ABSTRACT
Introduction: Numerous minimally invasive techniques have been developed for Hallux Valgus in recent years. Third-generation Minimally Invasive Chevron Akin (MICA) osteotomy has shown promising early results, but longer-term follow-up is required to assess whether patient clinical and radiological improvement is sustained. This cohort study presents three-year follow-up outcomes for patients of a single surgeon case series. Methods: Thirty-three patients underwent third-generation MICA surgery between 2017 and 2018. Patient clinical-reported outcome measures included American Orthopaedic Foot & Ankle Society (AOFAS), Manchester-Oxford Foot Questionnaire (MOXFQ) scores, and Coughlin satisfaction. Radiographic outcomes were evaluated after a period of three years using hallux valgus angle (HVA) and inter-metatarsal angle (IMA), and compared to pre- and early post-operative outcomes. Results: At 36 months, mean AOFAS scores improved from 48.2 to 95.6, mean MOXFQ scores improved from 57.6 to 6.7. Using the Coughlin scale, 81.8% of patients rated their outcome as 'Excellent' and 18.2% as 'Good'. Radiographic outcomes showed HVA and mean IMA decreased from 34.6 degrees to 16.0 degrees and from 13.1 to 6.1, respectively at 36 months. Conclusion: Third-generation MICA demonstrates promising patient satisfaction scores post-operatively, and we have shown these improvements are sustained over a minimum three-year follow-up period. Level of Evidence: Level IV, case series.
ABSTRACT
Background Despite advancements in primary correction of hallux valgus (HV), significant rates of reoperation remain across common techniques, with complications following primary correction up to 50% according to some studies. 1 This study explored different methods of surgery currently used in treating HV recurrence specifically (for which literature on the subject has been limited), evaluating open and adapted minimally invasive surgical (MIS) primary techniques used for revision. Methods In December 2020, literature search for both open and MIS surgical techniques in HV revision was conducted using PubMed, EMBASE, and MEDLINE library databases. Results and Conclusion Of initial 143 publications, 10 were finally included for data synthesis including 273 patients and 301 feet. Out of 301 feet, 80 (26.6%) underwent revision with MIS techniques (involving distal metatarsal osteotomies). Those undergoing grouped MIS revisions had an average improvement of 38.3 in their American Orthopaedic Foot and Ankle Society score, compared to 26.8 in those using open techniques. Revision approaches using grouped MIS techniques showed a postoperative reduction in intermetatarsal angle and HV angle of 5.6 and 18.4 degrees, respectively, compared to 15.5 and 4.4 degrees, respectively, for open techniques. There are, however, limitations in the current literature on MIS techniques in revision HV surgery specifically. MIS techniques grouped did not show worse outcomes or safety concerns compared to open techniques.
ABSTRACT
Healthcare service and patient barriers contribute to low referral to and uptake of pulmonary rehabilitation (PR). Solutions should support skilled clinician-patient conversations and span primary care-PR boundaries to prevent disjointed working. http://bit.ly/2PVKHZf.
