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Nishikawa DRC, Duarte FA, Saito GH, da Silva DA, Mann TS, de Miranda BR, Mendes AAM, Prado MP. Is there a tolerance for extension of the first metatarsal after the Lapidus procedure? A clinical, functional, and hindfoot radiographic analysis. INTERNATIONAL ORTHOPAEDICS 2024; 48:103-109. [PMID: 37582981 DOI: 10.1007/s00264-023-05932-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/05/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Based on the tripod concept of load distribution, our study aimed to evaluate whether a slight extension of first metatarsal (M1) that may occur after the Lapidus procedure (LP) could alter the radiographic measurements of the hindfoot and influence clinical and functional outcomes. METHODS Twenty-five patients (27 feet) were reviewed. Hindfoot radiographic analysis was based on seven measurements. Clinical and functional outcomes were evaluated with self-reported questionnaires. Transfer metatarsalgia was also assessed. Correlation analysis was performed according to variations of the studied variables. RESULTS The average extension of the M1 was 4.26 degrees (p < 0.001). None of the hindfoot radiographic measurements changed significantly (p = 0.13, p = 0.50, p = 0.19, p = 0.70, p = 0.11, p = 0.36, p = 0.83). Patients improved on most questionnaires (p < 0.001). None presented transfer metatarsalgia. No correlation between M1 extension and clinical and functional outcomes was found. CONCLUSION Possibly there is a tolerance of M1 extension in which it does not alter the radiographic measurements of the hindfoot, overload the lesser metatarsals, or compromise clinical and functional outcomes.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Hospital Do Servidor Público Municipal de São Paulo, 60, Castro Alves Street, Aclimação, São Paulo, SP, CEP: 01532-000, Brazil.
- Department of Orthopaedic Surgery, Clínica de Ortopedia E Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, São Paulo, SP, CEP: 05078-000, Brazil.
- Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, São Paulo, SP, CEP: 01508-000, Brazil.
| | - Fernando Aires Duarte
- Department of Orthopaedic Surgery, Clínica de Ortopedia E Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, São Paulo, SP, CEP: 05078-000, Brazil
| | - Guilherme Honda Saito
- Department of Orthopaedic Surgery, Hospital Sírio-Libanês, 91, Dona Adma Jafet Street, Bela Vista, São Paulo, SP, CEP: 01308-050, Brazil
| | - Daniel Araújo da Silva
- Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, São Paulo, SP, CEP: 01508-000, Brazil
| | - Tânia Szejnfeld Mann
- Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, São Paulo, SP, CEP: 01508-000, Brazil
| | - Bruno Rodrigues de Miranda
- Department of Orthopaedics, Hospital Do Servidor Público Municipal de São Paulo, 60, Castro Alves Street, Aclimação, São Paulo, SP, CEP: 01532-000, Brazil
| | - Alberto Abussamra Moreira Mendes
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
| | - Marcelo Pires Prado
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
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Nishikawa DRC, Duarte FA, Saito GH, de Miranda BR, Pontin PA, Mendes AAM, Prado MP. Impact of forefoot width variation on clinical and functional outcomes following the Lapidus procedure. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2853-2858. [PMID: 36871250 DOI: 10.1007/s00590-023-03506-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/26/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE This study aimed to evaluate the effect of variations in bony and soft tissue foot widths on clinical and functional outcomes after hallux valgus correction with the Lapidus procedure. METHODS Forty-three feet in 35 patients with a mean follow-up of 18.5 months undergoing the LP were reviewed. Clinical and functional data were assessed with the VAS for pain, AOFAS Scale, LEFS and SF-12 health survey, which is divided into physical and mental health composite scales (PCS-12 and MCS-12). Radiographic analysis of forefoot width was based on bony and soft tissue limits. Intermetatarsal-angle and HV-angle were also assessed. RESULTS Bony width changed significantly from 95.5 mm to 84.2 mm (11.8%) and soft tissue width from 107.12 mm to 100.84 mm (5.86%) (p < 0.001). IMA and HVA improved significantly. Significant clinical and functional improvements were observed, except in MCS-12. In simple linear regression, correlation was found between variations of bony width with Δ-AOFAS and Δ-PCS-12, meaning that as the forefoot narrows, their values increase (p = 0.02 and p = 0.005, respectively). It was also related to Δ-IMA, meaning that the forefoot narrows as these parameters improve (p < 0.001 and p < 0.001). Soft tissue width was related to Δ-PCS-12 and Δ-AIM. In multiple linear regression, the strongest correlation was between bony width variation and Δ-IMA (p = 0.029, r2 = 0.22). CONCLUSION Forefoot narrowing was correlated with improved clinical and functional outcomes, as measured by AOFAS and PCS-12. In addition, correction of the radiographic parameters, mainly IMA, reflected on a significant decrease in the forefoot width.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, São Paulo, SP, CEP: 01532-000, Brazil.
- Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, São Paulo, SP, CEP: 05078-000, Brazil.
- Department of Orthopaedic Surgery, Care Club, 4615, Brigadeiro Luís Antônio Avenue, Jardim Paulista, São Paulo, SP, CEP 01401-002, Brazil.
| | - Fernando Aires Duarte
- Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, São Paulo, SP, CEP: 05078-000, Brazil
- Department of Orthopaedic Surgery, Care Club, 4615, Brigadeiro Luís Antônio Avenue, Jardim Paulista, São Paulo, SP, CEP 01401-002, Brazil
| | - Guilherme Honda Saito
- Department of Orthopaedic Surgery, Hospital Sírio-Libanês, 91, Dona Adma Jafet Street, Bela Vista, São Paulo, SP, CEP: 01308-050, Brazil
| | - Bruno Rodrigues de Miranda
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, São Paulo, SP, CEP: 01532-000, Brazil
| | - Pedro Augusto Pontin
- Department of Orthopaedic Surgery, Care Club, 4615, Brigadeiro Luís Antônio Avenue, Jardim Paulista, São Paulo, SP, CEP 01401-002, Brazil
| | - Alberto Abussamra Moreira Mendes
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
| | - Marcelo Pires Prado
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
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Nishikawa DRC, Duarte FA, Saito GH, Pontin PA, Mendes AAM, Prado MP. Intraoperative Technical Tips to Improve Fusion Between the First and Second Metatarsals in the Original Lapidus Procedure. Foot Ankle Spec 2022; 16:159-167. [PMID: 35993303 DOI: 10.1177/19386400221118884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Fernando Aires Duarte
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Guilherme Honda Saito
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Pedro Augusto Pontin
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Alberto Abussamra Moreira Mendes
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Marcelo Pires Prado
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
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de Cesar Netto C, Ehret A, Walt J, Chinelati RMK, Dibbern K, de Carvalho KAM, Tazegul TE, Lalevee M, Mansur NSB. Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study. Arch Orthop Trauma Surg 2022; 143:2283-2295. [PMID: 35312845 PMCID: PMC10110656 DOI: 10.1007/s00402-022-04399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Instability/collapse of the medial column has been associated with many conditions, particularly progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA). Restoration of first ray length and sagittal plane alignment to restore the foot tripod is essential when treating these deformities. This study aimed to assess early results, healing, and complication rate of a distraction dorsal opening plantarflexion wedge allograft first tarsometatarsal joint fusion (LapiCotton Procedure) in patients with collapse/instability of the medial column. METHODS In this prospective cohort study, we included PCFD, HV, and MA patients that underwent a LapiCotton procedure. Fusion site healing was defined by > 50% bone bridging in both interfaces between allograft wedge and host bone using weight-bearing computed tomography (WBCT) after 3 months. First ray collapse radiographic correction and minor and major complications (deep dehiscence, deep infection, and reoperation) were assessed. RESULTS A total of 22 patients (22 feet) were included (11 PCFD, 6 MA, and 5 of HV patients). Mean follow-up was 5.9 months (range 3-12) and median allograft size was 8 mm (range 5-19 mm). Bone healing was observed in 91% of cases. Two minor complications (9%, both superficial dehiscence) and one major complication (4.5%, deep infection) were observed. Statistically significant improvement of the sagittal plane talus-first metatarsal angle was observed, with mean improvement of 9.4° (95% CI 6.7-12.1°; p < 0.0001). CONCLUSION In this prospective cohort study of 22 patients treated with the LapiCotton procedure for medial longitudinal arch collapse/instability, we observed a low complication rate (9% minor, 4.5% major), high healing rate after 3 months (91%), one clinically stable radiographic non-union (4.5%) and one unstable non-union (4.5%) needing reoperation. Our results demonstrate promising initial results for LapiCotton technique in treating collapse of the medial longitudinal arch in patients with PCFD, MA and HV deformities. Long-term results are needed to confirm these promising results. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Amanda Ehret
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Jennifer Walt
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | | | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Kepler Alencar Mendes de Carvalho
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Tutku Erim Tazegul
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Matthieu Lalevee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
| | - Nacime Salomão Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Department of Orthopedics and Traumatology, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
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