Revision of Malaligned Lapidus and Nonunited Lapidus

Buddecke, Donald E.; Reese, Eric R.; Prusa, Ryan D.

doi:10.1016/j.cpm.2020.03.010

Cited by 6 publications

(3 citation statements)

References 28 publications

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“…18,[23][24][25] After the MLP, excessive motions around the fusion site can occur causing an increase in the intermetatarsal angle, especially in the presence of IJH. 26 Besides, biomechanical and clinical studies have demonstrated that the IJH is more common in patients with HV than in the normal population. Evidence suggests that HV is actually a multiplanar instability with a combination of an increased transverse and rotational movements of the medial cuneiform in relation to the middle cuneiform.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Technical Tips to Improve Fusion Between the First and Second Metatarsals in the Original Lapidus Procedure

Nishikawa

Duarte

Saito

et al. 2022

Foot & Ankle Specialist

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The modified Lapidus procedure (MLP), which consists of fusion between the first metatarsal (M1) and medial cuneiform, has been widely performed with satisfactory clinical outcomes, but it has a variable nonunion rate ranging between 4% and 10% and loss of correction in up to 5.8% of the cases. Excessive motion around the site of tarsometatarsal arthrodesis, specially at the intercuneiform joint, is probably the reason. The original Lapidus procedure (OLP), which includes fusion of the M1 to second metatarsal (M2), may be beneficial in preventing nonunion and recurrence. The objective of this study was to describe intraoperative technical tips in the OLP to improve M1 to M2 fusion, which may prevent complications. Since the Lapidus procedure continues to gain popularity, it is the authors opinion that the OLP requires special attention because it is a more technically demanding surgery compared to the MLP. Level of Evidence: Level V: Expert opinion

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Section: Discussionmentioning

confidence: 99%

Intraoperative Technical Tips to Improve Fusion Between the First and Second Metatarsals in the Original Lapidus Procedure

Nishikawa

Duarte

Saito

et al. 2022

Foot & Ankle Specialist

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“…Initial outcomes of this triplanar correction demonstrate a powerful correction with greater stability [4][5][6] . Complications, including nonunion, malunion, recurrence, and transfer metatarsalgia, are similar to those of other hallux valgus correction techniques; however, complication rates may be lower with the Lapidus procedure 5 .…”

mentioning

confidence: 92%

Second Metatarsal Fracture During Lapidus Hallux Valgus Correction

Flaherty

Jie

2023

JBJS Case Connector

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Case: A 67-year-old woman with rheumatoid arthritis underwent Lapidus hallux valgus correction. Initial realignment was unsatisfactory, so the K-wire through the first and second metatarsals was removed. As the clamp was repositioned, the second metatarsal fractured through the K-wire hole. The Lapidus procedure was completed, and then, the fracture was fixed with a percutaneous K-wire. The tarsometatarsal fusion and second metatarsal fracture healed. Conclusion:Because second metatarsal structural integrity is imperative for use of the clamp, bone quality and K-wire holes from re-reduction should be considered. Although technically challenging, this case demonstrates percutaneous fracture reduction after Lapidus hallux valgus correction.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C59).

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“…The most common complication of Lapidus arthrodesis is a high non-union rate(9) which may require revision procedures like bone grafting and revision fixation(10). Inadequate contact of the fusion surfaces due to suboptimal osteotomies lead to delayed fusion and subsequent loss of implant stability.…”

Section: Introductionmentioning

confidence: 99%

Research Protocol for a Randomised Controlled Trial Comparing the Outcome of the 3D-Printed Patient-Specific-Instrument Assisted Lapidus Fusion vs Conventional Lapidus Fusion for Surgical Correction of Hallux Valgus Deformity

Ling,

Wei,

Chui

et al. 2023

Preprint

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IntroductionHallux valgus (HV) affects up to 30% of the population. Lapidus surgery with 1st tarsal-metatarsal joint arthrodesis is one of the most common surgical options for HV. Despite its popularity, the current procedure is not without complications. This investigation will be the world’s first Lapidus arthrodesis surgery utilising patient-specific instruments (PSI) as an assistive tool. We hypothesise that the PSI will enhance surgical precision, accelerate fusion rates, decrease non-unions, and reduce the need to use bone grafts.Methods and analysisThis is a single-blinded, parallel-group, randomised controlled trial comparing the outcome of the 3D-Printed PSI Assisted Lapidus Fusion (n=27) vs Conventional Lapidus Fusion (n=27) for HV deformity. Both groups will receive an identical postoperative rehabilitation of protected weight bearing and splinting. Outcomes will include foot function scores, radiological alignment and arthrodesis site assessment with X-ray and High-Resolution Peripheral Quantitative-Computed Tomography, and foot pressure analysis.Strengths and LimitationsStrengthsThis will be the world’s first randomised control trial utilising PSI for hallux valgus surgery.Surgeries are done by a team of experienced foot and ankle surgeons.LimitationsA single-centre study with a follow-up of only 1 year. However, the authors believe that traditional Lapidus surgery has known term results, and the chief hypothetical benefit of PSI-assisted surgery is faster bony fusion and less surgical complications, which will be evident within 1 year.

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Revision of Malaligned Lapidus and Nonunited Lapidus

Cited by 6 publications

References 28 publications

Intraoperative Technical Tips to Improve Fusion Between the First and Second Metatarsals in the Original Lapidus Procedure

Intraoperative Technical Tips to Improve Fusion Between the First and Second Metatarsals in the Original Lapidus Procedure

Second Metatarsal Fracture During Lapidus Hallux Valgus Correction

Research Protocol for a Randomised Controlled Trial Comparing the Outcome of the 3D-Printed Patient-Specific-Instrument Assisted Lapidus Fusion vs Conventional Lapidus Fusion for Surgical Correction of Hallux Valgus Deformity

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