Percutaneous Chevron/Akin (PECA) versus open scarf/Akin (SA) osteotomy treatment for hallux valgus: A systematic review and meta-analysis

Abstract

Purpose: The objective of the study is to compare the radiographic and clinical results of two techniques for the treatment of hallux valgus that have the same indication, the open scarf/Akin (SA) technique and the percutaneous Chevron/Akin (PECA).

Methods: A meta-analysis was performed with the studies found during a systematic review of articles included in electronic databases until 30 May 2020. The pooled analysis was summarized according to clinical outcomes, such as visual analog pain scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) score, radiographic outcomes and complications, with a 95% confidence interval.

Results: Three studies comparing the open scarf/Akin (SA) versus the PECA techniques were added to the analysis, corresponding to 235 feet, 102 in the PECA group and 133 in the SA. The final mean difference in the hallux valgus angle was 0.80 degrees and in the intermetatarsal angle 0.53, in the last radiographic evaluation. In the AOFAS score, the final mean difference was 4.97 points and in the VAS 0.14 in relation to the last clinical evaluation. Exposure to radiation during the surgical procedure was higher in the PECA group with a mean of 35.53 seconds.

Conclusions: The PECA surgical technique for the treatment of hallux valgus when compared with SA demonstrated similar radiographic correction, pain and function after six months of follow-up but with a longer radiation exposure time.

Register of systematic review (prospero): CRD42018096613.

Fig 1. PRISMA flowchart of the literature search and study selection.

Fig 2. Forest plot of the meta-analysis of the studies evaluating the final radiographic difference in the HVA.

Fig 3. Forest plot of the meta-analysis of the studies evaluating the final radiographic difference in the IMA.

Fig 4. Forest plot of the meta-analysis of the studies evaluating the difference in the AOFAS score at six months postoperatively.

Fig 5. Forest plot of the meta-analysis of the studies evaluating the difference in the visual analog pain scale score at one day postoperatively.

Fig 6. Forest plot of the meta-analysis of the studies evaluating the difference in the visual analog pain scale score at the last clinical evaluation.

Fig 7. Forest plot of the meta-analysis of the studies evaluating the relative risk of complications.

Fig 8. Forest plot of the meta-analysis of the studies evaluating the difference in exposure to intraoperative radiation between the types of surgical procedures.