Results of Hallux Valgus Surgery in Diabetic Patients With Good Glycemic Control.

BACKGROUND: Literature is sparse on whether diabetes affects outcomes of hallux valgus surgery. With the rising global prevalence of diabetes and diabetes being an independent predictor of poorer outcomes, particularly in foot and ankle surgery, we aimed to investigate the impact of diabetes on the outcomes of hallux valgus surgery. METHODS: We conducted a retrospective comparative cohort study of prospectively collected registry data of 951 feet in 721 patients who underwent surgery for symptomatic hallux valgus between 2007 and 2015 at our institution. All patients with diabetes were identified and matched with patients without diabetes for age, sex, and body mass index in a 1:2 ratio to construct the matched cohorts for analysis. Glycemic control in the diabetic cohort was assessed using preoperative HbA1c. The primary outcome measure was complication rates. Secondary outcomes were (1) deformity correction using the hallux valgus and intermetatarsal angles; (2) patient-reported outcomes using visual analog scale (VAS) for pain, Short Form-36 (SF-36) Physical and Mental Health subscales, and American Orthopaedic Foot & Ankle Society (AOFAS) scores; (3) patient satisfaction; and (4) reoperation rates up to 2 years postoperatively. Forty diabetic patients were identified and matched to 80 nondiabetic patients. Although matching was only performed for age, sex, and body mass index, the diabetic and the nondiabetic cohorts were also similar in hallux valgus severity, preoperative scores, and types of procedures performed. RESULTS: The mean preoperative HbA1c in our diabetic cohort was 7.1%. Both the diabetic and nondiabetic cohorts showed excellent AOFAS and VAS scores with no differences in degree of deformity correction, complication profiles, reoperation rates, outcome scores, and satisfaction at both 6 months and 2 years postoperatively. CONCLUSION: We believe stringent patient selection was key to reduced complication rates and good outcomes in diabetic patients. Well-selected diabetic patients remain suitable candidates for hallux valgus surgery. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Effect of Severity of Deformity on Clinical Outcomes of Scarf Osteotomies.

BACKGROUND: Literature is sparse on whether severity of hallux valgus affects outcomes of surgery. We thus aimed to evaluate the impact of hallux valgus severity on the clinical outcomes of surgery. METHODS: 83 consecutive scarf osteotomies performed by a single surgeon for symptomatic hallux valgus between 2007 and 2011 were divided into 3 groups (mild, moderate, and severe) based on severity of their preoperative hallux valgus using the hallux valgus and intermetatarsal angles. Outcomes were assessed using the visual analog scale (VAS) for pain, 36-Item Short Form Health Survey physical functioning (SFPF) and mental health (SFMH) subscales, and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores. These were assessed preoperatively and at 6 months and 2 years postoperatively. Patient satisfaction was assessed at 6 months and 2 years postoperatively. Eleven (13.2%), 54 (65.1%), and 18 (21.7%) feet were in the mild, moderate, and severe groups, respectively. RESULTS: There was no difference in preoperative VAS, SFPF, SFMH and AOFAS scores between the groups except for AOFAS scores for the second toe, which were poorer with increasing hallux valgus. Postoperatively, there was improvement across all outcome scores. VAS and AOFAS showed excellent scores, and patient satisfaction was high across all 3 groups (88.9%, 89.4%, and 86.7%). The severe group had slightly lower SFPF scores at 6 months (mild, 81.1; moderate, 84.0; severe, 74.3; P = .031) and 2 years postoperatively (mild, 93.4; moderate, 89.7; severe, 76.4; P = .005), and slightly poorer second toe scores for VAS (mild, 0.0; moderate, 0.1; severe, 1.2; P = .017) and AOFAS (mild, 94.7; moderate, 93.5; severe, 83.4; P = .043) at 2 years postoperatively. All other scores including patient satisfaction showed no between-group differences. Complication and revision rates between the groups were similar. CONCLUSION: Surgery for symptomatic hallux valgus lead to excellent outcomes and high patient satisfaction regardless of severity of deformity. LEVEL OF EVIDENCE: Level III, comparative series.

Arthroscopic debridement of the degenerative knee - Is there still a role?

OBJECTIVES: The role of arthroscopic debridement in the painful degenerative knee is controversial. Studies have shown that arthroscopic surgery for knee osteoarthritis provides no additional benefit to optimized physical and medical therapy. There are however, limited studies on the management of the subgroup of significantly symptomatic patients who remain refractory to maximal conservative treatment and are poor candidates for knee replacement surgery.We propose that with careful patient selection, arthroscopic debridement can provide good symptomatic relief with sustained benefits in the degenerative knee. METHODS: We performed a retrospective, single-surgeon study of 180 consecutive knee arthroscopies performed in 169 patients, aged 40 years and above, who had mechanical symptoms affecting their daily lives and underwent arthroscopic debridement after failure of a minimum 2 months of optimized medical and physical therapy. Severity of the knee osteoarthritis on plain radiographs was assessed using the Kellgren-Lawrence classification.Functional and satisfaction scores were assessed using Oxford Knee Score, Koos Knee Survey, Short Form-36, Numeric Pain Rating Scale, and questions adapted from the North American Spine Society Questionnaire. RESULTS: Excellent functional outcomes and patient satisfaction were reported in the majority of patients over the follow-up timeframe of 2-8 years. The mean pre-operative Kellgren-Lawrence score was 2.02 (SD 0.580). Significant improvements compared to pre-operative scores were seen across all scoring systems tested. 90% of patients reported good to excellent results. CONCLUSION: Arthroscopic knee debridement can provide good symptomatic relief and sustained benefits in significantly symptomatic patients with early degenerative knees who have failed conservative management. This is most useful in patients with mechanical symptoms secondary to degenerative meniscal tears or chondral flaps, and those with symptomatic patellofemoral osteoarthritis.