Percutaneous hallux valgus treatment: Unilaterally or bilaterally
Introduction
Minimally invasive hallux valgus techniques include arthroscopy, percutaneous and mini- incision osteotomies. The percutaneous surgery is a minimally invasive technique that consists of performing osteotomies, exostosectomies and soft tissues release through mini-incisions (1–3 mm long), under intra-operative fluoroscopy (Fig. 1), using a mini-blade and specific power rotatory burrs. [1], [2], [3], [4]. The stabilization is done with screws and/or with the dressing and taping.
The technique described in M. De Prado's book [1] recommends operating only one foot at a time. Currently, there is no consensus regarding the use of bilateral simultaneous percutaneous surgery for the Hallux valgus correction. Limited research is available comparing the outcomes of simultaneous bilateral versus unilateral foot surgery [5], [6]. Furthermore, there are no published studies evaluating this issue concerning percutaneous surgery.
The aim of this study was to evaluate whether there is a difference between the results of patients that have been percutaneously operated on one foot and those operated on both feet at the same surgical time for mild to moderate Hallux valgus correction.
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Material and methods
We retrospectively evaluated 93 feet, in 61 patients, operated between December 2005 and March 2009 using percutaneous surgery for mild to moderate Hallux valgus treatment. The patients were operated in the same Hospital, 29 patients (group I) unilaterally and 32 patients (group II) bilaterally at the same surgical time, by three surgeons from the same foot and ankle unit. All patients had symptomatic Hallux valgus with no response to conservative treatment and there had been no previous
Results
The mean follow-up was 24.0 months (6–43) in group I, and 28.0 months (4–42) in group II. The average postoperative AOFAS score was 86.8 (29–100); 82.9 (29–100) in group I and 88.6 (40–100) in group II (p > 0,05) (Table 1). 90.3% of the cases were satisfied or very satisfied – 90.6% in group I, and 89.7% in group II (p > 0.05). (Table 1).
Radiological evaluation showed a significant correction of all the three angles, similar in both groups There was no statistically significant difference (p > 0,05)
Discussion
Many studies have evaluated bilateral versus unilateral surgery in large joints, but limited research is available comparing the outcomes of bilateral foot surgery versus unilateral foot surgery [5], [6]. There are some articles about mini-incision distal osteotomies of M1, namely the Bosch technique [13] and the Magnan osteotomy [14], [15], advocating good results with bilateral surgery. However there is no consensus regarding simultaneous bilateral correction of mild to moderate Hallux valgus
Conclusion
The similar results obtained on both groups suggest that the simultaneous bilateral percutaneous surgery gives equivalent results to the unilateral, which has an important socioeconomic impact since there is only one recovery time for both feet. Further research is needed.
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