Traitement de l’hallux valgus par mini-chevron : résultats cliniques et radiologiques à 5,6 ans de recul

Abstract : Introduction: the aim of our study is to describe the mini-chevron technique associated with Akin osteotomy and to analyze the clinical and radiographic results at 5,6 years of average followup. Material and method: it was a retrospective single-center study of patients treated between January 2008 and December 2015 for an isolated hallux valgus by mini chevron surgery by 6 surgeons from Bordeaux University Hospital. The average age of patients was 54 years [16-79]. The data were collected prospectively during the postoperative year by the referring surgeon, and patients were reviewed in consultation between June and August 2018 by an independent reviewer for analysis at the last follow-up. The analysis was clinical (AOFAS, pain, range of motion, complications, recurrence, satisfaction) and radiographic (Inter Metatarsal Angle IMA, Hallux Valgus Angle HVA, and osteoarthritis). Results: 116 patients (139 feet, 95% women) were treated for an hallux valgus and had minimal follow-up of one year postoperatively, and 60 patients (74 feet) were reviewed at the last follow-up. The preoperative AOFAS score 66.35 +/- 7.4 [47-85] was improved at 1 year by 28.63 points (p <0.001) with a stable result at the last follow-up. The AOFAS pain was preoperatively 26.8 +/- 6, 38 +/- 4 at 1 year and 39 +/- 3.4 at the last follow-up (p <0.001). Overall articular range of motion was reduced to 1 year from 96.5 ° +/- 16.7 ° to 89.5 ° +/- 17° (p = 0.0005) but improved at the last follow-up to 103 8 ° +/- 16.9 ° (p = 0.003). The preoperative IMA was 13.4 ° +/- 2.9 ° [5-23], 7.7 ° +/- 2.1 ° [4-14] (p <0.001) at one year, and 7 ° +/- 2.7 ° [3-16] at the last follow-up (p <0.001). The preoperative HVA was 29.3 ° +/- 7.1 ° [9-50], 12.4 ° +/- 3.5 ° [5-24] at one year (p <0.001) and of 12.9 ° +/- 5.2 ° [2-30] (p <0.001) at the last follow-up. The complication rate was 27% at one year (45% of complains of hardware and removal) and 23% at the last follow-up (64.7% of metatarsalgia or second clawtoe). Osteoarthritis occurred in 8.1% of cases (6feet) and recurrence was observed in 5.4% of cases (4feet). The satisfaction score was 8,9/10 with 91% satisfied patients. Conclusion: the treatment of hallux valgus by mini Chevron is a simple, reproducible, effective technique with a significant improvement in the quality of life of patients, reliable over time, which provides significant satisfaction, with acceptable rate of complications. It is therefore a real powerful tool in the surgery of the hallux valgus.
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Master Thesis
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Marion Dias. Traitement de l’hallux valgus par mini-chevron : résultats cliniques et radiologiques à 5,6 ans de recul. Médecine humaine et pathologie. 2018. ⟨dumas-02077271⟩

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