Study On The Correlation Of Recurrence After Scarf Osteotomy Combined With McBride Procedure For Moderate & Severe Hallux Valgus And The Severity Of Flatfoot

Objective The recurrence of hallux valgus deformity is one of the common complications after orthopedic surgery.The factors causing the recurrence of hallux valgus are complicated,such as failure to correct the real underlying pathogenesis of hallux valgus,failure of postoperative internal fixation,lack of experience of surgeons and improper surgical selection.This paper mainly discussed whether the severity of hallux valgus and concomitant flatfoot will affect the recurrence rate of deformity after scarf osteotomy combined with McBride operation to correct moderate and severe hallux valgus.Methods 56 patients(57 feet)with moderate or severe hallux valgus surgery who met the researchful requirements in the Department of orthopaedic trauma of the northern theater general hospital from January 2014 to December 2019 were selected for retrospective analysis.All patients underwent Scarf combined with McBride osteotomy.The hallux valgus angle(HVA),the first and second intermetatarsal angle(IMA)and the distal metatarsal angle(DMAA)of each patient were measured and recorded by two orthopedic surgeons according to the imaging examination.At the same time,the degree of the first metatarsal angle of the talus was measured and recorded to evaluate the severity of flatfoot.SPSS 21.0 statistical program was used to analyze the available information collected.Result (1)There were 56 patients in our research,including 57 feet,35 feet were female and 22 feet were male.There are 1.59 times as many women as men.The age ranged from 21 years to 74 years,with an average of(49.18 ± 15.49)years old.During the follow-up period from 6 weeks to 12 months after operation,7 feet recurred(HVA > 15 °),and 1 foot was reoperated,the total recurrence rate was 12.28%;(2)preoperative HVA greater than 45 degree was significantly correlated with the increased recurrence rate of moderate to severe hallux valgus(P < 0.05).3 months after operation,the HVA and DMAA of the two groups were significantly different(P < 0.05).At 6months after operation,the two groups’ HVA,IMA and DMAA had no differ significantly(P < 0.05).After 1 year,the recrudescent category’s HVA,IMA and DMAA were visibly higher,and the differences of imaging indexes between the groups were statistically significant(P < 0.05).Through the comparative analysis of imaging indexes in the two groups,we noticed that HVA increased significantly from 6 weeks to 6months after operation(P < 0.05).After 6 months,there was no clear discrepancy(P >0.05),but there was no significant difference in IMA and DMAA in different periods(P > 0.05);(3)among all the feet,35 feet had no flatfoot,12 feet were mild flatfoot,and10 feet were moderate and severe flatfoot.In the no flatfoot group,one foot recurred,the recurrence rate was 2.86%.Two patients with mild flatfoot recurred,the recurrence rate was 25%.In moderate and severe flatfoot group,4 feet recurred,the rate of recurrence was 30%.Dring the 6 months postoperation,there were distinct discrepancies in HVA and IMA among 3 categories(P < 0.05).At 1 year postoperation,HVA,IMA,DMAA of the three groups were statistically significant(P < 0.05).Fisher exact test was employed to analyze the relevance between the severity of flatfoot and postoperative recurrence of hallux valgus.The results demonstrated the recurrence rate of malformation in mild flatfoot category and moderate severe flatfoot category was visibly higher than that in normal category(P < 0.05).And there was no distinct discrepancy between mild flatfoot category and moderate severe flatfoot category(P >0.05).Conclusions (1)for patients who undergoing Scarf osteotomy combined with McBride operation,HVA will have different degrees of correction loss in 6 months after operation,and the amount of correction loss is related to the severity of flatfoot before operation.If there is no significant progress in HVA during this period,the recurrence rate of postoperative deformity will be significantly reduced;(2)for the patients with moderate or severe hallux valgus combined with flatfoot,the recurrence rate of hallux valgus deformity was significantly higher than the patients without flatfoot;(3)the difference of halluxvalgus’ recurrence rate which between patients with mild flatfoot and moderate to severe flatfoot after the treatment of scarf osteotomy combined with McBride operation is not the same.