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Scarf osteotomy as a salvage procedure for treatment of recurrent hallux valgus deformity
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Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
152 Scarf osteotomy as a salvage procedure for treatment of recurrent hallux valgus deformity J. Kane 1,∗ , R. Lewis 2 , H. Gotha 3 , D. Myer 4 , J. Brodsky 1 1
Baylor University Medical Center, United States Univerity of Texas Southwestern, United States 3 First State Orthopedics of Delaware, United States 4 OrthoIndy, United States 2
Introduction: Symptomatic recurrence is a known complication following bunionectomy. Rates of recurrence have been reported to be as high as 16%. No consensus regarding optimal surgical management exists. Few have investigated the efficacy of proximal first metatarsal scarf osteotomy for recurrent hallux valgus (rHV). We examine radiographic and clinical outcomes of scarf as salvage for rHV, compared to a cohort of primary scarf osteotomies. Methods: 41 consecutive patients undergoing scarf for rHV and 94 consecutive primary scarfs were retrospectively compared. Demographics, preoperative/postoperative radiographs (HVA/IMA/DMAA/HVIP/sesamoid station/1st MTP joint congruency), preoperative/postoperative patient reported outcomes (PROs) (VAS/AOFAS hallux score/SF36 score), perioperative complications, recurrence, iatrogenic hallux varus necessitating 1st MTP fusion were recorded. Multivariate analysis was conducted to detect statistically significant differences (p < 0.05). Results: Demographics between the groups were similar. Length of follow-up was greater after revision scarfs (p < 0.00001). Statistically significant differences were detected in HVA/DMAA/HVIP between cohorts. No preoperative/postoperative differences in PROs were detected. Both groups had statistically/clinically significant improvements in VAS/AOFAS scores. A statistically significant difference in the rate of subsequent first MTP fusion existed (12.2% revision; 1.06% primary; p = 0.004). Discussion: Revision bunionectomy with scarf results in similar improvements in PROs and radiographic correction for hallux valgus. Similar complication rates existed. The exception was recurrent deformity which was higher after revision surgery. In recurrent bunions, DMAA was higher preoperatively trending towards a greater rate of preoperative joint congruency. This suggests recurrence is a result of first metatarsal malunion. Additionally, less increase in HVIP after revision surgery suggests that most of the recurrent deformity was in a single plane. http://dx.doi.org/10.1016/j.fas.2017.07.241
153 Subsidence of TAA associated with deterioration of ankle scale only in non-inflammatory arthritis H. Ito 1,∗ , I. Takahiro 2 , M. Furu 1 , M. Ishikawa 1 , M. Azukizawa 1 , S. Matsuda 1 1 2
Kyoto University, Japan Takayama Redcross Hospital, Japan
Background: There have been few reports regarding radiographic measurements to detect worsening of clinical symptoms in total ankle arthroplasty (TAA), and the differences between noninflammatory arthritis (NA) and rheumatoid arthritis (RA). Aims: To compare clinical and radiographic outcomes of TAA between NA and RA.
Methods: We conducted a comparative study in a prospective TAA cohort in our institution. After exclusion of revision cases and cases with 2-component system from 35 TAA, 26 cases were eligible for further analyses. The average age at the time of surgery was 65.0, and the mean follow-up period was 4.0 years. All of these patients underwent primary TAA with a single 3-component system (FINE total ankle system, Nakashima Medical Co., Japan). Clinical outcomes and radiological measurements were compared. Results: The Japanese Society for Surgery of the Foot scale (JSSF scale) significantly improved after operation both in RA (n = 14) and NA (n = 12) cases. TLS angle improved after surgery while TAS angle did not. Significant tibia and talus subsidence of the implant were found at the time of the follow-up in both. However, the subsidence was significantly associated with deterioration of JSSF scale in NA cases, while that was not in RA cases. Conclusion: TAA improved symptoms, function and radiological measurements both in NA and RA cases. Subsidence of implants was associated with deterioration of clinical scale in NA, but not necessarily in RA. http://dx.doi.org/10.1016/j.fas.2017.07.242
154 Are patients undergone medial displacement calcaneal osteotomy with flexor digitorum longus transfer able to return to sports C.A. Di Silvestri 1,∗ , R. D’Ambrosi 1 , C. Maccario 1 , E.W. Tan 2 , F.G. Usuelli 1 1 IRCCS Galeazzi Milano, Università degli Studi di Catania, Italy 2 Department of Orthopaedic Surgery-Keck Medicine of USC, United States
Introduction: Gold standard in treatment of adult flatfoot due to posterior tibial tendon dysfunction is nowadays medial displacement calcaneal osteotomy with flexor digitorum longus transfer. Purpose of this study was to assess if patients undergone medial displacement calcaneal osteotomy with flexor digitorum longus transfer can practice sports. Methods: 48 patients (21 men, 43.75%; 27 women, 56.25%), mean age at time of surgery of 42.3 years (range 19–74 years), were reviewed with a medium follow-up of 30 months (range, 27–34 months). Pre- and post-operatively, each patient was evaluated clinically and by standard weight-bearing X-rays (antero-posterior, lateral and Saltzman 20◦ views). Moreover, everyone’s sporting activities and Sports Athlete Foot and Ankle Score (SAFAS) were collected. Results: Before surgery, 29 of 48 (60.4%) patients practiced sports, spending an average of 1.4 h/week (range, 0–6 h/week); after surgery, 40/48 (83.3%) practiced sports with an average of 3.5 h/week (range, 0–15 h/week). Both measured angle parameters showed to significantly improve (p < 0.01): Meary’s angle decrease from 11.3 ± 6.3◦ to 7.2 ± 5.5◦ ; calcaneal pitch improved from 16.1 ± 4.3◦ to 19.4 ± 4.8◦ . SAFAS scores showed satisfactory outcomes in every section: symptoms tolerance (85.90%), pain tolerance (88.30%), daily living performance (96.2%), sports (86.45%). Conclusion: Results of our study showed that after medial displacement calcaneal osteotomy and flexor digitorum longus transfer, patients affected by adult flatfoot associated with posterior tibial tendon dysfunction can return to practice sport activities, with an average increase of number of activities and of hours spent for patient. http://dx.doi.org/10.1016/j.fas.2017.07.243
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
152 Scarf osteotomy as a salvage procedure for treatment of recurrent hallux valgus deformity J. Kane 1,∗ , R. Lewis 2 , H. Gotha 3 , D. Myer 4 , J. Brodsky 1 1
Baylor University Medical Center, United States Univerity of Texas Southwestern, United States 3 First State Orthopedics of Delaware, United States 4 OrthoIndy, United States 2
Introduction: Symptomatic recurrence is a known complication following bunionectomy. Rates of recurrence have been reported to be as high as 16%. No consensus regarding optimal surgical management exists. Few have investigated the efficacy of proximal first metatarsal scarf osteotomy for recurrent hallux valgus (rHV). We examine radiographic and clinical outcomes of scarf as salvage for rHV, compared to a cohort of primary scarf osteotomies. Methods: 41 consecutive patients undergoing scarf for rHV and 94 consecutive primary scarfs were retrospectively compared. Demographics, preoperative/postoperative radiographs (HVA/IMA/DMAA/HVIP/sesamoid station/1st MTP joint congruency), preoperative/postoperative patient reported outcomes (PROs) (VAS/AOFAS hallux score/SF36 score), perioperative complications, recurrence, iatrogenic hallux varus necessitating 1st MTP fusion were recorded. Multivariate analysis was conducted to detect statistically significant differences (p < 0.05). Results: Demographics between the groups were similar. Length of follow-up was greater after revision scarfs (p < 0.00001). Statistically significant differences were detected in HVA/DMAA/HVIP between cohorts. No preoperative/postoperative differences in PROs were detected. Both groups had statistically/clinically significant improvements in VAS/AOFAS scores. A statistically significant difference in the rate of subsequent first MTP fusion existed (12.2% revision; 1.06% primary; p = 0.004). Discussion: Revision bunionectomy with scarf results in similar improvements in PROs and radiographic correction for hallux valgus. Similar complication rates existed. The exception was recurrent deformity which was higher after revision surgery. In recurrent bunions, DMAA was higher preoperatively trending towards a greater rate of preoperative joint congruency. This suggests recurrence is a result of first metatarsal malunion. Additionally, less increase in HVIP after revision surgery suggests that most of the recurrent deformity was in a single plane. http://dx.doi.org/10.1016/j.fas.2017.07.241
153 Subsidence of TAA associated with deterioration of ankle scale only in non-inflammatory arthritis H. Ito 1,∗ , I. Takahiro 2 , M. Furu 1 , M. Ishikawa 1 , M. Azukizawa 1 , S. Matsuda 1 1 2
Kyoto University, Japan Takayama Redcross Hospital, Japan
Background: There have been few reports regarding radiographic measurements to detect worsening of clinical symptoms in total ankle arthroplasty (TAA), and the differences between noninflammatory arthritis (NA) and rheumatoid arthritis (RA). Aims: To compare clinical and radiographic outcomes of TAA between NA and RA.
Methods: We conducted a comparative study in a prospective TAA cohort in our institution. After exclusion of revision cases and cases with 2-component system from 35 TAA, 26 cases were eligible for further analyses. The average age at the time of surgery was 65.0, and the mean follow-up period was 4.0 years. All of these patients underwent primary TAA with a single 3-component system (FINE total ankle system, Nakashima Medical Co., Japan). Clinical outcomes and radiological measurements were compared. Results: The Japanese Society for Surgery of the Foot scale (JSSF scale) significantly improved after operation both in RA (n = 14) and NA (n = 12) cases. TLS angle improved after surgery while TAS angle did not. Significant tibia and talus subsidence of the implant were found at the time of the follow-up in both. However, the subsidence was significantly associated with deterioration of JSSF scale in NA cases, while that was not in RA cases. Conclusion: TAA improved symptoms, function and radiological measurements both in NA and RA cases. Subsidence of implants was associated with deterioration of clinical scale in NA, but not necessarily in RA. http://dx.doi.org/10.1016/j.fas.2017.07.242
154 Are patients undergone medial displacement calcaneal osteotomy with flexor digitorum longus transfer able to return to sports C.A. Di Silvestri 1,∗ , R. D’Ambrosi 1 , C. Maccario 1 , E.W. Tan 2 , F.G. Usuelli 1 1 IRCCS Galeazzi Milano, Università degli Studi di Catania, Italy 2 Department of Orthopaedic Surgery-Keck Medicine of USC, United States
Introduction: Gold standard in treatment of adult flatfoot due to posterior tibial tendon dysfunction is nowadays medial displacement calcaneal osteotomy with flexor digitorum longus transfer. Purpose of this study was to assess if patients undergone medial displacement calcaneal osteotomy with flexor digitorum longus transfer can practice sports. Methods: 48 patients (21 men, 43.75%; 27 women, 56.25%), mean age at time of surgery of 42.3 years (range 19–74 years), were reviewed with a medium follow-up of 30 months (range, 27–34 months). Pre- and post-operatively, each patient was evaluated clinically and by standard weight-bearing X-rays (antero-posterior, lateral and Saltzman 20◦ views). Moreover, everyone’s sporting activities and Sports Athlete Foot and Ankle Score (SAFAS) were collected. Results: Before surgery, 29 of 48 (60.4%) patients practiced sports, spending an average of 1.4 h/week (range, 0–6 h/week); after surgery, 40/48 (83.3%) practiced sports with an average of 3.5 h/week (range, 0–15 h/week). Both measured angle parameters showed to significantly improve (p < 0.01): Meary’s angle decrease from 11.3 ± 6.3◦ to 7.2 ± 5.5◦ ; calcaneal pitch improved from 16.1 ± 4.3◦ to 19.4 ± 4.8◦ . SAFAS scores showed satisfactory outcomes in every section: symptoms tolerance (85.90%), pain tolerance (88.30%), daily living performance (96.2%), sports (86.45%). Conclusion: Results of our study showed that after medial displacement calcaneal osteotomy and flexor digitorum longus transfer, patients affected by adult flatfoot associated with posterior tibial tendon dysfunction can return to practice sport activities, with an average increase of number of activities and of hours spent for patient. http://dx.doi.org/10.1016/j.fas.2017.07.243