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Outcomes After Chevron Osteotomy with and Without Additional Akin Osteotomy: A Retrospective Comparative Study
Patryk Kuliński1, Michał Rutkowski1, Łukasz Tomczyk2
1Department of Trauma and Orthopaedic Surgery, T. Marciniak Lower Silesia Specialist Hospital - Emergency Medicine Center, Fieldorfa 2, 54-049 Wroclaw, Poland.
Insights
Combining chevron and Akin osteotomies for hallux valgus surgery helps maintain lower long-term hallux valgus angles (HVA) and interphalangeal angles (IPA). This combined approach is recommended as it does not increase adjacent-joint arthritis or affect initial correction.
Area of Science:
- Orthopedic Surgery
- Foot and Ankle Surgery
- Radiographic Analysis
Background:
- Chevron osteotomy is a common surgical approach for hallux valgus correction.
- Often combined with Akin osteotomy, but guidelines for technique selection are lacking.
- Limited data exists on long-term correction stability and adjacent-joint arthritis development after first-ray surgery.
Purpose of the Study:
- To assess radiographic outcomes of chevron osteotomy with and without Akin osteotomy.
- To compare the long-term effectiveness of these surgical techniques.
Main Methods:
- Retrospective study of 117 patients (2016-2019).
- Groups: 99 patients with chevron osteotomy alone, 18 with combined chevron-Akin osteotomy.
- Radiographic parameters (IMA, HVA, IPA) assessed preoperatively, at 6 weeks, and long-term follow-up.
Main Results:
- Chevron-Akin osteotomy maintained lower long-term HVA and IPA compared to chevron alone.
- Chevron osteotomy group showed a significant increase in mean HVA over time.
- No significant differences in IMA, adjacent-joint arthritis, or complications between groups.
Conclusions:
- Combined chevron-Akin osteotomy reduces the risk of increased HVA and IPA in long-term follow-up.
- Additional Akin osteotomy does not increase adjacent-joint arthritis risk.
- Combining chevron and Akin osteotomies is recommended for hallux valgus correction.
Background:
Chevron osteotomy is one of the most common approaches to hallux valgus corrective surgery. This procedure is often combined with Akin osteotomy of the proximal phalanx of the hallux. There are no definitive guidelines specifying the indications for a given osteotomy technique nor data on postoperative loss of correction or the effect of the type of first-ray surgery on the development of adjacent-joint arthritis. The aim of this study was to assess radiographic treatment outcomes via chevron osteotomy with and without Akin osteotomy.
Methods:
The study evaluated 117 patients treated in the period 2016-2019. Ninety-nine of those patients underwent distal chevron osteotomy alone, and 18 patients underwent a combined chevron-Akin double osteotomy. The analyzed radiograms had been obtained preoperatively, at 6 weeks after surgery, and after a long-term follow-up. The following parameters were assessed: the intermetatarsal angle (IMA), hallux valgus angle (HVA), interphalangeal angle (IPA), postoperative recurrence of valgus deformity, adjacent-joint arthritis, and complications.
Results:
Chevron-Akin osteotomy helped maintain lower HVA and IPA values in long-term follow-up in comparison with those in the patients who underwent chevron osteotomy alone. The chevron osteotomy group showed a significant increase in the mean HVA from 18.37° at the first follow-up visit to 20.81° at the last follow-up visit. There were no differences between the groups in terms of the remaining assessed radiographic parameters. Hallux valgus surgery does not increase adjacent-joint arthritis.
Conclusion:
The use of combined chevron-Akin osteotomy does not affect HVA or IMA correction. The combination of chevron and Akin osteotomies reduces the risk of increased HVA and IPA in long-term follow-up. The additional Akin osteotomy does not increase the risk of adjacent-joint arthritis. Combining chevron osteotomy with Akin osteotomy is recommended in hallux valgus deformity correction.
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