04/15/2021    Burton J. Katzen, DPM

RE: MIS Bunion Surgery Leads to Faster Recovery: IL Podiatrist (Michael Loshigian, DPM)

In response to Dr. Loshigian, post about there
being no significant evidence that there is faster
recovery time with minimally invasive surgery, I
will agree that the long term results of
traditional vs. MIS might be the same depending on
the procedure and surgeon. I assume what Dr.
Loshigian calls “significant evidence” means
evidence based medicine. Unfortunately, in would be
extremely difficult to satisfy surgeons who require
level 1 or 2 evidence.

At level 1, you would have to have patients agree
to have one foot performed traditionally and one
foot using MIS techniques. At level 2, you would
have to have patients sign up for surgery and
randomly assign the type of surgery to a surgeon
when he arrives at the operating room. Therefore,
this leaves opinions as anecdotal based on our
experience (level 5).

Approximately 20% of my bunion surgery involves
patients who had one foot performed traditionally
and never had the other one done, and another 5%
redo’s following traditional surgery.

I always do a patient survey 2 months following my
surgical procedures, and I believe Dr. Loshigian
would be amazed at my survey results and patient
satisfaction with MIS vs traditional.

Unfortunately, after 43 years of performing MIS,
this is the only evidence I have. We are very
fortunate to have academy members like Dr. Don
Peacock who are now involved in academic studies,
hopefully soon to be published, addressing these
facts and concerns. Also, due to the increasing
popularity of MIS, many surgeons who do not
actually perform MIS procedures as recognized by
the academy advertise themselves as performing MIS,
but actually perform traditional procedures through
smaller incisions. Recently, I came across a
patient who stated she had MIS and had 3 screws in
the 1st metatarsal with a traditional approach
incision.

Burton J. Katzen, DPM, President, The Academy of
Minimally Invasive Foot and Ankle Surgery.

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