Lapidus Proceedure

NewsBot · Apr 25, 2024

The Surgical Learning Curve for Modified Lapidus Procedure for Hallux Valgus Deformity
J. Benjamin Jackson et al
Source

Background
Hallux valgus is one of the most common orthopaedic deformities of the foot, affecting as much as 23% of the population age 18 to 65. In addition to its high prevalence, it has a complex multifactorial pathogenesis. Surgical correction options have variable rates of success and new techniques are being developed. The modified Lapidus procedure attempts to correct in 3 planes of deformity, which may create a steeper learning curve for those newly adopting the technique.
Methods
A retrospective review was performed on patients who underwent hallux valgus reconstruction with a modified Lapidus procedure between March 2018 and July 2020. Exclusion criteria included revision surgery, 6 or more concurrent procedures, or a flexor digitorum longus tendon transfer for adult acquired flatfoot correction.
Results
There were a total of 81 modified Lapidus procedures for hallux valgus within the study time frame and 68 were included in the study. Over a period of 2 years there was a significant decrease in overall surgery duration from 78.93 minutes at month 0 to 61.80 minutes at 24 months (P = .036). The average preoperative/postoperative intermetatarsal angles were 15.08° and 4.91°, respectively. There was an average decrease of 10.17°. The rate of nonunion was 4.41% (3/68), and the rate of recurrence at 6 months was 5.88% (4/68). There was not a significant difference in the rate of recurrence (P = .394) or the rate of nonunion (P = .817) as the surgeon increased in experience.
Conclusion
Although there is a significant learning curve for the modified Lapidus procedure, it is largely overcome by the 23rd case. Additionally, experience with the technique does not appear to affect the patient outcomes of nonunion or recurrence.
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NewsBot · May 2, 2024

Patient expectation and satisfaction post lapidus procedure for severe type hallux valgus surgery in Saudi Arabia: a singlecenter study
Abbas Hadi Alsuwayj et al
Source

Objective: This study aimed to evaluate the patient’s satisfaction and expectations post-hallux valgus (HV) surgery. Methods: A survey-based, cross-sectional study was conducted among patients who had undergone HV surgery (Lapidus procedure) at a university hospital in Riyadh; from January 2020 to December 2022. The participants were interviewed by telephone in December 2022. The questionnaire was divided into two parts. The first part demonstrates patient’s personal data, and the second part focuses mainly on patient expectations and satisfaction. Results: A total of 28 patients who underwent corrective surgery for HV were included. Patients’ ages ranged from 18 to 59 years. Around 60.7% of patients had high expectations before the surgery. Where 53.6% reported that they faced no problems after the operation, while 46.4% reported that they had problems after surgery such as pain, stiffness, nonunion or recurrent deformity. When patients were asked to describe their original foot condition since treatment, 39.3% showed a much better case, 32.1% said it was better, 17.9% said it was the same, and 10.7% showed deterioration. A total of 14 (50%) cases were satisfied regarding surgery output, 5 (17.9%) showed some satisfaction or uncompleted treatment and 9 (32.1%) were unsatisfied. Conclusion: It was concluded that 67.9% of the patient satisfaction was related to improvement after the surgery. Due to the level of education, gender, and patients’ high expectations before surgery; it is recommended to conduct multiple research on this topic and increase the data and variables.
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NewsBot · Jun 2, 2024

Midterm outcomes of the modified Lapidus arthrodesis using the Phantom® Intramedullary Nail System for the treatment of hallux valgus
Juan Carlos Benavente Valdivia , Diego Reategui Villegas
Foot and Ankle Surgery; 31 May 2024

Background
Lapidus arthrodesis is one of the most commonly used techniques in the correction of moderate and severe hallux valgus. We analyzed the clinical and radiological outcomes after using the Phantom® Lapidus intramedullary nail to find an effective technique with low complications.

Methods
We retrospectively analyzed data of 52 patients who underwent a modified Lapidus arthrodesis with an intramedullary nail at our center from November 2019 to September 2022. The mean follow-up period was 27 (range, 18–34) months. Clinical results were evaluated using the visual analog scale (VAS), the European Foot and Ankle Society score (EFAS) and the American Orthopaedic Foot and Ankle Society score (AOFAS); three different radiological measures were analyzed.

Results
The mean AOFAS score increased from 44.8 to 82 points. The mean EFAS score increased from 11.2 to 20.1 points. The mean VAS score decreased by 4.7 points. The mean EFAS Sport score was increased from 9.2 (SD 4.6) to 12.6 (SD 5.4) points. The intermetatarsal angle decreased from 15° to 6.9° and the hallux valgus angle by a mean of 17.9°. The forefoot width reduced from 93.6 to 84.7 mm. All results were statistically significant (p <.001). One case of nonunion was recorded. No implant-related complications were observed.

Conclusions
This device was effective in correcting moderate to severe hallux valgus, with significant patient satisfaction. Its complication rate was not higher than that of other fixation devices. Correct compression of the arthrodesis, absence of extraosseous material, and multidirectional stability are important qualities of this implant for the correct treatment of this pathology.
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NewsBot · Jun 2, 2024

Optimal Fixation Requirements for Lapidus Bunionectomies: A Comprehensive Review and Analysis

NewsBot · Jun 29, 2024

Immediate Weightbearing after Modified Lapidus Arthrodesis Using a Medial Plate: A Retrospective Descriptive Cohort Study
Yang S. Kang, MSc, BSc (Hons) et al
Source

The modified Lapidus procedure has emerged as a versatile solution for various pedal pathologies, particularly hallux abducto valgus. There have been numerous modifications over time regarding fixation techniques, joint preparation methods, graft utilization, and weightbearing protocols. However, concerns persist regarding prolonged non-weightbearing postoperatively, prompting the need for alternative approaches. This retrospective descriptive cohort analysis assessed the outcomes of 40 feet from 34 patients who underwent the modified Lapidus procedure with a medial plating system, aimed to evaluate immediate weightbearing outcomes on union rate, fixation-related complications, and functional outcomes. Among the 40 feet, findings showed a 95% (38/40) union rate within 6 months, with 2.5% (1/40) experiencing delayed union and 2.5% (1/40) facing fixation-related complications. There is a single case of malunion in the cohort. Additionally, statistically significant improvements were observed across all domains of the Manchester-Oxford Foot Questionnaire at p < .001. These findings suggest immediate weightbearing as a potential alternative to traditional non-weightbearing protocols. However, the study's retrospective nature and lack of a comparative group warrant cautious interpretation. Further research is essential to validate these findings and refine postoperative care protocols. By challenging conventional practices, this study underscores the complexity of optimizing patient outcomes in modified Lapidus procedure management. Tailored approaches and prospective investigations are imperative for establishing definitive guidelines and enhancing surgical techniques in this domain.
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NewsBot · Jul 4, 2024

Secondary Surgery Following Lapidus Bunionectomy
Lewis A Kane et al
J Foot Ankle Surg. 2024 Jun 22:S1067-2516(24)00114-5.

While the Lapidus bunionectomy is a common procedure utilized to address hallux valgus, the incidence of secondary surgery is not well established. Our primary goal was to determine the incidence of revision surgery and hardware removal following the Lapidus bunionectomy in addition to the risk factors associated with each. A retrospective nested case-control study of adult patients who underwent a Lapidus bunionectomy for symptomatic hallux valgus over a nine-year period was performed. The incidence rates and 95% confidence intervals (CI) of secondary surgery in the three years following the procedure along with the estimated independent associations and odds ratios between baseline demographic, clinical, and radiographic characteristics were calculated. Of the original cohort of 2,540 patients, 127 were identified (5.0%; CI: 4.1%, 5.8%) who underwent revision surgery and 165 (6.5%; CI: 5.5%, 7.5%) who underwent hardware removal following Lapidus bunionectomy. Initially, the hallux valgus angle, intermetatarsal angle, and tibial sesamoid position were risk factors for revision surgery. However, in adjusted analyses for revision surgery, using a screw for third point of fixation emerged as the only independent risk factor (odds ratio [OR]=3.01; CI: 1.59, 5.69). In adjusted analyses for hardware removal, female sex (OR=2.33; CI: 1.08, 5.00) and third point of fixation (OR=2.92; CI: 1.82, 4.69) emerged as independent risk factors. While the overall risks associated with Lapidus bunionectomy are low and the need for revision surgery are low, this study helps to identify specific risk factors for secondary surgery and hardware removal to help in evaluation and discussion with patients.
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NewsBot · Jul 14, 2024

Correlation of Clinical Outcomes and Relative Position of the First Metatarsal After the Modified Lapidus Procedure
Chris C Cychosz et al
Foot Ankle Int. 2024 Jun 13

Background: Hallux valgus is a complex 3-dimensional deformity, and the modified Lapidus is a commonly used procedure to correct moderate to severe cases. Shortening and elevation of the first ray can occur with this procedure, which may result in increased pressure on the lesser metatarsal heads. However, there is currently no consensus regarding an accepted length and elevation of the first ray following the modified Lapidus. Therefore, the purpose of this study is to evaluate the impact of the position of the first ray on patient-reported outcome measures.

Methods: This retrospective study identified 68 patients (72 feet) who underwent the modified Lapidus bunionectomy over a 4-year period at a single institution with a median follow-up of 24 months (range, 11-35.6 months). Patients were included if they were over 18 years of age, had pre- and postoperative weightbearing computed tomography (WBCT) scans, and preoperative and minimum 1-year postoperative Patient-Reported Outcome Measurement Information System (PROMIS) scores. PROMIS scores from 6 domains including physical function, pain interference, pain intensity, global physical health, global mental health, and depression were evaluated and compared pre- and postoperatively. Radiographic parameters were measured and compared before and after surgery. Paired t tests were used to evaluate the significance of pre- to postoperative changes. Differences between cohorts were compared using Mann-Whitney U test for continuous variables or Fisher exact test for categorical variables. Correlation between radiographic measurements and patient-reported outcomes were assessed using the Spearman rank rho estimate and visualized with scatterplots with a linear regression.

Results: PROMIS physical function, pain interference, pain intensity, and global physical health improved significantly following the modified Lapidus (all P < .001); however, scores did not show any significant correlation with shortening of the first ray up to a maximum shortening of 4.8 mm. The length of the first metatarsal relative to the second decreased by an average of 2.7 mm following the procedure when measured on WBCT (P < .001), and 2.6 mm when measured on plain radiographs (P < .001). No significant elevation of the first ray was observed postoperatively.

Conclusion: This study revealed that the Lapidus bunionectomy resulted in significantly improved pain and physical function at short-term follow-up. The amount of first ray shortening and elevation that occurred in this cohort did not adversely affect patient-reported outcomes.
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NewsBot · Aug 28, 2024

This clinical trial was just registered:
Prospective Study of Minimally Invasive Lapidus Procedure for Hallux Valgus Deformities

Brief Summary
The Lapidus procedure corrects bunions, a condition called hallux first ray deformity. Using minimally invasive surgery (MIS) to perform this procedure on patients with hallux valgus deformity is a newer approach. Because it's newer, there is not studies on how patients feel about it directly through patient reported outcomes (PROMs), which involve patients filling out questionnaires. Previous studies have looked at information that could be gathered from radiographs. This study looks specifically at how well bones heal after the MIS procedure and how patients feel about it based on their recorded responses in PROMs. The Lapidus procedure involves a step where the surgeon checks for the amount of cartilage removal, which can be done by inserting a mini camera into the joint (arthroscopically) or through a small incision for visual inspection. These two methods of checking cartilage removal are the two treatment groups for this study that patients are randomly assigned to.

The main goals of the study are as follows:

To determine healing in minimally invasive Lapidus. Evaluated by bones fusing together at 12 weeks post-operation.
To determine patient reported outcomes following Lapidus procedures
To determine the relationship between patient-reported outcomes and percent bone healing.
To assess the nonunion (bone not fusing together) rate and re-operation rate following Lapidus procedures
To assess the correction achieved on radiographic and standing CT measurements.
To compare radiographic and Standing CT assessment of hallux valgus deformity and correction after surgery.
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NewsBot · Sep 10, 2024

Lapidus Arthrodesis for Correction of Hallux Valgus Deformity: A Systematic Review and Meta-Analysis
Maximilian Waehner et al
Source

Background. The aim of this study was to evaluate and compare different fixation methods to achieve Tarsometatarsal joint I (TMT-1) arthrodesis in patients with hallux valgus regarding radiographic correction, complication profile, and clinical outcomes. Methods. A systematic review and meta-analysis included primary literature results of evidence level 1 to 3 studies in German and English. Inclusion and exclusion criteria were established and applied, along with parameters suitable for comparison of data. Results. 16 studies with a total of 1176 participants met the inclusion criteria for this analysis. Twelve evaluation criteria were compared among 3 fixation techniques; comprised of a screw-only, dorsomedial plating- and plantar plating cohort. There was no statistical difference in deformity correction (both intermetatarsal- and hallux valgus angle), or AOFAS score between the cohorts. The complication rate was 13% in the plantar-, 19.5% in the dorsomedial-, and 24.5% in the screw cohort. Nonunion was seen in 0.7% of participants in the plantar, 1.4% in the dorsomedial, and 5.3% in the screw group. The time until complete weightbearing correlated positively with the development of nonunion, with a coefficient of 0.376 (P = .009). Hardware removal was performed in 11.8% of patients in the dorsomedial cohort, 7.7% in the screw cohort, and 3.6% in the plantar cohort. Conclusion. Based on the results of meta-analysis of heterogeneous studies, plantar plating facilitated early weightbearing and patient mobilization compared to the other fixation methods, while carrying the lowest nonunion, hardware removal, and general complication risk. However, owing to the relatively small number of patients in the plantar plating group, more work is necessary to elucidate the benefits of plantar plating for a first tarsometatarsal joint arthrodesis. Development of complications appears to be largely dependent on the fixation model, rather than patient mobilization alone.
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NewsBot · Sep 26, 2024

Lapidus Arthrodesis for Correction of Hallux Valgus Deformity: A Systematic Review and Meta-Analysis
Maximilian Waehner et al
Source

Background. The aim of this study was to evaluate and compare different fixation methods to achieve Tarsometatarsal joint I (TMT-1) arthrodesis in patients with hallux valgus regarding radiographic correction, complication profile, and clinical outcomes. Methods. A systematic review and meta-analysis included primary literature results of evidence level 1 to 3 studies in German and English. Inclusion and exclusion criteria were established and applied, along with parameters suitable for comparison of data. Results. 16 studies with a total of 1176 participants met the inclusion criteria for this analysis. Twelve evaluation criteria were compared among 3 fixation techniques; comprised of a screw-only, dorsomedial plating- and plantar plating cohort. There was no statistical difference in deformity correction (both intermetatarsal- and hallux valgus angle), or AOFAS score between the cohorts. The complication rate was 13% in the plantar-, 19.5% in the dorsomedial-, and 24.5% in the screw cohort. Nonunion was seen in 0.7% of participants in the plantar, 1.4% in the dorsomedial, and 5.3% in the screw group. The time until complete weightbearing correlated positively with the development of nonunion, with a coefficient of 0.376 (P = .009). Hardware removal was performed in 11.8% of patients in the dorsomedial cohort, 7.7% in the screw cohort, and 3.6% in the plantar cohort. Conclusion. Based on the results of meta-analysis of heterogeneous studies, plantar plating facilitated early weightbearing and patient mobilization compared to the other fixation methods, while carrying the lowest nonunion, hardware removal, and general complication risk. However, owing to the relatively small number of patients in the plantar plating group, more work is necessary to elucidate the benefits of plantar plating for a first tarsometatarsal joint arthrodesis. Development of complications appears to be largely dependent on the fixation model, rather than patient mobilization alone.
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NewsBot · Oct 18, 2024

A novel construct for Lapidus bunionectomy utilizing nitinol staples
Ashley T. Russo, DPM, MS, Edward C. Kormylo, DPM
Source

The Lapidus bunionectomy is a popular procedure that allows for powerful hallux valgus correction through arthrodesis of the first metatarsal-cuneiform joint. Although widely used since its advent in the 1930s, controversy still exists surrounding what the most superior fixation construct is for this procedure. Commonly used fixation constructs include, but are not limited to, crossed screws, plate and screws, and monorail external fixators. Nitinol staples, although relatively new to the internal fixation world, offer unique advantages that other forms of internal fixation do not. These advantages include easy insertion, dynamic compression, and superelasticity which may impact rates of bunion recurrence, nonunion, and malunion, all of which are of concern with this procedure. This study details a unique surgical technique for the Lapidus bunionectomy utilizing a 2-leg staple dorsally and a 4-leg staple medially in a 90 degree construct. We propose that use of a 4-leg staple medially may mimic the advantages of plantar plating without the difficulty of positioning and obtaining adequate anatomic exposure.
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NewsBot · Oct 29, 2024

How the Lapidus Has Evolved

NewsBot · Nov 17, 2024

Association Between Postoperative Medial-Middle Intercuneiform Joint Widening and Recurrence Rates in Hallux Valgus Treated With Modified Lapidus Procedure
Jaeyoung Kim et al
Source

Background:
Although an association between intercuneiform (C1-C2) joint instability and the recurrence of hallux valgus (HV) deformity after the modified Lapidus procedure has been suggested, there is currently no radiographic evidence to support it. This study aims to investigate radiographic changes in the C1-C2 joint after the modified Lapidus procedure for HV correction, using weightbearing computed tomography (WBCT).
Methods:
This retrospective cohort study included 52 feet (50 patients) with HV who underwent modified Lapidus procedure and had preoperative and postoperative WBCT. Patients who had an additional transfixation screw between the first and second ray were excluded. The preoperative and average 6.5 months postoperative C1-C2 distance, C1-C2 angle, and C1-ground angle were measured on coronal multiplanar reconstructed WBCT images. Radiographic parameters between the recurrence group (n = 9) and nonrecurrence group (n = 43) were compared. Recurrence of HV deformity was characterized by a postoperative hallux valgus angle (HVA) greater than 20 degrees.
Results:
Nine of 52 patients (17.3%) had recurrence of their HV deformity. The recurrence group had greater changes in the C1-C2 distance; the median widening in the recurrence group was 0.7 mm (IQR, 0.6-0.8), whereas the nonrecurrence group was 0.3 mm (IQR, 0.1-0.4, P < .001). Regression analysis showed that increase in the C1-C2 distance were significantly associated with recurrence (odds ratio, 1.79; 95% CI, 1.18-3.77; P = .0015). Although no preoperative imaging parameters were associated with a change in the C1-C2 distance, increasing postoperative sesamoid position (r = 0.32, P = .022) and HVA (r = 0.28, P = .046) were correlated with a greater change in the C1-C2 joint gapping.
Conclusion:
Our study results suggest a possible association between early postoperative widening of the C1-C2 joint and the recurrence of the HV deformity following a modified Lapidus procedure. This raises, but does not answer, the question as to whether the routine stabilization of intercuneiform joint directly or indirectly may help reduce the rate of hallux valgus recurrence when performing the modified Lapidus procedure.
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Lapidus Proceedure

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Lapidus Procedure

Best shoe to wear 4 months post op Lapidus bunionectomy

Lapidus or scarf surgery for bunion?

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Lapidus surgery

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Lapidus Proceedure

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Lapidus Procedure

Best shoe to wear 4 months post op Lapidus bunionectomy

Lapidus or scarf surgery for bunion?

Help? Lapidus surgery failed, what to do?

Lapidus surgery

Lisfranc after Lapidus

8 months post Lapidus

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