Demineralized Bone Matrix Fiber Allograft Augmentation in Minimally Invasive Hallux Valgus Surgery

Abstract

Background:

Minimally invasive surgery (MIS) for hallux valgus correction has demonstrated excellent clinical and radiographic outcomes. However, there are occasions where there is limited bone formation and remodelling despite successful union. This study investigated whether demineralised bone matrix fibre allograft augmentation could be associated with greater radiographic bone formation compared with standard percutaneous technique.

Methods:

A retrospective comparative study of patients undergoing fourth-generation percutaneous hallux valgus correction with demineralised bone matrix fibre allograft augmentation (DBM group) or without (NDBM group). Primary outcome was radiographic healing assessed at 6 weeks, 3 months, and 6 months using a validated classification system. Secondary outcomes included patient-reported outcome measures (Manchester-Oxford Foot Questionnaire [MOXFQ], EuroQol 5-dimension, 5-level [EQ-5D-5L], visual analogue scale [VAS] Pain), and radiographic parameters (intermetatarsal angle, hallux valgus angle).

Results:

Between September 2022 and July 2024, a total of 215 patients (191 female; 24 male; 316 feet) underwent fourth-generation percutaneous metatarsal extra-capsular transverse osteotomy for hallux valgus correction. Patients were divided into 2 groups: DBM, 222 feet; and NDBM, 94 feet. Radiographic follow-up was available for 75.2% (167 feet) of DBM and 79.8% (75 feet) of NDBM cases. The DBM group showed significantly improved radiographic union scores at 3 and 6 months (P = .005-.027) but not 6 weeks (P = .06). There were no significant differences between groups in terms of final patient-reported outcome measures or radiographic deformity correction (P > .05). Multivariable regression analysis adjusting for baseline confounders found that DBM was associated with a statistically but not clinically significant improvement in patient-reported outcome measures (PROMs; based on the minimal clinically important difference); however, PROM findings should be interpreted cautiously, given baseline imbalance and approximately 50% loss to follow-up. The additional cost of bone graft augmentation was USD$1780 per procedure.

Conclusion:

The addition of demineralised bone matrix fibre allograft to the lateral healing zone, was associated with higher radiographic healing scores and a greater proportion classified radiographically as united at scheduled time points following percutaneous hallux valgus surgery. Future studies should investigate whether other biological adjuncts could further optimize healing in specific patient populations or identify those that may not demonstrate bony remodelling.