Relevancy Grading of Outcome-Predicting Factors After Distal Chevron Osteotomy for Hallux Valgus Correction.

Background: The purpose of this study was to identify radiographic risk factors for loss of correction (LOC) after hallux valgus surgery and to weight their importance for LOC.

Methods: We retrospectively assessed the radiographs of 1,082 consecutive chevron osteotomy cases regarding early LOC from initially postoperative to 6 and 12 weeks postoperative. The influence of preoperative and postoperative radiographic parameters on LOC of the hallux valgus angle (HVA) and the intermetatarsal 1-2 angle (IMA) was evaluated using nonparametric Spearman rank correlations and multiple linear regression analyses.

Results: Mean ± SD LOC from initially postoperative to 6 and 12 weeks postoperative were 1.4° ± 2.7° and 3.4° ± 2.6° for the IMA and 3.5° ± 5.4° and 7.6° ± 5.6° for the HVA, respectively. Significant correlations were found between LOC of the HVA or IMA for preoperative IMA, HVA, distal metatarsal articular angle, proximal to distal phalangeal articular angle (PDPAA), and joint congruity as well as for postoperative IMA, HVA, PDPAA, joint congruity, and sesamoid position. Categorization of outcome-predicting postoperative radiographic factors revealed the following parameters to be important, in descending order: HVA, sesamoid position, IMA, PDPAA, and joint congruity.

Conclusions: Multiple preoperative and postoperative radiographic parameters correlate with early LOC after hallux valgus surgery. Relevancy grading revealed the postoperative HVA and sesamoid position to be the most important parameters, followed by the IMA, PDPAA, and joint congruity. Consequently, total deformity correction, taking all aspects of the hallux valgus deformity into account, seems reasonable.