus 90052, 5600 PD Eindhoven, The Netherlands; Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Postbus 1350, 5602 ZA Eindhoven, The Netherlands.

PMID: 27888787
DOI: 10.1016/j.foot.2016.09.002

Abstract

Clinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient's point of view has mostly been conducted by means of more physician-based outcome measures. The goal of this study was to evaluate the effect of the Chevron osteotomy for hallux valgus on patients' daily lives using the Foot and Ankle Outcome Score (FAOS) as a validated and a hallux valgus specific patient reported outcome measure (PROM). Secondary outcome measures were radiological correction, complication rate, and re-operations. All 438 Chevron procedures (336 patients), at two surgical hospital sites in the period between January 2010 and October 2014, were retrospectively evaluated with a follow-up of at least 6 months. Patients were invited to fill in a cross-sectional online FAOS. For the FAOS, a total response of 60% was achieved. The FAOS ranged between 71 and 88 with a follow-up of on average 36 months. Patients with an undercorrection of their hallux valgus (11.6% of the procedures) scored significantly lower on three subscales of the FAOS (range between 61 and 77 versus 72-84). Patients who had a reoperation (12.6% of the procedures) also scored significantly lower on four subscales: 58-100 versus 73-89. Postoperative radiological measurements improved significantly with a mean difference of 6.1 (5.9; 6.4) degrees for the intermetatarsal angle and 13.7 (13.0; 14.5) degrees for the hallux valgus angle. In this large study cohort, Chevron osteotomy for hallux valgus offers good PROM scores on FAOS. These scores were significantly lower in patients with radiological undercorrection or with a reoperation. Results of the FAOS appear to modulate with physician based outcomes and therapeutic incidents. Improvement of outcome may therefore well be possible by increased attention on these surgical details.

Keywords: Chevron osteotomy; Foot and ankle outcome score; Hallux valgus; Patient reported outcome measures.

MeSH terms

Cohort Studies
Female
Follow-Up Studies
Hallux Valgus / surgery*
Humans
Male
Metatarsal Bones / surgery
Middle Aged
Osteotomy / methods*
Patient Reported Outcome Measures*
Patient Satisfaction
Postoperative Complications
Reoperation
Retrospective Studies