Minimally Invasive Hallux Valgus Surgery: Comparing Patient Outcomes Between Consultant-Led and Supervised Trainee Procedures

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Minimally invasive surgery (MIS) for hallux valgus deformity is gaining popularity due to reduced patient morbidity, shortened hospital stays, and shorter recovery times. However, the transition from traditional open surgery to MIS techniques presents a significant learning curve for surgeons and poses potential challenges in training junior surgeons. This study compared radiographic outcomes, Manchester-Oxford Foot Questionnaire (MOXFQ) scores, operative time, and complications between cases performed by a consultant experienced in MIS hallux valgus (HV) surgery versus trainees performing the same procedure under consultant supervision. Methods: We compared radiographic and prospective patient reported outcomes between 50 consecutive patients (mean age 55.3±15.6 years) who underwent MIS HV correction by a single consultant and 53 consecutive patients (mean age 60.7±15.9 years) operated on by four trainees under single consultant supervision. Primary outcomes included hallux valgus angle (HVA), intermetatarsal angle (IMA), and MOXFQ scores. Secondary outcomes included operative time and complications. Results: The consultant group showed significant mean HVA reduction from 32.0±6.7° to 8.0±3.9° (mean change 22.5±4.9°, p< 0.05) and IMA reduction from 14.0±2.4° to 4.0±1.6° (mean change 9.5±2.1°, p< 0.05). The trainee group achieved comparable significant corrections with HVA reduction from 31.4±8.2° to 10.0±5.4° (mean change 18.8±6.4°,p < 0.05) and IMA reduction from 13.8±2.2° to 6.3±2.6° (mean change 8.7±2.8°, p< 0.05). There was no statistically significant difference in radiographic outcomes or MOXFQ scores at 6 and 12 months post-operation (p>0.05). While operative time was increased in the trainee group, overall complication rates were similar, with minor variations in screw removal rates and delayed wound healing. Conclusion: Although operative time was increased in the trainee group, the comparable radiographic corrections, MOXFQ domain scores, and complication rates at 12 months suggest that MIS HV correction can be safely taught to surgical trainees in the elective foot & ankle setting under appropriate supervision.