Hallux valgus

O2291 HALLUX VALGUS - IMMEDIATE OPERATION VS. ONE YEAR WAITING WITH OR WITHOUT ORTHOSES. A RANDOMIZED CONTROLLED TRIAL

Markus Torkki, Antti Malmivaara, Scppo Seitsalo, Veijo Hoikka, Pekka Laippala, Pekka Paavoiainen.

Finland

Aims: Hallux valgus operations cannot always he carried out immediately due to long waiting lists. Effect of waiting for hallux valgus surgery has not been under investigation in a randomized controlled study. Methods: 209 consecutive patients (mean age 48 years. 93% female) with a painful hallux valgus were randomi/ed in three groups: immediate operation or one year waiting time with or without foot orthoses. The follow-up period was 2 years. Main outcome measure was pain intensity during walking (VAS O to 100). Results: During the first year 64/71. 0/69 and 4/69 patients were operated in surgery, orthosis and no-orthosis groups, respectively, and during the two-year follow-up 66.43 and 48, respectively. At one-year follow-up the pain was least intensive in surgery group. At two year follow-up the pain intensity was similar in all groups. The satisfaction with treatment was the best in the surgery group and orthosis group as was the fact also with the cosmetic disturbances. The total costs of care were similar in all groups. Conclusion: Immediate operation is superior to delayed operation or foot orthoses, as the benefit from surgery is obtained already during the first follow-up year. If this, however, because of limited operative capacity is not possible, one year waiting, with or without orthois. does not jeopardize the results.

O2292 INCIDENCE OF VENOUS THROMBOSIS FOLLOWING OPERATIVE HALLUX VALGUS CORRECTIONS PROSPECTIVE. PHLEBOGRAPHIC CONTROLLED STUDY

R. Radi. N. Kastner. H. Portugaller. R. Windhager.

Department of Orthopaedic Surgery, University of Graz, Graz, Austria

Aim: The operative correction of the hallux valgus deformity is a frequently performed procedure. However, the exact rate of postoperative deep vein thrombosis is unknown. We performed a prospective, phlebographically controlled study to quantify the rate of postoperative venous thrombosis following operative hallux valgus correction and to evaluate the need of a medical thrombosis prophylaxis. Methods: Consecutive patients undergoing subcapital osteotomy of the first metatarsal bone for correction of hallux valgus deformity were included in the study. Patients with clinical or hematological risk factors for venous thrombosis were excluded from the study. One hundred patients with a mean (±SD) age of 48.9+13.9 years were operated on and they did not get a medical thrombosis prophylaxis. At a mean (±SD) of 27.8± 4.1 days postoperatively. all patients were assessed by using phlebography. Results: The rate of postoperative venous thrombosis was four percent (four patients). The mean (±SD) age of the patients in the thrombosis group was 61.7± 6,1 years and in the no thrombosis group the mean age was 48.4± 13.9 years (p=().()34). Conclusions: Patients following hallux valgus surgery are at a low risk of venous thrombosis but the need of a medical thrombosis prophylaxis should be calculated individually for each patient according to the known levels of risks. A routine thrombosis prophylaxis might be justified for patients with risk factors and particularly for patients over sixty years of age.

02293 THE EFFECT OF DIFFERENT GEOMETRIC CONFIGURATIONS OFTHE WEIL OSTEOTOMY ON PLANTAR PRESSURE IN AN IN VITRO CADAVER MODEL

E. Stamatis, J. Lau, B. Parks, L. Schon.

Union Memorial Hospital, Baltimore, Maryland, USA

Aims: To evaluate the effect of different geometric configurations of the Weil osteotomy on the plantar pressures in a dynamic in vitro cadaver model. Methods: Ten specimens consisting of 5 matched pairs of cadaver lower extremities were tested. Each pair of specimens had an oblique Weil osteotomy with 5 mm shift performed on one side, and a standard (parallel) Weil osteotomy with 5 mm shift on the other. Then, a 4 mm slice resection, and metatarsal head resection were performed sequentially on each specimen.The plantar pressures were measured while cyclically loaded to 700 N at a frequency of 1 Hz with a F scan in-shoe sensor in intact specimens, and after each intervention. Results: This is the first study to demonstrate that the plantar translation of the metatarsal head occurring with a more oblique Weil osteotomy compared to a standard (parallel) Weil osteotomy did not significantly increase plantar pressure in a dynamic in vitro cadaver model. Furthermore, the addition of a 4 mm slice resection did not significantly unload the metatarsal head. Metatarsal head resection was required to significantly unload the metatarsal head (p=0.02). Conclusions: The different geometric configurations of the Weil osteotomy did not significantly alter plantar pressures in a dynamic cadaver model. Metatarsal head resection was required to significantly unload the metatarsal head. Future studies of the effect of metatarsal osteotomies on plantar pressure should include evaluation in a dynamic in vitrocadaver model to account for all factors, which determine the distribution of plantar pressure.

02294 HALLUX VALGUS: EXCISION ARTHROPLASTY OR DISTAL OSTEOTOMY!

Tavakkolizadeh Adel. A.N. Murty. Dasari Kishore, Sait Suhaib, A. Addisson

Aims:To compare the results of Keller's excision arthroplasty with those of distal osteotomy for hallux valgus in patients less than 55 years of age. Patients and Methods: 20 consecutive patients less than 55 years of age with hallux valgus who had undergone unilateral Keller's excision arthroplasty were individually matched for age and sex with 20 patients who had undergone distal metatarsal osteotomy. The patients were reviewed for the purpose of this study. The review process included self assessment using foot function index. Hallux metatarsal function index and general health assessment using SF36, patients subjective rating of the result, dynamic foot pressure measurements using F-scan. Standing AP radiographs of both feet were also taken at the review. The results were compared within the two groups and the results statistically analysed. Results: The mean age of the patients in osteotomy group was 44 yrs and that in Kellers group was 44.5 yrs.The sex ratio was 16:4 (M:F) in both groups. The average follow up was 30 months in osteotomy group compared with 38 months in Keller's group. The mean Foot function index score was 3 ± 4 in osteotomy group. The hallux metatarsa! score was 93 ± 13. In the Kellers group the scores were 24±33 and 80 ±22 respectively. The difference was statistically significant. (Paired T test two tailed p

O2295 HALLUX VALGUS-TREATMENT ALGORITHM: IS THE RADIOGRAPHIC ASSESSMENTRELIABLE?

A.S. Aster. M.C. Forster, R. Rajan, K.J. Patel, R. Asirvatham.

Lincoln County Hospital, Lincoln, UK

Aims: To assess the reliability and repeatability of the five described methods of measuring hallux valgus (HVA) and intermetatarsal angles (IMA).The diagnosis of congruency of first MTP joint was also assessed. Methods: Five Orthopaedic staff analysed 50 pre-operative standing foot radiographs on two occasions. ANOVA was used to examine the difference between the five methods and between the five observers, for both IMA and HVA. Kappa test was used to measure agreement in diagnosing congruency between two occasions. Results: The mean IMA and HVA varied significantly between some of the methods (p

O2296THE LUDLOFF OSTEOTOMY FOR HALLUX VALGUS CORRECTION. 2 TO 4 YEAR FOLLOW UP

H.-J. Trnka, F. Gruber, R. Jankovsky, F. Machacek, P. Ritschl.

Orthopaedic Hospital Gersthof, Vienna

Aims: The aim of this prospective study was to analyse the Ludloff osteotomy for its potential of correcting hallux valgus deformity. Methods: Between September 1998 and October 1999 84 consecutive patients who underwent a Ludloff osteotomy were included in this prospective study. All patients were examined preoperatively and at a minimum follow up of 2 years according a standardized questionnaire based on the HMIS of the American Foot and Ankle Society. X-rays were taken preoperatively, at 6 weeks and at final follow up. Results: 75 patients were available for an average follow up of 33 months (24 to 41). The average preoperative HMIS was 52 points and at follow up 87 points. 78% of the patients rated the outcome as excellent and good. 82% of patients were painfree at follow up. Radiological evaluation revealed a preoperative average hallux valgus angle (HV) of 36° and a preoperative average intermetatarsal angle (IM) of 17°This was corrected by surgery to an average HV of 14° and an average IM of 8°. Preoperatively sesamoidposition Grade III was present I 71%. Garde II in 29%. At follow up Grade O was present in 60%m Grade 1 in 37% and Grade2 in 3%. ' There was no Grade 3 sesamoid position at follow up. Conclusions: The ludloff osteotomy is a good alternative for the correction of severe hallux valgus deformity. In elderly patients and osteoporotic bone early weightbearing should not be allowed because of poor bone quality.

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