25-Year revision, reoperation, and complication risk following 150,000 hallux valgus bunion operations in England.

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.