Postoperative Opioid Use Is Uncommon After Third- and Fourth-Generation Percutaneous Hallux Valgus Surgery: A Prospective Single-Surgeon Case Series

Abstract

Background:

Modern percutaneous hallux valgus surgery, including the minimally invasive chevron and Akin (MICA) technique, is considered to cause less pain than traditional methods because of reduced soft tissue morbidity. Nevertheless, opioids are often prescribed postoperatively. This study investigates whether mild to moderate analgesics (World Health Organization [WHO] level 1 and 2) are sufficient for pain control following modern percutaneous hallux valgus correction.

Methods:

This prospective single-surgeon case series includes 125 consecutive feet that underwent MICA surgery between May 2018 and May 2023; 95 feet (76%) were included with ≥12-month follow-up. Data on pre- and postoperative analgesic consumption and radiologic parameters were recorded. Patient-reported analgesic consumption was collected at prespecified visits via electronic questionnaires; no pill counts were performed. The primary endpoint was the proportion of patients using any opioid by the end of postoperative week 2. Secondary outcomes included radiologic parameters and complication rates.

Results:

The mean follow-up period was 1.6 years (±0.5). Fourteen percent (95% CI 0.08-0.22) required any opioids within the first two postoperative weeks, with a mean of 23.3 morphine milligram equivalents (MME; 95% CI 9.7-37.0). Two percent (95% CI 0.01-0.07) required WHO level 3 opioids. Seventy-five percent of patients stopped taking analgesics within 3 weeks (95% CI 0.65-0.82). Significant improvements were observed in hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA).

Conclusion:

In this prospective case series within a standardized care pathway, most patients did not require opioids, and high-potency opioids were rarely used. Routine prescription of high-potency opioids after third/fourth-generation percutaneous hallux valgus correction may be unnecessary for most patients in similar settings. Hardware-related findings should be interpreted cautiously because the screw design and osteotomy technique changed during the study period, which may have confounded comparisons.

Graphical Abstract

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