Patient Reported Outcomes and Recurrence following 127 Primary Lapidus Surgeries for Hallux Valgus

Abstract

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Treatment for symptomatic hallux valgus encompasses a spectrum of surgical options to appropriately address the degree of deformity. The modified Lapidus has emerged as a powerful surgical option to address moderate to severe deformity as well as hallux valgus with 1st ray hypermobility. Unlike metatarsal osteotomies, the literature is lacking in clinical and radiographic outcomes. Previous retrospective series have reported recurrence rates less than 15%, but our experience found a higher recurrence rate. We aimed to evaluate the effect of radiographic recurrence on patient reported outcome measures and satisfaction. Methods: After obtaining institutional board review approval, patients were identified by procedural billing codes from 2012- 2016. Only primary Lapidus surgeries were included. All patients were contacted and invited to return to obtain patient reported outcome scores (AOFAS, FAAM) and assess satisfaction. HVA>=20 at final follow-up was used to define recurrence. Data was analyzed utilizing statistical analysis software (SAS v9.4).328 surgeries were identified with 255 eligible and contacted for follow-up. 77 surveys were completed in person and 50 were completed over the phone or via email with total response rate of 50%. Results: Average follow-up was 59 months. 38% had radiographic recurrence (48/127), 24% perceived recurrence (30/125), and 9.5% had reoperation for recurrence (12/126). AOFAS scores were lower with radiographic recurrence (p=0.01) and perceived recurrence (p=0.003). FAAM-ADL scores were not different in radiographic recurrence (p=0.79) but were lower in perceived recurrence (p=0.001). Overall, satisfaction was good-excellent in 74% and fair-poor in 26%. For radiographic (p=0.03) and perceived recurrence (p<0.0001), there was lower satisfaction reported. 78% would repeat surgery. Decision to repeat surgery was not different for radiographic recurrence with 81% without vs 74% with recurrence (p=0.37) saying they would have surgery again. However, it was different for perceived recurrence with 84% without vs 59% with recurrence saying they would have surgery again (p=0.01). Conclusion: Despite a high radiographic recurrence rate (38%), only a portion perceived a recurrence (24%) and an even smaller proportion (9.5%) had a reoperation for the recurrence. Nonetheless, these results suggest radiographic and clinical outcomes are not as high as previously reported for the modified Lapidus procedure.

Treatment of Hallux Valgus with Metatarsus Adductus

“…8 Outcomes following bunion correction are influenced by the durability of the correction, and recurrence is associated with poorer clinical outcomes and patient satisfaction. [22][23][24] Burg et al suggest that outcomes of HV can be improved by addressing MA in tandem when present. The authors review the indications, measurements, and postoperative protocol, as well as demonstrate a technique for an MIS correction of HV in the setting of MA.…”

“…Only 2 of the 21 feet within the reported data had radiographic recurrence (HVA >20 degrees), with preoperative MAA in the sample ranging from 17 degrees to 46 degrees 8 . Outcomes following bunion correction are influenced by the durability of the correction, and recurrence is associated with poorer clinical outcomes and patient satisfaction 22–24 . Burg et al suggest that outcomes of HV can be improved by addressing MA in tandem when present.…”

Impact of Asymptomatic Flatfoot on Clinical and Radiographic Outcomes of the Modified Lapidus Procedure in Patients With Hallux Valgus

“…7,26 Interestingly, the modified Lapidus procedure, which is the fusion of the first TMT joint, is a technique that is frequently used to correct both hallux valgus and flatfoot deformities. 5,22 The Lapidus procedure has been found to correct not only the forefoot deformity but also the hindfoot deformity (or 3D correction) in flatfoot deformity. 11 Thus, it is reasonable to assume that hallux valgus patients with radiographic evidence of flatfoot deformity would benefit from the Lapidus procedure.…”