Abstract
Category:
Bunion; Other
Introduction/Purpose:
Hallux valgus is known to be more prevalent and present with greater severity in the elderly population compared to the younger age group. However, surgical treatment of hallux valgus in the elderly carries a risk of suboptimal results owing to porotic bone quality and multiple comorbidities typical of this age group. Although the third-generation minimally invasive Chevron and Akin osteotomy (MICA) technique, which features minimal soft tissue disruption and rigid internal fixation, may be an attractive option for surgical treatment of hallux valgus in the elderly, its outcomes have not been thoroughly investigated. This study sought to compare the outcomes of third-generation MICA procedures in patients aged 65 and older with those in the cohort under 65 years of age.
Methods:
In this retrospective cohort study, 76 patients (79 feet) who underwent the third generation MICA procedure for hallux valgus and were followed up for at least 1 year were stratified into 2 groups: ≥65 years old (Group 1: 36 feet) and < 65 years old (Group 2: 40 feet). Radiographic assessments included HV angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), and patient satisfaction rating. Postoperative complications, including recurrence of the deformity, reduction loss and reoperation, were assessed.
Results:
The average age at the time of surgery in group 1 was 70.9 ± 5.8 (range 65~90) years, and in group 2, 50.2 ± 2.8 (range 21~ 63), respectively. In the elderly group, Bone Mineral Density (BMD) was measured -2.9. The mean HVA, IMA and DMAA significantly improved at the final follow-up in both groups, respectively (all P < .001). Both preoperative and postoperative HVA were significantly greater in group 1 (both, P < .001), and the change of this parameter after surgery was also lower in group 1 than in group 2 (P < .001). There were significantly higher rates of reduction loss (16% vs 2.5%) and recurrence (11.1% vs 0.5%). However, clinical scores and patient satisfaction rates did not differ significantly.
Conclusion:
The present study demonstrates that chronological age, specifically categorized as 65 years or older, exhibits no substantial influence on the clinical outcomes following third-generation MICA surgery. Nevertheless, it is imperative to adequately apprise patients of the potential for reduction loss and recurrence, possibly due to age-associated bone fragility.
