25-Year revision, reoperation, and complication risk following 150,000 hallux valgus bunion operations in England.
Munro J., Atife M., Hennessy C., Abram S., Brown R., Loizou C., Sharp R., Kendal A.
BACKGROUND: Hallux valgus surgery is common, with recurrence rates of 4%-78%. Further surgery is costly for individuals and healthcare systems. The study investigates revision surgery risk, further forefoot surgery and 90-day complications of hallux valgus surgery in England. METHODS: An England population study of 152,061 operations was performed using the Hospital Episode Statistics database (1998-2023). The primary outcome was Kaplan-Meier analysis of revision surgery free survival. Secondary outcomes included 90-day complication rates, mortality and long-term risk of ipsilateral forefoot surgery. Cox proportional hazard modelling was used to identify those at highest risk of further surgery. RESULTS: Revision-free survival was 93.0% at 25 years. Higher risk was seen in females (HR 1.12), white patients (HR 1.65), age 40-59 (HR 2.2), and the most deprived groups (HR 1.52). Overall, 4.6% had revision correction and 2.6% underwent fusion. CONCLUSION: Hallux valgus surgery is safe, with low revision risk and complication rates. LEVEL OF EVIDENCE: III.