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A Comparison of Postoperative Patient-reported Outcomes After Hallux Surgery With a Modified Lapidus Versus a
Benjamin J Jackson1, Heidi Ventresca, Kaleb Eaton
1From the Department of Orthopaedic Surgery, University of South Carolina School of Medicine, Columbia, SC (Jackson, Eaton, Altobello, and Gonzalez), Department of Orthopaedic Surgery, University of Louisville, Louisville, KY (Ventresca).
Background:
The modified Lapidus procedure (MLP) and metaphyseal extra-articular transverse and Akin osteotomy (META) are acceptable surgical treatment options for treating hallux valgus. The current literature is evolving when comparing the different procedures' effects on patient-reported outcomes and postoperative complications. This study aims to compare postoperative outcomes, radiographic outcomes, and patient-reported outcomes using the Patient-reported Outcome Information System for MLP and META.
Methods:
This study retrospectively reviewed patients who underwent an MLP or META for the treatment of moderate to severe hallux valgus without associated first tarsometatarsal (TMT) instability between February 2020 and February 2022. Demographic data, radiographic outcomes, and Patient-reported Outcome Information System scores, including pain interference, physical function (PF), and mobility scores, were collected. The paired Student T- test and Wilcoxon rank sum test were used to compare continuous variables and the chi-squared test for categorical variables.
Results:
A total of 145 patients were included in the study. The average follow-up for MLP and META patients was 61.3 and 52.2 weeks, respectively. META patients had significantly higher improvements in PF (5.3 vs. 2.2, P = 0.03) and mobility (5.5 vs. 2.9, P = 0.02) scores compared with MLP patients. META patients also had a significantly lower nonunion rate (2.6% vs. 14.3%, P = 0.02), implant failure rate (0% vs. 10.4%, P < 0.01), recurrence rate (0% vs. 7.4%, P = 0.02), and greater improvement in hallux valgus angle (18.6° vs. 15.8°, P = 0.03) compared with those treated with MLP.
Conclusion:
META was found to improve patient-reported outcomes markedly more than MLP, with a lower radiographic nonunion rate, implant failure rate, and recurrence rate, and higher improvement in hallux valgus angle. These findings suggest META is a viable option in patients with mild, moderate, or severe HV deformity without TMT instability.
Level Of Evidence:
III.