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Lapidus Proceedure

Discussion in 'Foot Surgery' started by Robertisaacs, Dec 14, 2009.

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    Read all about it...

    http://www.podiatrytoday.com/article/5542

    Wheeless textbook of orthopaedics describes it as...

    I'm interested in peoples thoughts on this one from a biomechanics viewpoint. When is it a preferred operation and what are the long term considerations in terms of the windlass and 1st ray function.

    It would be fascinating to do a before and after on a VLS. Has anyone done this?

    Regards
    Robert
     
  2. podrick

    podrick Active Member

    It is a very good procedure for both severe hallux valgus with a hypermobile first ray or even for a very severe hallux valgus without a hypermobile first ray.It corrects a high IM angle and can be done in combination with an akin or another distal osteotomy to correct a high HA or PASA for instance.
     
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    Fixation of Lapidus Arthrodesis with a Plantar Interfragmentary Screw and Medial Locking Plate: A Report of 88 Cases
    James M. Cottom, Anand M. Vora
    Journal of Foot and Ankle Surgery; Article in Press
     
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    Comparative study of Lapidus bunionectomy using different osteosynthesis methods
    N. Gutteck, D. Wohlrab, A. Zeh, F. Radetzki, K.-S. Delank, S. Lebek
    Foot and Ankle Surgery; Available online 15 June 2013
     
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    Long-term results of the Hohmann and Lapidus procedure for the correction of hallux valgus: A prospective, randomised trial with eight- to 11-year follow-up involving 101 feet.
    Faber FW, van Kampen PM, Bloembergen MW
    The Bone & Joint Journal [2013, 95-B(9):1222-1226]
     
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    Correction of Frontal Plane Rotation of Sesamoid Apparatus during the Lapidus Procedure: A Novel Approach
    Lawrence A. DiDomenico
    The Journal of Foot and Ankle Surgery Volume 53, Issue 2, March–April 2014, Pages 248–251
     
  9. Troy Harris

    Troy Harris Member

    I heard a speaker at a regional ACFAS meeting last year who said all HAV surgeries are Lapidus until a good reason exists to do otherwise. The Lapidus allows correction in the sagittal plane, transverse plane, and frontal plane. The advantages of frontal plane correction in particular are addressed in the below article:

    Journal of Foot and Ankle Surgery
    Volume 52, Issue 3 , Pages 348-354, May 2013
    Relationship of Frontal Plane Rotation of First Metatarsal to Proximal Articular Set Angle and Hallux Alignment in Patients Undergoing Tarsometatarsal Arthrodesis for Hallux Abducto Valgus: A Case Series and Critical Review of the Literature
    Paul Dayton, DPM, MS, FACFAS, Mindi Feilmeier, DPM, FACFAS, Merrell Kauwe, BS, Jordan Hirschi, BS
     
  10. drsarbes

    drsarbes Well-Known Member

    The Lapidus is one of those procedures that has appreciated a renewed popularity, mainly due to the improved fixation techniques. In the right hands you can certainly correct a lot of pathology with it.

    Is it MY go to procedure? No.
    Why?
    Not because there is anything wrong with it, it's only because of my training and experience. As with many osteotomy procedures, one tends to refine them as they perform them. The "in my hands" statement tells it all.
    If you feel that "in my hands" statement should not be counted on in surgery, that all procedures should be repetitive and successful, then you haven't done enough surgery to appreciate it.

    Personally I think it should only be used when fusing the first M-C joint gives some added benefit, otherwise, leave the joint alone.

    Steve
     
  11. bob

    bob Active Member

    Whilst the Lapidus is certainly a great procedure for significant intermetatarsal angles, 1st met-cuneiform joint osteoarthrosis and decreased dorsiflexion stiffness of the first ray, I would not consider it my 'go to' procedure for hallux valgus. Osteotomies such as the scarf have the ability to 'correct' the deformity in all three planes whilst sparing joints and allowing slightly quicker return to mobility than the Lapidus. Horses for courses.
     
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    The incidence of nonunion after lapidus arthrodesis using staple fixation.
    Mallette JP, Glenn CL, Glod DJ.
    J Foot Ankle Surg. 2014 May-Jun;53(3):303-6.
     
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    Immediate Weightbearing after Lapidus Arthrodesis with External Fixation.
    Lamm BM, Wynes J.
    J Foot Ankle Surg. 2014 May 28
     
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    Effects of the Lapidus Arthrodesis and Chevron Bunionectomy on Plantar Forefoot Pressures
    Christy M. King, DPM, AACFAS, Graham A. Hamilton, DPM, FACFAS, Lawrence A. Ford, DPM, FACFAS
    The Journal of Foot and Ankle Surgery; Volume 53, Issue 4, July–August 2014, Pages 415–419
     
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    A Retrospective Study of Two Lapidus Groups, Each With a Different Method of Rail Application
    Thomas A. Paulick et al
    The Journal of Foot and Ankle Surgery; Articles in Press
     
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    Modified Lapidus Arthrodesis With Crossed Screw Fixation: Early Weightbearing in 136 Patients
    Christy M. King, DPM, Johanna Richey, DPM, Sandeep Patel, DPM, FACFAS, David R. Collman, DPM, FACFAS
    The Journal of Foot and Ankle Surgery; Articles in Press
     
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    Enhanced Lapidus Arthrodesis: Crossed Screw Technique with Middle Cuneiform Fixation Further Reduces Sagittal Mobility
    Melissa M. Galli, DPM, MHA, AACFAS, Jeffrey E. McAlister, DPM, Gregory C. Berlet, MD, Christopher F. Hyer, DPM, MS, FACFAS
    The Journal of Foot and Ankle Surgery; Articles in Press
     
  19. Troy Harris

    Troy Harris Member

    I've got a patient with dorsal first met-cuneiform exostosis that was removed 4 years ago, but has recurred. His pain is primarily from shoe rub. He does not currently use custom orthotics. He presents for surgical management. Any thoughts on lapidus vs another exostectomy? I am afraid that exostectomy may result in recurrence as it did before, yet the patient is below 40 years old and there is apparently no osteoarthritis and there is no malalignment. The first ray is sligtly hypermobile and he suffers from a Morton's neuroma in the same foot. Any thoughts are appreciated.
     
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    Correction power and complications of first tarsometatarsal joint arthrodesis for hallux valgus deformity
    Madeleine Willegger, Johannes Holinka, Robin Ristl, Axel Hugo Wanivenhaus, Reinhard Windhager, Reinhard Schuh
    International Orthopaedics; November 2014
     
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    Arthrodiastasis of the Lateral Column with Medial Fusion: A Retrospective Examination of Medial Double and Lapidus Arthrodeses
    Melissa M. Galli, DPM, MHA, AACFAS, Nicole M. Protzman, MS, Stephen A. Brigido, DPM, FACFAS
    The Journal of Foot and Ankle Surgery; Articles in Press
     
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    Corrective Realignment Arthrodesis of the First Tarsometatarsal Joint Without Wedge Resection
    Jeffrey E. McAlister, DPM, AACFAS; Kyle S. Peterson, DPM, AACFAS; Christopher F. Hyer, DPM, MS
    Foot Ankle Spec December 3, 2014
     
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    Intraoperative Evaluation of Medial Intercuneiform Instability After Lapidus Arthrodesis: Intercuneiform Hook Test
    Justin J. Fleming, DPM, FACFAS, Kwasi Y. Kwaadu, DPM, AACFAS, Jeanine C. Brinkley, DPM, AACFAS, FAPWCA, Yvonne Ozuzu, DPM
    Jnl Foot Ank Surg; Article in Press
     
  24. danielywu

    danielywu Active Member

    Human foot needs over 100 muscles, tendons and ligaments to stabilize and operate 28 bones for you know why (function). Any deviation from such ingenious engineering at birth, by trauma or surgery may disturb its optimal function. Low (loose) or high (rigid) arches, accessory navicula (extra bone), tarsal coalition (one less joint) and posterior tibial tendon dysfunction are good examples. Lapidus procedure sacrifices a normal joint and a price has to be paid but the young and active may not be able to afford.
    After metatarsocuneiform joint fusion, first ray varus deviation can still happen through its neighboring tarsal joints. I have used syndesmosis procedure to correct two recurrence cases after Lapidus procedure. One has been followed up for >2 years and the other > 5 years. There is no recurrence yet but only compromised function in terms of discomfort of the fused foot in carrying out more demanding activities such as sports and high-heels.
    I can only show the 2-year case for discussion since the 5-year case is being submitted for a case-study report.

    Daniel
     

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  25. Dieter Fellner

    Dieter Fellner Well-Known Member

    Daniel:

    If I am not mistaken we discussed this Lapidus rescue in Hong Kong. The outcome probably does not meet your customary expectations(some gaping remains) but the level of improvement from this salvage is remarkable all the same. I would not have predicted residual transverse plane mobility, post Lapidus.

    Dieter
     
  26. danielywu

    danielywu Active Member

    Dear Dieter:

    Indeed, there is very little room in medial tarsal joints for transverse plane movement of the first ray and it is almost impossible to discern by plain 2-dimension x-ray. But the medial tarsal joints were absolutely responsible for her first ray varus-deviation recurrence after MCJ fusion and there should have had absolutely problem to move it back to where it was after her Lapidus. Indeed her left foot without previous surgery was much easier to correct by syndesmosis procedure but she is still happy with her right foot in terms of restored functions, albeit the residual metatarsalgia due to her shortened first ray. Equally important is that I do not expect her hallux valgus deformity will recur in the future. At least I have followed my other case for more than five years already without any slightest sign of recurrence.

    Daniel
     
  27. Dieter Fellner

    Dieter Fellner Well-Known Member

    Daniel:

    Another good example, to remind us how much we yet have to learn about the complex motions of the foot. It is all too tempting to consider only segmental function, when performing bunion surgery. Post Lapidus there is certainly a reduction in saggital plane 1st ray motion. This being a key factor to prompt many a surgeon to reach into the Lapidus tool box.

    Interestingly, several good papers demonstrate the effect on saggital plane motion s/p capital osteotomy v. Lapidus is pretty much the same.

    So, the expectation with Lapidus is tight control also in transverse plane alignment. I am not (and have never been) a big fan of Lapidus (exception: pain from 1st MCJ DJD). Pre-syndesmosis procedure, I found a well executed scarf osteotomy can achieve everything a Lapidus promises to do, without the additional burden of protracted cast immobilization. In addition, I have noticed on XR s/p Lapidus oftentimes there remains a significant gap between metatarsal heads 1 and 2. And recurrence of bunion deformity also is a risk.
     
  28. danielywu

    danielywu Active Member

    Dear Dieter:

    Most surgeries are a trade-off btwn repair and surgical trauma. The merits of Lapidus procedure are its effectiveness in being able to correct the most severe deformities and also stabilizing the first metatarsal. I always firmly believe hallux valgus feet are mainly a function problem due to first metatarsal displacement and hypermobility. By fusing the MTC joint, it means its neighboring joints have to take up its usual stresses and the longitudinal arch would also become stiffer like in pes cavus feet.
    Syndesmosis procedure, a soft tissue technique, can also correct the most severe deformities and also stabilize first metatarsal but without sacrificing the normal function of the MTC joint and foot. Preserving the length of first ray and integrity of first metatarsal are also very important in keeping its surgical trauma less functionally unfriendly.

    Daniel
     
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    Lapidus Procedure in Younger Patients: Return to Sports and Physical Activities
    John A. Karbassi, MD, Andover, MA
    Jeanne Yu, BS, New York, NY
    Carol A. Mancuso, MD, New York, NY
    Andrew J. Elliott, MD, New York, NY
    Martin J. O'Malley, MD, New York, NY
    David S. Levine, MD, Bedford, NY
    Matthew M. Roberts, MD, New York, NY
    Jonathan T. Deland, MD, New York, NY
    Scott Ellis, MD, New York, NY
    Presented at AAOS Annual Meeting; March 2015
     
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    Salvaging of a Failed Lapidus Procedure by the Soft Tissue Osteodesis Procedure: A Six-Year Follow-up Case Report
    Daniel Y. Wu
    The Foot; Article in Press
     
  31. danielywu

    danielywu Active Member

    This report was a different case from the one that I have reported earlier in this same thread and it was also a bilateral osteodesis procedure of failed Lapidus procedure in one foot due to symptomatic recurrence of metatarsus primus varus deformity despite a solid metatarsocuneiform joint fusion and also its contralateral foot with a painful virgin metatarsus primus varus deformity. There was no sign of deformity recurrence of either foot after more than 6 years of follow-up. The salvaged Lapidus foot was slightly less satisfactory than the virgin hallux valgus foot due likely to its fused metatarsocuneiform joint and shortened first ray. This case-report demonstrated again the deformity correction and recurrence prevention potential of osteodesis procedure even for the most demanding situations. The report contains 13 images showing especially x-rays at every relevant and informative stage from pre-Lapidus to 6-year post-osteodesis procedures.
    The author
     
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    Functional Restoration and Risk of Non-union of the First Metatarsocuneiform Arthrodesis for Hallux Valgus: A Finite Element Approach
    Duo Wai-Chi Wong, Yan Wang, Ming Zhang, Aaron Kam-Lun Leung
    Journal of Bimechanics; Article in Press
     
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    Endosseous Fixation Device for Lapidus Arthrodesis: Technique, Early Experience, and Comparison With Crossed Screw Fixation
    Marek E. Zelent, DPM, FACFAS, David J. Neese, DPM, FACFAS, Paul H. Peterson, DPM
    JFAS; Article in Press
     
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    Quantitative Analysis of the Degree of Frontal Rotation Required to Anatomically Align the First Metatarsal Phalangeal Joint During Modified Tarsal-Metatarsal Arthrodesis Without Capsular Balancing
    Paul Dayton, DPM, MS, FACFAS, Merrell Kauwe, DPM, Lawrence DiDomenico, DPM, FACFAS, Mindi Feilmeier, DPM, FACFAS, Rachel Reimer, PhD
    JFAS; Article in Press
     
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    Return to Sports and Physical Activities After the Modified Lapidus Procedure for Hallux Valgus in Young Patients
    Aoife MacMahon et al
    Foot & Ankle International November 17, 2015
     
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    Placement of Plantar Plates for Lapidus Arthrodesis
    Anatomical Considerations
    Christian Plaass et al
    Foot & Ankle International December 2, 2015
     
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    Subjective versus Objective Assessment in Early Clinical Outcome of Modified Lapidus Procedure for Hallux Valgus Deformity
    S. Chopra et al
    Clinical Biomechanics; Article in Press
     
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    A Multicenter, Retrospective Study of Early Weightbearing for Modified Lapidus Arthrodesis
    Mark A. Prissel et al
    Journal of Foot and Ankle Surgery; Article in Press
     
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