Radiographic Correction after Hallux Valgus Surgery: A Meta-analysis

CATEGORY: Bunion; Midfoot/Forefoot INTRODUCTION/PURPOSE: There are over 100 different means by which to surgically correct hallux valgus. None have been proven to be more effective in radiographic correction over another. Frequently, recurrence is noted. There has been no large-scale meta-analysis of studies reporting radiographic outcomes of surgical treatment for hallux valgus deformity. The purpose of the meta-analysis was to pool data to see if certain osteotomies have higher complication or recurrence rates. METHODS: We performed a meta-analysis of studies reporting the radiographic outcomes of surgical correction for hallux valgus deformity. We pooled the data of 287 studies since 1980 that met our inclusion criteria. We divided the surgical procedures into proximal-based osteotomies (PB, n=2047), shaft-based (SB, n=1569), and distal-based (DB, n=7835). We calculated the hallux valgus angle (HVA) and intermetatarsal angle (IMA) correction as well as metatarsal shortening, recurrence, and hallux varus after surgery. ANOVA analysis was used to compare the means among the groups. RESULTS: A total of 287 treatment studies met the inclusion criteria. The pooled rates of HVA correction between the PB, SB, and DB were: 20.7, 20, and 16.8 degrees respectively (p=.0004). The pooled rates of IMA correction between the PB, SB, and DB were: 8.5, 7.3, and 6.0 degrees respectively (p<.0001).There was a significant difference among the groups with the development of hallux varus (p=.003) and with metatarsal shortening (p=.025). There was no difference in the rate of recurrence. CONCLUSION: Despite the large pooling of data, no consistent superiority of any corrective osteotomy stood out. Fortunately, there is no difference in the recurrence rate among the osteotomies. Further randomized studies could help elucidate the best surgery for each patient.