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Published on: February 17, 2018
Percutaneous Chevron and Akin (PECA) Osteotomies for Severe Hallux Valgus Deformity With Mean 3-Year Follow-up
Thomas L Lewis1, Robbie Ray1, Peter Robinson2
1King's College Foot and Ankle Unit, King's College NHS Foundation Trust, London, United Kingdom.
Insights
Percutaneous surgery effectively corrects severe hallux valgus (HV) deformity, significantly improving radiographic measures and patient satisfaction. This minimally invasive approach offers a viable solution with low recurrence rates for complex HV cases.
Area of Science:
- Orthopedic surgery
- Foot and ankle surgery
- Minimally invasive procedures
Background:
- Severe hallux valgus presents significant surgical challenges, including high recurrence and residual deformity rates.
- Clinical and radiographic outcomes of percutaneous surgery for severe hallux valgus remain largely unknown.
Purpose of the Study:
- To evaluate the clinical and radiographic outcomes of third-generation percutaneous chevron and Akin osteotomy (PECA) for severe hallux valgus deformity.
- To assess patient satisfaction and recurrence rates following PECA surgery.
Main Methods:
- Retrospective review of 59 feet in 50 patients undergoing PECA for hallux valgus with HVA >40° or IMA >20°.
- Analysis of pre- and post-operative radiographic data (IMA, HVA) and patient-reported outcome measures.
Main Results:
- Significant improvement in both intermetatarsal angle (IMA) and hallux valgus angle (HVA) post-surgery (P < .001).
- High patient satisfaction reported, with 76.8% highly satisfied.
- Low recurrence rate of 7.5% observed over a mean follow-up of 3.1 years.
Conclusions:
- Percutaneous surgery for severe hallux valgus achieves substantial deformity correction.
- PECA surgery leads to high patient satisfaction and improved quality of life.
- The procedure demonstrates reasonable rates of residual deformity and low recurrence.
Background:
Patients with severe hallux valgus deformity present technical and operative challenges with high rates of recurrence and residual deformity. The clinical and radiologic outcomes of percutaneous surgery for severe hallux valgus are not known.
Methods:
A retrospective review of consecutive patients with a hallux valgus angle (HVA) >40 degrees or intermetatarsal angle (IMA) >20 degrees who underwent third-generation percutaneous chevron and Akin osteotomy (PECA) for hallux valgus deformity correction.
Results:
Between December 2012 and August 2019, 59 feet in 50 patients underwent PECA. Preoperative and follow-up radiographic data were available for 53 feet (89.8%). Postoperative clinical patient-reported outcome measures and satisfaction results were available for 51 feet (86.4%). The mean clinical and radiographic follow-up was 3.1 years and the mean postoperative Manchester-Oxford Foot Questionnaire Index score was 15.1. There was a statistically significant improvement (P < .001) in both IMA and HVA following surgery (IMA 17.5-5.1 degrees; HVA 44.1-11.5 degrees). All patients reported they were satisfied with their outcome, with 76.8% reporting they were highly satisfied. The hallux valgus recurrence rate was 7.5%.
Conclusion:
Percutaneous surgery for severe hallux valgus deformity can achieve a large deformity correction, patient satisfaction, and quality of life, with reasonable rates of residual deformity and low rates of recurrence.
Level Of Evidence:
Level IV, case series.
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