title: Preoperative radiological factors correlated to long-term recurrence of hallux valgus following distal chevron osteotomy.
abstract: BACKGROUND
  The purpose of this article was to analyze the long-term radiologic results after distal chevron osteotomy for hallux valgus treatment and to determine the preoperative radiographic factors correlating with radiological recurrence of the deformity.
  
  
  METHODS
  The study included 100 consecutive patients who received distal chevron osteotomy for hallux valgus. The osteotomy included fixation with an absorbable pin in 50 cases, and no fixation in the other 50. For 6 weeks postoperatively, half of each group used a soft cast and half had a traditional elastic bandage. Weight-bearing radiographs were evaluated at 6 weeks, 6 months, 1 year, and a mean of 7.9 (range, 5.8-9.4) years postoperatively.
  
  
  RESULTS
  At the final follow-up, radiological recurrence of hallux valgus deformity (HVA > 15 degrees) was observed in 56 feet (73%). Eleven feet (14%) had mild recurrence (HVA < 20 degrees), 44 (57%) moderate (20 degrees ≥ HVA < 40 degrees), and 1 (1%) severe (HVA ≥ 40 degrees). All recurrences were painless, and thus no revision surgery was required. Long-term hallux valgus recurrence was significantly affected by preoperative congruence, DMAA, sesamoid position, HVA, and I/II IMA.
  
  
  CONCLUSIONS
  Radiological recurrence of hallux valgus deformity of 15 degrees or more was very common at long-term follow-up after distal chevron osteotomy. Preoperative congruence, DMAA, sesamoid position (LaPorta), HVA, and I/II IMA significantly affected recurrence.
  
  
  METHODS
  Level III, comparative case series.
authors.affiliation: Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Pentikainen
authors.affiliation: Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
authors.forename: Risto
authors.initials: R
authors.lastname: Ojala
authors.affiliation: Department of Surgery and Anesthesiology, Oulu University Hospital, Oulu, Finland.
authors.forename: Pasi
authors.initials: P
authors.lastname: Ohtonen
authors.affiliation: Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Jouni
authors.initials: J
authors.lastname: Piippo
authors.affiliation: Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland juhana.leppilahti@ppshp.fi.
authors.forename: Juhana
authors.initials: J
authors.lastname: Leppilahti
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D001858:Bone Nails; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D009989:Orthotic Devices; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D010147:Pain Measurement; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012008:Recurrence; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hallux valgus; chevron osteotomy; congruence; distal metatarsal articular angle; sesamoid arthritis; tibial sesamoid