Article
A comparison of long-term outcomes of hallux valgus correction – the original versus a modified Kramer osteotomy
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Authors
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Johannes Pachinger
- Kantonsspital Frauenfeld, Frauenfeld, Switzerland
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JoEllen Welter
- Kantonsspital Frauenfeld, Frauenfeld, Switzerland
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Ralph Zettl
- Kantonsspital Frauenfeld, Frauenfeld, Switzerland
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Florian Hess
- Kantonsspital Frauenfeld, Frauenfeld, Switzerland
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Christoph Knoth
- Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| Published: | October 23, 2017 |
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Outline
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Objectives: We compared clinical and radiological outcomes of the original Kramer osteotomy with a modified technique that stabilizes the metatarsal head with an angular implant - the LINK® internal hallux fixator (Waldemar LINK GmbH & Co. KG, Hamburg, Germany).
Methods: Of the 114 feet surgically treated for hallux valgus at our institution between 2004 and 2012, 72 underwent a modified Kramer osteotomy (MKO) and 42 had a Kirschner wire procedure (K-wire). The original Kramer osteotomy with a titan K-wire was performed in patients who did not require lateral release and/or had an allergy to nickel. Data from patient medical records and follow-up visits were used in the analyses.
Results: The only significant difference in patient and clinical characteristics was the median age (MKO = 54 years (IQR 45-60); K-wire = 43 years (IQR 26-53) p< 0.001). In terms of short-term outcomes (3 months postoperative), both surgical groups showed significant improvements in angle measurements (HVA, DMAA, IMA). Three cases of postoperative complications occurred in each group (p=0.422). Seventy percent of the treated feet (80/114) were available for long-term assessments at median of 5 years (IQR 5-7) for MKO and 6 years (IQR 4-9) (p=0.547). No significant loss of correction was noted in either group. Of the 80 feet assessed, 83% were considered 'successful' ( >80 AOFAS and <30 FFI), and no differences were observed between the groups (p=0.348). Multivariate logistic regression tests did not indicate significant differences in the two groups; model included variables such as age, surgical technique, and angle severity.
Conclusion: Both techniques showed similarly favorable long-term clinical and radiological results with no significant loss of correction. The modified Kramer osteotomy has a high rate of hardware removal, which should be considered preoperatively. For patients who meet the inclusion criteria, the original Kramer osteotomy is a reliable and effective treatment option for hallux valgus deformities.
