Comparing The Midterm Outcomes Of Midfoot Japas Osteotomy And First Ray Osteotomy For The Treatment Of Cavovarus Deformity In Children

Objective:To compare the clinical outcome of two different surgical methods,Japas osteotomy and first ray osteotomy,in the treatment of cavovarus deformity in children.Methods:Retrospective analysis was performed on the clinical outcome of 80 cases of cavovarus deformities from January 2012 to Deceber 2019.30 cases of mild and moderate cavovarus deformity underwent osteotomy based on soft tissue release.Among them,16 cases of 22 feet underwent first ray osteotomy and 14 cases of 21 feet underwent midfoot Japas osteotomy.The ankle-posterior foot(Wicart)scoring system was used to evaluate the excellent and good rates of the two surgical methods.The standing bearing position X-ray films were taken before and at the last follow-up after surgery,and the Meary,Hibb and Pitch Angle were measured to compare the clinical outcome of the two surgical methods in the correction of mild and moderate cavovarus deformity.Result:(1)All patients were followed up for an average of 30 months.There was no statistical significance in the comparison of the Meary,Hibb and Pitch Angle between first ray osteotomy and midfoot Japas osteotomy,indicating that the two groups had similar deformities.(2)Compared with Meary,Hibb and Pitch Angle in the last follow-up of the two groups,the P>0.05 showed no statistical significance,indicating that the two surgical methods had similar effect on the correction of deformities.(3)The excellent and good rates of Wicart score in the last follow-up were 87% in the first ray osteotomy,90% in the midfoot Japas osteotomy.Fisher’s test P >0.05 indicated that the excellent and good rates of the two treatments were similar,and the difference was not statistically significant.(4)The difference in operative time and intraoperative blood loss between the two groups was statistically significant(P>0.05),indicating that the first ray osteotomy had significant advantages in operative time and intraoperative blood loss compared with the midfoot Japas osteotomy.Conclusion:In this study,there was no significant difference between the first ray osteotomy and the midfoot Japas osteotomy,in the postoperative outcomes of mild to moderate cavovarus deformities with the deformity apex located at the medial cuneiform or naviculocuneiform joint.However,the amount of intraoperative blood loss and operation time of the first ray osteotomy were better than that of the midfoot Japas osteotomy.Therefore,the first ray osteotomy could be considered as the surgical osteotomy plan.