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The Incidence of Complications Following Scarf Osteotomy for the Treatment of Hallux Valgus: A Systematic Review with Meta-Analysis

Published:November 26, 2022DOI:https://doi.org/10.1053/j.jfas.2022.11.017

      Abstract

      The Scarf osteotomy is a surgical procedure performed to correct a hallux valgus deformity. Multiple studies have supported use of the procedure with favorable outcomes. In contrast, there have been studies showing a significant complication rate with the procedure. Incidence of complications remains underreported in the literature. We performed a systemic review and meta-analysis examining a wide range of reported complications and associated clinical outcomes from the Scarf osteotomy. One hundred and sixteen publications were identified and twenty-five (21.6%) met our inclusion criteria. A total of 1,583 Scarf procedures were included. Weighted mean follow up was 26.4 months [Range 12–168 months]. We found a 5.1% rate of recurrence, 3.5% rate of troughing, 1.0% rate of avascular necrosis (AVN), 1.8% rate of nonunion, 2.7% rate of malunion, 2.4% rate of infection, 5.3% rate of complex regional pain syndrome (CRPS), and 3.4% rate of hallux varus. An average decrease in intermetatarsal angle (IMA) of 6.3° was observed. No statistical difference was found in outcomes when comparing Scarf vs Scarf with additional procedure performed at time of surgery. To our knowledge, this systematic review and meta-analysis contains the highest number of scarf procedures analyzed and presents complication rates on multiple adverse outcomes.

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