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Kang YS, Chan T, Wilkinson A. Immediate Weightbearing after Modified Lapidus Arthrodesis Using a Medial Plate: A Retrospective Descriptive Cohort Study. J Foot Ankle Surg 2024:S1067-2516(24)00138-8. [PMID: 38944232 DOI: 10.1053/j.jfas.2024.06.004] [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: 01/22/2024] [Revised: 05/18/2024] [Accepted: 06/09/2024] [Indexed: 07/01/2024]
Abstract
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 nonweightbearing 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 nonweightbearing 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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Affiliation(s)
- Yang S Kang
- Department of Podiatric Surgery, Derbyshire Community Health Services NHS Foundation Trust, Ilkeston, Derbyshire, United Kingdom.
| | - Tommy Chan
- Department of Podiatric Surgery, Derbyshire Community Health Services NHS Foundation Trust, Ilkeston, Derbyshire, United Kingdom; Department of Podiatric Surgery, Doncaster & Bassetlaw Hospitals NHS Foundation Trust, Mexborough, South Yorkshire, United Kingdom; Coriel Orthopaedic Group, Doncaster, United Kingdom
| | - Antony Wilkinson
- Department of Podiatric Surgery, Doncaster & Bassetlaw Hospitals NHS Foundation Trust, Mexborough, South Yorkshire, United Kingdom; Coriel Orthopaedic Group, Doncaster, United Kingdom
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2
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Kane LA, Weintraub MLR, Mitchell L, Parker M, King CM, Pollard JD. Secondary Surgery Following Lapidus Bunionectomy. J Foot Ankle Surg 2024:S1067-2516(24)00114-5. [PMID: 38914154 DOI: 10.1053/j.jfas.2024.05.011] [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: 02/21/2024] [Revised: 05/22/2024] [Accepted: 05/25/2024] [Indexed: 06/26/2024]
Abstract
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 9-year period was performed. The incidence rates and 95% confidence intervals (CI) of secondary surgery in the 3 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 2540 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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Affiliation(s)
- Lewis A Kane
- Department of Podiatric Surgery, Kaiser Permanente Diablo Service Area, Walnut Creek, CA
| | | | - Logan Mitchell
- Department of Podiatric Surgery, Sutter Medical Foundation, Yuba City, CA
| | | | - Christy M King
- Department of Podiatric Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | - Jason D Pollard
- Department of Podiatric Surgery, Kaiser Permanente Oakland, Oakland, CA.
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3
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Rigby RB, McWilliam JR, Jenkins BT. Tension Side Fixation for Lapidus Arthrodesis: A Retrospective Analysis. J Foot Ankle Surg 2024; 63:372-375. [PMID: 38266808 DOI: 10.1053/j.jfas.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/19/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
Moderate to severe hallux valgus deformity often requires a Lapidus procedure (first-tarsometatarsal arthrodesis). Traditional methods include a dorsal approach with dorsal or medial fixation. However, studies demonstrate plantar/tension-side fixation, provides superior load to failure and fixation strength. This could improve outcomes, address comorbidities, and accelerate postoperative protocols; however, a paucity exists for patient outcomes in the literature regarding tension-side-fixation. The purpose of this study is to report the outcomes for tension-side Lapidus fixation. A retrospective analysis was performed of 81 patients who underwent tension-side-fixation Lapidus. Data collection consisted of: time to weight-bear, time to return to regular shoegear, hardware removal rate, revision rate, recurrence rate, relative metatarsal shortening, and nonunion rates. Mean patient age was 44 years old (range: 16-82). There were 65 females, and 16 males. The average time to weightbearing was 10.4 days. Time to return to regular shoegear was a mean of 6 weeks (ranging 2-10 weeks). Hardware removal rate was 1.2%. The recurrence rate was 8.6% (7 of 81 patients) and 5 of those 7 patients experienced recurrence before frontal-plane-correction was adopted by the surgeon. The revision rate was 0% and despite 8.6% recurrence, no patients were dissatisfied or requested a revisional procedure. The first-metatarsal shortening was a mean of 0.42 mm. The complications were as follows: 7% superficial dehiscence, 1.2% superficial wound infection, 0% deep infection, and 1.2% asymptomatic nonunion. This study suggests tension-side-fixation for Lapidus arthrodesis may allow for safe early return to weightbearing, early return to regular shoegear, low hardware removal rate, low revision rate, low metatarsal shortening, and low nonunion rate.
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Affiliation(s)
- Ryan B Rigby
- Logan Regional Orthopedics, Intermountain Healthcare, Logan, UT; Attending, Intermountain Medical Center Podiatry Residency Program, Logan, UT
| | - James R McWilliam
- White Plains Hospital Physicians Associates, White Plains, NY; Assistant Clinical Professor of Orthopaedic Surgery, New York Medical College, Valhalla, NY
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Limaye N, Kotwal T, Alkhalfan Y, Lewis TL, Abbasian A. First tarsometatarsal arthrodesis for severe hallux valgus using the tension band principle - Technical tip and case series. Foot (Edinb) 2024; 58:102069. [PMID: 38325170 DOI: 10.1016/j.foot.2024.102069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/05/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Hallux valgus (HV) is a common foot pathology. Severe HV in the presence of Tarsometatarsal joint (TMTJ) instability is often managed with arthrodesis of the 1st TMTJ. There are concerns regarding non-union and malunion (particularly the early loss of inter-metatarsal angle correction before complete arthrodesis). We report our medium-term results of a small series of patients that underwent an evolved surgical technique utilising orthogonal staples and a transverse suture button fixation to address biomechanical concerns with traditional Lapidus arthrodesis. METHODS A retrospective study of a consecutive series of patients who underwent this surgical technique between February 2017 and May 2022. Clinical outcomes were validated through Patient-reported outcomes measures (PROMS); EuroQol-5 Dimension (EQ-5D) and Manchester-Oxford Foot Questionnaires (MOXFQ). Radiographic parameters (hallux valgus (HVA), intermetatarsal (IMA), distal metatarsal articular angle (DMAA)) were assessed. Union of the arthrodesis and complications were recorded. RESULTS During the study period, 9 feet underwent the procedure. Radiographic data was available for all nine and PROMS data for seven (77.8%). Significant improvement occurred in all radiographic deformity parameters at mean 6-month follow-up. Mean ± standard deviation correction calculated preoperatively as HVA 40.2°, IMA 19.3° and DMAA 15.8°, corrected to HVA 15.4°, IMA 5.8° and DMAA 5.9° postoperatively. (HVA; P < 0.001, IMA; P < 0.001, DMAA; P < 0.001) Clinical PROMs at mean follow-up of 2 years were MOXFQ 34.4 ± 25.2, EQ-5D-5 L 0.819 ± 0.150 and VAS pain 13.6 ± 13.6. There were no cases of non-union, Tibialis anterior tendon irritation or hallux varus. Complications included first MTPJ stiffness in one case and CRPS and dorsiflexion malunion of the first ray in another patient. CONCLUSION This preliminary study of the procedure used in this series confirm this is a safe surgical technique to address severe HV with a low rate of non-union and significant radiographic improvements. A larger patient dataset is needed to evaluate this procedure robustly.
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Affiliation(s)
- Neil Limaye
- Guy's and St Thomas Hospitals NHS Foundation Trust, London, UK
| | - Tejas Kotwal
- Guy's and St Thomas Hospitals NHS Foundation Trust, London, UK
| | | | - Thomas L Lewis
- Guy's and St Thomas Hospitals NHS Foundation Trust, London, UK
| | - Ali Abbasian
- Guy's and St Thomas Hospitals NHS Foundation Trust, Kings College University of London, London, UK.
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King CM, Castellucci-Garza FM. The Lapidus Bunionectomy Revolution: Current Concepts and Considerations. Clin Podiatr Med Surg 2024; 41:43-58. [PMID: 37951678 DOI: 10.1016/j.cpm.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Hallux valgus is a common foot deformity in which many surgical techniques have been introduced. Originally, Paul Lapidus detailed a midfoot arthrodesis technique to address the deformity and medial column instability that served as the foundation for the modified Lapidus bunionectomy. The appreciation of the multiplanar nature of hallux valgus deformity continues to evolve and helps to guide the investigation of the ideal surgical correction to yield more predictable results and reduced complications. Various fixation constructs have been used over the years for the Lapidus bunionectomy without a clear superior fixation technique, and literature supports early weight-bearing with each.
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Affiliation(s)
- Christy M King
- Kaiser San Francisco Bay Area Foot & Ankle Residency Program, Kaiser Oakland Foundation Hospital, 275 MacArthur Boulevard, Clinic 17, Oakland, CA 94611, USA; Foot & Ankle Surgery, Orthopedics and Podiatry Department, Kaiser Oakland, Oakland, CA, USA.
| | - Francesca M Castellucci-Garza
- Kaiser San Francisco Bay Area Foot & Ankle Residency Program, Kaiser Oakland Foundation Hospital, Oakland, CA, USA; Foot & Ankle Surgery, Orthopedics and Podiatry Department, Kaiser Antioch, 4501 Sand Creek Road, Antioch, CA 94531, USA
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Patel S, Dionisopoulos SB, Schmalhaus MJ. Early Functional Rehabilitation in Foot and Ankle Surgery. Clin Podiatr Med Surg 2024; 41:59-71. [PMID: 37951679 DOI: 10.1016/j.cpm.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
The traditional postoperative management of common foot and ankle procedures has involved a prolonged period of immobilization and nonweight bearing. The concern was loss of correction and fixation failure. However, it has been shown that a prolonged period of nonweight bearing can predispose patients possible deep vein thrombosis, disuse osteopenia, cardiovascular complications, and generalized deconditioning. The authors' institution has published studies reviewing the efficacy of early weight bearing after first metatarsophalangeal joint arthrodesis, modified Lapidus bunionectomy, and open reduction and internal fixation of ankle fractures. This article highlights the literature and rationale supporting the safety of early weight-bearing protocols.
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Affiliation(s)
- Sandeep Patel
- San Francisco Bay Area Foot and Ankle Residency, The Permanente Medical Group, Diablo Service Area, 1425 South Main Street, Walnut Creek, CA 94596, USA.
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Paranjape CS, Zhang J, Lalli T, Lin FC, Tennant JN. Radiographic and Patient-Reported Outcomes of a Low-Cost Modified Lapidus Bunion Correction Technique. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231200482. [PMID: 37786608 PMCID: PMC10541767 DOI: 10.1177/24730114231200482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Background The modified Lapidus (ML) is a powerful procedure for correction of hallux valgus (HV) with emerging techniques. Studies considering patient-reported outcomes, radiographic measures, complications, and implant costs are currently limited. Methods Retrospective cohort with prospectively collected Patient Reported Outcome Information System Physical Function (PROMIS-PF) Computerized Adaptive Test (CAT) scores, radiographic parameters (intermetatarsal angle, IMA; hallux valgus angle, HVA; and tibial sesamoid position, TSP), complications, and total operative time and implant costs were reviewed from 2014 to 2019. Results Seventy-three feet (68 patients) underwent bunion correction by ML with lag-screw fixation. Median age was 55.8 years (IQR 45.6, 53.9), 4 of 73 (5.5%) were male, 11 of 73 (15.1%) were smokers, and 15 of 73 (20.6%) were diabetic (median HbA1c 6.4% [IQR 6.0, 7.4], none insulin dependent, 5 of 15 with neuropathy). Complications included 6 of 73 (8.2%) wound issues resolved with topical or oral treatment, 9 of 73 (12.3%) painful or broken hardware requiring hardware removal. Two of 73 (2.7%) had persistent pain despite union. One of 73 (1.4%) was overcorrected and required first MTP arthrodesis. Of 3 nonunions (2.7%), 1 resolved with corrected hypothyroidism, 1 was asymptomatic and required no treatment, 1 had a hallux valgus recurrence and sought revision surgery elsewhere. Preoperative radiographic angles were HVA 35 degrees, IMA 14 degrees which improved at final postoperative follow up to HVA 10 degrees, IMA 6 degrees. Tibial sesamoid position improved from 6.05 ± 1.00 to 2.22 ± 1.38. Thirty-two patients had preoperative and 42 had 1-year postoperative outcomes. PROMIS-PF (51% collection rate) was 43 (IQR 37,52) preoperatively, 37 (31, 39) at 6 weeks, 46 (42, 51) at 3 months, and 49 (41, 53) at >360 days postoperatively. The drop in PROMIS-PF between preoperative and 6 weeks and the rise from 6 weeks to 3 months were statistically significant. Pre- and postoperative PROMIS-PF scores were not significantly different. Implant cost averaged US$146. Discussion/Conclusion We report low complication rates and costs with high patient postoperative functional and radiographic outcomes. PROMIS-PF decreased acutely postoperatively but recovered and maintained high levels by 3 months postoperatively. Level of Evidence Level IV, case series.
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Affiliation(s)
| | - Jingru Zhang
- University of North Carolina, Chapel Hill, NC, USA
| | - Trapper Lalli
- University of North Carolina System, Chapel Hill, NC, USA
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Cardoso DV, Veljkovic A. General Considerations About Foot and Ankle Arthrodesis. Any Way to Improve Our Results? Foot Ankle Clin 2022; 27:701-722. [PMID: 36368793 DOI: 10.1016/j.fcl.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nonunion and adjacent joint osteoarthritis (OA) are known complications after a fusion procedure, and foot and ankle surgeons are commonly exposed to such disabling complications. Determining who is at risk of developing nonunion is essential to reducing nonunion rates and improving patient outcomes. Several evidenced-based modifiable risk factors related to adverse outcomes after foot and ankle arthrodesis have been identified. Patient-related risk factors that can be improved before surgery include smoking cessation, good diabetic control (HbAc1 <7%) and vitamin D supplementation. Intraoperatively, using less invasive techniques, avoiding joint preparation with power tools, using bone grafts or orthobiologics in more complex cases, high-risk patients, nonunion revision surgeries, and filling in bone voids at the arthrodesis site should be considered. Postoperatively, pain management with NSAIDs should be limited to a short period (<2 weeks) and avoided in high-risk patients. Furthermore, early postoperative weight-bearing has shown to be beneficial, and it does not seem to increase postoperative complications. The incidence of surrounding joint OA after foot and ankle fusion seems to increase progressively with time. Owing to its progression and high probability of being symptomatic, patients must be informed consequently, as they may require additional joint fusions, resulting in further loss of ankle/foot motion. In patients with symptomatic adjacent joint OA and unsatisfactory results after an ankle arthrodesis, conversion to total ankle arthroplasty (TAA) has become a potential option in managing these complex and challenging situations.
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Affiliation(s)
- Diogo Vieira Cardoso
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland.
| | - Andrea Veljkovic
- Division of Orthopaedics and Trauma Surgery, British Columbia University, Vancouver, Canada
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Liu GT, Chhabra A, Dayton MJ, Dayton PD, Duke WJ, Farber DC, Hatch DJ, Kile DA, Koay J, McAleer JP, Raissi A, Raspovic KM, Santrock RD, Taylor RP, VanPelt MD, Wukich DK. One- and Two-Year Analysis of a Five-Year Prospective Multicenter Study Assessing Radiographic and Patient-Reported Outcomes Following Triplanar First Tarsometatarsal Arthrodesis With Early Weightbearing for Symptomatic Hallux Valgus. J Foot Ankle Surg 2022; 61:1308-1316. [PMID: 35613971 DOI: 10.1053/j.jfas.2022.04.008] [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: 12/19/2021] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 02/03/2023]
Abstract
We report one- and 2-year results of a prospective, 5-year, multicenter study of radiographic, clinical, and patient-reported outcomes following triplanar first tarsometatarsal arthrodesis with early weightbearing. One-hundred and seventeen patients were included with a mean (95% confidence interval [CI]) follow-up time of 16.6 (15.5, 17.7) months. Mean (95% CI) time to weightbearing in a boot walker was 7.8 (6.6, 9.1) days, mean time to return to athletic shoes was 45.0 (43.5, 46.6) days, and mean time to return to unrestricted activity was 121.0 (114.5, 127.5) days. There was a significant improvement in radiographic measures with a mean corrective change of -18.0° (-19.6, -16.4) for hallux valgus angle, -8.3° (-8.9, -7.8) for intermetatarsal angle and -2.9 (-3.2, -2.7) for tibial sesamoid position at 12 months (n = 108). Additionally, there was a significant improvement in patient-reported outcomes (Visual Analog Scale, Manchester-Oxford Foot Questionnaire, and Patient-Reported Outcomes Measurement Information System) and changes were maintained at 12 and 24 months postoperatively. There was 1/117 (0.9%) reported recurrence of hallux valgus at 12 months. There were 16/117 (13.7%) subjects who experienced clinical complications of which 10/117 (8.5%) were related to hardware. Of the 7/117 (6.0%) who underwent reoperation, only 1/117 (0.9%) underwent surgery for a nonunion. The results of the interim report of this prospective, multicenter study demonstrate favorable clinical and radiographic improvement of the HV deformity, early return to weightbearing, low recurrence, and low rate of complications.
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Affiliation(s)
- George T Liu
- Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Avneesh Chhabra
- Professor of Radiology & Orthopedic Surgery, Chief of Musculoskeletal Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mindi J Dayton
- Foot and Ankle Center of Iowa/Midwest Bunion Center, Ankeny, IA
| | - Paul D Dayton
- Foot and Ankle Center of Iowa/Midwest Bunion Center, Ankeny, IA
| | | | - Daniel C Farber
- Associate Professor of Orthopaedic Surgery, Vice Chair for Education, University of Pennsylvania Medicine, Perelman School of Medicine, Philadelphia, PA
| | | | | | - Jennifer Koay
- Associate Professor of Radiology, West Virginia University, School of Medicine, Morgantown, WV
| | | | | | - Katherine M Raspovic
- Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Michael D VanPelt
- Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane K Wukich
- Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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Do DH, Sun JJ, Wukich DK. Modified Lapidus Procedure and Hallux Valgus: A Systematic Review and Update on Triplanar Correction. Orthop Clin North Am 2022; 53:499-508. [PMID: 36208892 DOI: 10.1016/j.ocl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This review article examines contemporary methods and assesses radiographic outcomes and postoperative complications following the modified Lapidus procedure. A systematic review demonstrated significant improvements in intermetatarsal angle, hallux valgus angle, and tibial sesamoid position. We are updating a modified Lapidus technique for achieving triplanar correction of hallux valgus. Two cases of hallux valgus, one primary and one recurrent, are presented. As demonstrated in the systematic review, outcomes of Lapidus procedures create future opportunities. Surprisingly, only 78% of the studies assessed for this review reported on the hallux valgus angle and only 33% reported on tibial sesamoid position.
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Affiliation(s)
- Dang-Huy Do
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA
| | - Joshua Jian Sun
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA
| | - Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA.
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11
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King CM, Doyle MD, Castellucci-Garza FM, Lyon L, Richey J, Patel S, Collman DR. Addressing Transverse Plane Instability in the Modified Lapidus Arthrodesis: A Comparative Study of Screw Versus Suture and Button Fixation Device Technique. J Foot Ankle Surg 2022; 61:979-985. [PMID: 35491340 DOI: 10.1053/j.jfas.2021.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/02/2021] [Accepted: 12/13/2021] [Indexed: 02/03/2023]
Abstract
The Lapidus arthrodesis is a powerful procedure for the correction of hallux valgus with metatarsus primus varus. Yet, first ray instability may persist despite correction of the primary deformity with 2 crossed screw fixation. A third screw is often utilized as the additional point of fixation for noteworthy residual transverse plane motion, but it is not without potential complications. The suture and button fixation device may be an appropriate alternative to the third screw construct. This retrospective cohort study identified clinical / radiographic outcomes and complication rates following a third point of fixation with either a screw or suture and button fixation device in patients undergoing a modified Lapidus arthrodesis. One surgeon performed all of the Lapidus procedure with a third screw while the other surgeon performed all with a suture and button fixation device. Of 136 consecutive patients who underwent a modified Lapidus arthrodesis, 83 (61%) patients required a third point of fixation for satisfactory stabilization of the first ray. Surgical technique was similar between the 2 surgeons; however, one utilized the suture and button fixation device method (n = 36), while the other used a third screw for fixation (n = 47). Many of the clinical outcomes, radiographic results, and the union rate were similar between the 2 methods. Nineteen (40%) complications occurred in the third screw group compared to 6 (17%) in the suture and button fixation device group. However, the third screw group demonstrated 100% maintenance of deformity correction at 1 year versus 95% in the suture and button fixation device group. Although fixation with a suture and button fixation device was associated with fewer complications, a larger study is necessary to determine if these variations are statistically significant.
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Affiliation(s)
- Christy M King
- Residency Director and Attending Staff, Department of Orthopedics, Kaiser San Francisco Bay Area Foot and Ankle Residency Program Kaiser Foundation Hospital, Oakland, CA.
| | - Matthew D Doyle
- Foot and Ankle Surgeon, Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, CA
| | - Francesca M Castellucci-Garza
- Attending Staff, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics, Kaiser Foundation Hospital, Antioch, CA
| | - Liisa Lyon
- Senior Data Consultant, Division of Research, Kaiser Permanente, Oakland, CA
| | | | - Sandeep Patel
- Attending Staff, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics, Kaiser Foundation Hospital, Antioch, CA
| | - David R Collman
- Attending Staff, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics, Kaiser Foundation Hospital, San Francisco, CA
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Meyr AJ, Doyle MD, King CM, Kwaadu KY, Nasser EM, Ramdass R, Theodoulou MH, Zarick CS. The American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Hallux Valgus. J Foot Ankle Surg 2022; 61:369-383. [PMID: 34706857 DOI: 10.1053/j.jfas.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | - Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship - Palo Alto Medical Foundation, Mountain View, CA
| | - Christy M King
- Residency Director, Kaiser San Francisco Bay Area Foot & Ankle Residency Program and Attending Surgeon, Kaiser Foundation Hospital, Oakland, CA
| | - Kwasi Y Kwaadu
- Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| | | | - Roland Ramdass
- Residency Training Committee, INOVA Fairfax Medical Campus, Fairfax, VA
| | - Michael H Theodoulou
- Chief Division of Podiatric Surgery, Cambridge Health Alliance, and Instructor of Surgery, Harvard Medical School, Boston, MA
| | - Caitlin S Zarick
- Assistant Professor, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
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13
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Del Vecchio JJ, Cordier G, Dealbera ED, Slullitel G, Lopez V, Manzanares-Céspedes MC, Dalmau-Pastor M. Correction Power of Percutaneous Adductor Tendon Release (PATR) for the Treatment of Hallux Valgus: A Cadaveric Study. J Foot Ankle Surg 2021; 60:1103-1109. [PMID: 34039513 DOI: 10.1053/j.jfas.2021.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 01/19/2021] [Accepted: 02/21/2021] [Indexed: 02/03/2023]
Abstract
Osteotomies are commonly used in order to correct hallux valgus deformity. However, soft tissue structures also play an essential role in the etiology, progression, and treatment of hallux valgus (HV). The purpose of the present study was to analyze the correcting power (varus), reduction strength (sesamoid) and rotation of metatarsal and proximal phalanx after percutaneous adductor tendon release (PATR). To date, no study addresses this issue. Eleven cadaveric fresh-frozen below-the-knee cadaveric lower limbs with associated hallux valgus deformity were used. These specimens were subjected to a constant abduction force after PATR. HV and intermetatarsal angles showed statistically significant differences when comparing the preoperative and postoperative periods. PATR showed to be a reliable technique as the adductor tendon was completely released in 9 cases, and 75% released in the remaining 2 feet. The study supports that PATR provides powerful and quantifiable correction of HV deformity and can be accurately performed percutaneously.
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Affiliation(s)
- Jorge Javier Del Vecchio
- Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro-Hospital Universitario-Solis 461, Ciudad Autónoma de Buenos Aires (CABA), Argentine; Department of Kinesiology and Physiatry, Universidad Favaloro, CABA, Argentina; Minimally Invasive Foot and Ankle Society (MIFAS by Grecmip), Merignac, France.
| | - Guillaume Cordier
- Minimally Invasive Foot and Ankle Society (MIFAS by Grecmip), Merignac, France; Clinique du Sport Bordeaux-Mérignac, Institut du Sport, Merignac, France
| | - Eric Daniel Dealbera
- Foot and Ankle Surgery and Limb Salvage Fellowship, Foot and Ankle Section, Fundación Favaloro-Hospital Universitario, Ciudad Autónoma de Buenos Aires (CABA), Buenos Aires, Argentina
| | - Gastón Slullitel
- Department of Foot and Ankle Surgery, Institute of Orthopedics "Dr. Jaime Slullitel", Santa Fe, Argentina
| | - Valeria Lopez
- Department of Foot and Ankle Surgery, Institute of Orthopedics "Dr. Jaime Slullitel", Santa Fe, Argentina
| | - Maria Cristina Manzanares-Céspedes
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Miki Dalmau-Pastor
- Minimally Invasive Foot and Ankle Society (MIFAS by Grecmip), Merignac, France; Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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14
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Brissey N, Buffington A, Bush W. Early Results of Immediate Weightbearing Following First Tarsometatarsal Joint Arthrodesis With Plantar Locking Plate and Dorsal Compression Screw. J Foot Ankle Surg 2021; 60:494-500. [PMID: 33509719 DOI: 10.1053/j.jfas.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 10/09/2019] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
Arthrodesis of the first tarsometatarsal joint (TMT1) reduces pathologic angles at the anatomic center of rotation of angulation and presents a substantial correction potential in 3 planes in the treatment of hallux abductovalgus. The optimal fixation method remains unclear since prevailing dorsomedial locking plates and/or compression screws depict elevated implant-associated complications. Medical records of 49 patients that underwent 53 TMT1 arthrodeses in hallux abductovalgus interventions were included. Median average visual analog scale scores decreased (p < .001) from 6.8 (range 4-10) to 2.7 (range 0-10), first intermetatarsal angles were reduced (p < .001) from 17.39° (range 12°-28°) to 7.16° (range 3°-12°), standing lateral first metatarsal angles improved (p < .001) from 21.66° (range 12°-29°) to 23.94° (range 14°-31°) and tibial sesamoid positions were plantarized (p < .001) from 6.02° (range 4°-7°) to 2.79° (range 1°-6°). Plantar plating allowed immediate weightbearing with transition to normal shoe gear at 6 weeks. Complications occurred in 6 (11.34%) feet including 1 (1.89%) nonunion, 1 (1.89%) delayed union, 1 (1.89%) hallux varus, 1 (1.89%) incomplete recurrence, 1 (1.89%) minor dehiscence, and 1 (1.89%) hardware irritation. Plantar locking plates combined with a dorsal compression screw presented a favorable tension-side implant location that closed the fusion site under load. This facilitated substantial reductions in complications, pathologic angles, and pain.
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Affiliation(s)
| | - Adam Buffington
- Resident, Podiatric Medicine and Surgery Program, OSF Saint Anthony Medical Center, Rockford IL
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15
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Ehredt DJ, Kawalec J, Ligas C, Seidel J, Benson B, Reiner MM, Connors J. The Lapidus Arthrodesis: Examining the Effect of the Metatarsal Base Transfixion Screw. J Foot Ankle Surg 2021; 60:333-338. [PMID: 33349538 DOI: 10.1053/j.jfas.2020.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 02/03/2023]
Abstract
The modified Lapidus bunionectomy is a useful and highly powerful procedure for correcting hallux abducto valgus. Traditionally reserved for "severe" deformities, this procedure has seen a recent resurgence in the podiatric community for its unique ability to achieve tri-planar correction of this challenging deformity. Although this procedure has been extensively studied in both biomechanical labs and the clinical arenas, no clear consensus has been achieved regarding optimal fixation for this thought-provoking procedure. The current study examined the differences in strength between commercially available 5-hole locking plates with interfragmentary compression vs a crossed-screw with a third "transfixation" screw construct in a controlled setting. Ten fresh-frozen cadaveric match pair limbs (20 total limbs) were used to complete this study. Ten limbs were randomly assigned to a 3-screw construct. The other 10 contralateral limbs were assigned to a commercially available 5-hole locking plate (5 stainless steel and 5 titanium alloy) with an interfragmentary lag screw construct. The first rays were then isolated and potted into a 4-point bending device. The specimens were loaded to failure in a servohydraulic load frame at a controlled rate. Failure was defined as catastrophic or 3 mm of plantar gapping at the arthrodesis site. The mean maximal load to failure was 310.9 ± 109.4 N for the 3-screw construct. The mean maximal load to failure for the locking plate constructs was 264.1 ± 100.9 N. This difference was not statistically significant (p = .328). These results suggest that a 3-screw construct for Lapidus arthrodesis is as strong as commercially available locking plate constructs.
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Affiliation(s)
- Duane J Ehredt
- Associate Professor, Division of Foot and Ankle Surgery, Kent State University College of Podiatric Medicine, Independence, OH.
| | - Jill Kawalec
- Professor and Director of Research, Kent State University College of Podiatric Medicine, Independence, OH
| | - Chandler Ligas
- Podiatric Medical Student, Kent State University College of Podiatric Medicine, Independence, OH
| | - Joslin Seidel
- Podiatric Medical Student, Kent State University College of Podiatric Medicine, Independence, OH
| | - Bradley Benson
- Podiatric Medicine and Surgery Resident, Saint Vincent Charity Medical Center, Cleveland, OH
| | | | - James Connors
- Assistant Professor, Division of Foot and Ankle Surgery, Kent State University College of Podiatric Medicine, Independence, OH
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16
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Long J, Lauf JA, Whitehead B, Cheney N, Law TD. Recurrence of Hallux Valgus After Modified Lapidus Procedure With Successful Fusion of the Intermetatarsal and Intercuneiform Joints. Cureus 2021; 13:e15418. [PMID: 34249565 PMCID: PMC8254418 DOI: 10.7759/cureus.15418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 11/05/2022] Open
Abstract
Background The Lapidus procedure has become a popular procedure in correcting hallux valgus deformities and has undergone several modifications in an effort to improve the efficacy of the procedure. The senior author modifies this procedure with the addition of an intermetatarsal and intercuneiform fusion. Our hypothesis is that this will improve the procedure outcomes and decrease deformity recurrence. Methods We reviewed patient charts who underwent the procedure between 2014 and 2017 performed by the senior author. This yielded 47 reviewable cases, with 34 meeting study criteria. The cases were analyzed for standard hallux valgus measurements (intermetatarsal angle [IMA], hallux valgus angle [HVA]) and fusion on X-ray. Results The results of the study showed partial intermetatarsal and intercuneiform fusion failure in seven (20%) cases, and one case where the great toe fell into varus. These cases were excluded. In the remaining cases, there was a statistically significant improvement in the HVA and IMA between the preoperative X-ray and first postoperative X-ray. Additionally, there was no significant difference between HVA and IMA between first and final postoperative radiographs. There was a significant increase in IMA for the fusion failure cases (p=0.001). Conclusion Clinically, our findings demonstrate that successful union is possible with low recurrence and complication rates when using this modification of the Lapidus procedure in patients with hallux valgus deformity.
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Affiliation(s)
- Joseph Long
- Medicine, The Ohio State University College of Medicine, Columbus, USA
| | - Jason A Lauf
- Orthopedic Surgery, Ohio University Heritage College of Osteopathic Medicine, Dublin, USA
| | - Brent Whitehead
- Orthopedic Surgery, Ohio University Heritage College of Osteopathic Medicine, Dublin, USA
| | - Nick Cheney
- Orthopedic Surgery, Ohio University Heritage College of Osteopathic Medicine, Columbus, USA
| | - Timothy D Law
- Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, USA
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17
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Vaida J, Ray JJ, Shackleford TL, DeCarbo WT, Hatch DJ, Dayton P, McAleer JP, Smith WB, Santrock RD. Effect on Foot Width With Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420934804. [PMID: 35097396 PMCID: PMC8697068 DOI: 10.1177/2473011420934804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Foot width reduction is a desirable cosmetic and functional outcome for patients with hallux valgus. Triplanar first tarsometatarsal (TMT) arthrodesis could achieve this goal by 3-dimensional correction of the deformity. The aim of this study was to evaluate changes in bony and soft tissue width in patients undergoing triplanar first TMT arthrodesis. METHODS After receiving Institutional Review Board approval, charts were retrospectively reviewed for patients undergoing triplanar first TMT arthrodesis for hallux valgus at 4 institutions between 2016 and 2019. Patients who underwent concomitant first metatarsal head osteotomies (eg, Silver or Chevron) or fifth metatarsal osteotomies were excluded. Preoperative and postoperative anteroposterior weightbearing radiographs were compared to evaluate for changes in bony and soft tissue width. One hundred forty-eight feet from 144 patients (48.1 ± 15.7 years, 92.5% female) met inclusion criteria. RESULTS Preoperative osseous foot width was 96.2 mm, compared to 85.8 mm postoperatively (P < .001). Preoperative soft tissue width was 106.6 mm, compared to 99.3 mm postoperatively (P < .001). Postoperatively, patients had an average 10.4 ± 4.0 mm reduction (10.8% reduction) in osseous width and average 7.3 ± 4.0 mm reduction (6.8% reduction) in soft tissue width. CONCLUSIONS Triplanar first TMT arthrodesis reduced both osseous and soft tissue foot width, providing a desirable cosmetic and functional outcome for patients with hallux valgus. Future studies are needed to determine if patient satisfaction and outcome measures correlate with reductions in foot width. Level of evidence: Level III, retrospective comparative study.
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Affiliation(s)
- Justin Vaida
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Justin J Ray
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | | | | | - Daniel J Hatch
- Foot and Ankle Center of Northern Colorado, Greeley, CO, USA
| | - Paul Dayton
- Foot & Ankle Center of Iowa, Midwest Bunion Center, Ankeny, IA, USA
| | - Jody P McAleer
- Jefferson City Medical Group, Department of Podiatry, Jefferson City, MO, USA
| | - W Bret Smith
- Mercy Orthopedic Associates, Mercy Regional Medical Center, Durango, CO, USA
| | - Robert D Santrock
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
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18
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Abstract
Postoperative management of hallux valgus varies widely. Setting preoperative expectations is an important aspect of attaining a successful outcome, but this is not routinely reviewed in the literature. This chapter offers suggestions on successfully navigating this area of patient care. Current concepts focus on pain control, immobilization, and return to activities. This chapter also reviews the current literature in these areas and sets out the authors' preferred management in the postoperative setting.
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Affiliation(s)
- William A Hester
- Sidney Kimmel Medical College, Thomas Jefferson University, The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
| | - David I Pedowitz
- Foot & Ankle Fellowship, Sidney Kimmel Medical College, Thomas Jefferson University, The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
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19
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Boffeli TJ, Hyllengren SB. Can We Abandon Saw Wedge Resection in Lapidus Fusion? A Comparative Study of Joint Preparation Techniques Regarding Correction of Deformity, Union Rate, and Preservation of First Ray Length. J Foot Ankle Surg 2019; 58:1118-1124. [PMID: 31562062 DOI: 10.1053/j.jfas.2019.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/30/2019] [Accepted: 02/01/2019] [Indexed: 02/03/2023]
Abstract
The traditional joint preparation technique for Lapidus fusion involves wedge resection using a saw to achieve correction of intermetatarsal angular deformity. The main drawback of this approach is undesirable shortening of the first ray, which can predispose to second ray overload that may preclude the procedure for a subset of patients or may necessitate second metatarsal shortening osteotomy. The goal of this study was to determine whether a first ray length-preserving joint preparation technique (curette and bur) achieves equivalent correction of deformity and fusion rate without first ray shortening compared with the standard saw wedge resection technique. A retrospective review of consecutive cases from January 2007 to August 2014 identified 62 patients who underwent 65 Lapidus fusions for hallux valgus correction with crossed-screw fixation. All patients treated from 2007 to 2010 had saw wedge resection, whereas all patients treated from 2011 to 2014 had curette and bur joint preparation without use of a saw. The mean intermetatarsal angle correction was 9.06° (range 5° to 14.7°) in the saw wedge resection group and 8.11° (range 2.8° to 15.5°) in the curette and bur group, a difference that was not statistically significant. The mean amount of first ray shortening was -3.14 (range -6.1 to 0) mm in the saw wedge resection group and -0.86 (range -2.3 to 4.2) mm in the curette and bur group, a result that was statistically significant. Osseous union was confirmed radiographically at 10 weeks postoperatively in all cases. These findings suggest that first ray length can be preserved using a more conservative joint preparation technique regardless of preoperative deformity, without compromising correction of deformity or union rate.
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Affiliation(s)
- Troy J Boffeli
- Director, Foot and Ankle Surgical Residency Program, Regions Hospital/HealthPartners Institute for Education and Research, St. Paul, MN
| | - Shelby B Hyllengren
- Foot and Ankle Surgeon, Allina Health Cambridge Medical Center, Cambridge, MN.
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20
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Ray JJ, Koay J, Dayton PD, Hatch DJ, Smith B, Santrock RD. Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing. Foot Ankle Int 2019; 40:955-960. [PMID: 31056950 DOI: 10.1177/1071100719847700] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus is a multiplanar deformity of the first ray. Traditional correction methods prioritize the transverse plane, a potential factor resulting in high recurrence rates. Triplanar first tarsometatarsal (TMT) arthrodesis uses a multiplanar approach to correct hallux valgus in all 3 anatomical planes at the apex of the deformity. The purpose of this study was to investigate early radiographic outcomes and complications of triplanar first TMT arthrodesis with early weightbearing. METHODS Radiographs and charts were retrospectively reviewed for 57 patients (62 feet) aged 39.7 ± 18.9 years undergoing triplanar first TMT arthrodesis at 4 institutions between 2015 and 2017. Patients were allowed early full weightbearing in a boot walker. Postoperative radiographs were compared with preoperative radiographs for hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), and lateral round sign. Any complications were recorded. RESULTS Radiographic results demonstrated significant improvements in IMA (13.6 ± 2.7 degrees to 6.6 ± 1.9 degrees), HVA (24.2 ± 9.3 degrees to 9.7 ± 5.1 degrees), and TSP (5.0 ± 1.3 to 1.9 ± 0.9) from preoperative to final follow-up (P < .001). Lateral round sign was present in 2 of 62 feet (3.2%) at final follow-up compared with 52 of 62 feet (83.9%) preoperatively. At final follow-up, recurrence was 3.2% (2/62 feet), and the symptomatic nonunion rate was 1.6% (1/62 feet). Two patients required hardware removal, and 2 patients required additional Akin osteotomy. CONCLUSION Early radiographic outcomes of triplanar first TMT arthrodesis with early weightbearing were promising with low recurrence rates and maintenance of correction. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Justin J Ray
- 1 Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
| | - Jennifer Koay
- 2 Department of Radiology, West Virginia University, Morgantown, WV, USA
| | | | - Daniel J Hatch
- 4 Department of Podiatric Medicine and Surgery, North Colorado PMS Residency, Greeley, CO, USA
| | - Bret Smith
- 5 Orthopedics, University of South Carolina, Palmetto Health-USC Orthopedic Center, Lexington, SC, USA
| | - Robert D Santrock
- 1 Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
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21
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Crowell A, Van JC, Meyr AJ. Early Weightbearing After Arthrodesis of the First Metatarsal-Medial Cuneiform Joint: A Systematic Review of the Incidence of Nonunion. J Foot Ankle Surg 2019; 57:1204-1206. [PMID: 30253966 DOI: 10.1053/j.jfas.2018.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Indexed: 02/03/2023]
Abstract
Arthrodesis of the first metatarsal-medial cuneiform articulation is a reliable and effective surgery for correction of hallux abducto valgus deformity. However, one potential relative contraindication to the procedure is the extended period of non-weightbearing immobilization that is typically associated with the postoperative course. The objective of this investigation was to perform a systematic review of the incidence of nonunion after early weightbearing in patients who underwent arthrodesis of the first metatarsal-medial cuneiform articulation for correction of a hallux abducto valgus deformity. We performed a review of electronic databases with the inclusion criteria of retrospective case series, retrospective clinical cohort analyses, and prospective clinical trials with 15 or more participants; a mean follow-up period ≥12 months; a postoperative early weightbearing protocol (defined as ≤2 weeks); a clear description of the fixation construct; and a reported incidence rate of nonunion. Eight studies met our inclusion criteria, with a total of 443 arthrodeses analyzed. Of these, 16 (3.61%) were described as developing a nonunion. This would likely be considered an acceptable rate of nonunion when considering this procedure and might indicate that the Lapidus procedure does not always require an extended period of postoperative non-weightbearing immobilization.
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Affiliation(s)
- Amanda Crowell
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Jennifer C Van
- Clinical Assistant Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Andrew J Meyr
- Clinical Assistant Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
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22
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Dayton P, Hatch DJ, Santrock RD, Smith B. Biomechanical Characteristics of Biplane Multiplanar Tension-Side Fixation for Lapidus Fusion. J Foot Ankle Surg 2018; 57:766-770. [PMID: 29752220 DOI: 10.1053/j.jfas.2018.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Indexed: 02/03/2023]
Abstract
Although plating on the plantar, tension-side of the metatarsocuneiform joint provides an inherent biomechanical advantage for Lapidus arthrodesis, it has not been widely adopted owing to the morbidity associated with plantar application. To overcome these limitations, a modification to 90-90 locked biplanar plating was developed to provide the biomechanical advantages of multiplanar fixation and tension-side fixation, allowing application through a conventional incision. We tested the hypothesis that biplanar plating with tension-side fixation (low-profile straight dorsal plate and anatomic medial-plantar plate) would demonstrate improved mechanical stability compared with a previously tested 90-90 biplanar construct (small straight plate dorsally and medially) under cyclic loading. Both constructs were tested in static load to failure (3 pairs) and cyclic loading (10 pairs) with plantar cantilever bending using surrogate anatomic bone models. With static ultimate failure, the biplanar plate construct with tension-side fixation failed at a significantly greater failure load than did the straight biplanar plate construct (247.3 ± 18.4 N versus 210.9 ± 10.4 N; p = .04). With cyclic failure testing, the biplanar plate construct with tension-side fixation endured a significantly greater number of cycles (206,738 ± 49,103 versus 101,780 ± 43,273; p < .001) and a significantly greater dynamic failure load (207.5 ± 24.3 N versus 162.5 ± 20.6 N; p < .001) compared with the straight biplanar plate construct. These results have demonstrated that under simulated static and cyclic Lapidus arthrodesis loading, biplanar plating with tension-side fixation provides superior strength compared with the straight biplanar construct. Thus, this construct shows promise for clinical application as a practical approach to tension-side fixation and an early return to weightbearing after Lapidus fusion.
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Affiliation(s)
- Paul Dayton
- Assistant Professor, College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA.
| | - Daniel J Hatch
- Surgical Director, Podiatric Medicine and Surgery Residency Program, Northern Colorado Medical Center, Greeley, CO
| | - Robert D Santrock
- Associate Professor, Department of Orthopaedics, and Chief, Division of Foot and Ankle Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Bret Smith
- Director, Foot and Ankle Division, Palmetto Health-USC Orthopedic Center, Lexington, SC; Associate Professor, Department of Orthopedics, University of South Carolina, Lexington, SC
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23
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Drummond D, Motley T, Kosmopoulos V, Ernst J. Stability of Locking Plate and Compression Screws for Lapidus Arthrodesis: A Biomechanical Comparison of Plate Position. J Foot Ankle Surg 2018; 57:466-470. [PMID: 29472168 DOI: 10.1053/j.jfas.2017.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Indexed: 02/03/2023]
Abstract
Lapidus (first tarsometatarsal joint) arthrodesis is an established and widely used procedure for the management of moderate to severe hallux valgus, especially in cases involving hypermobility of the first tarsometatarsal joint. Multiple fixation methods are available, and several previous investigations have studied the relative strengths of these methods, including dorsomedial and plantar plating comparisons. However, these studies compared plates of varying designs and mechanical properties and used varying modes of compression and interfragmentary screw techniques. The present study mechanically investigated the resulting motion, stiffness, and strength of identical locking plate constructs fixed at various anatomic positions around the first tarsometatarsal joint. In a bench-top study, fourth-generation composite bones were divided into 3 fixation groups, each having identical interfragmentary screw applications, and randomized to 1 of 3 plate positions: dorsal, medial, or plantar. The plates applied in each case were identical locking plates, precontoured to fit the anatomy. Each construct was experimentally tested using a cantilever bending approach. The outcomes obtained were stiffness, yield force, displacement at yield, ultimate force, and displacement at ultimate force. The plantar plate position showed superior initial stiffness and force to ultimate failure. The plantar and medial plate positions exhibited superior force to yield. The medial plate position was superior regarding displacement tolerated before the yield point and catastrophic failure. The dorsal plate position was not superior for any outcome measured. Plantar and medial plating each offered biomechanical benefits. Clinical studies using similarly matched constructs are required to show whether these findings translate into improved clinical outcomes.
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Affiliation(s)
- David Drummond
- Clinical Instructor, Department of Surgery, Louisiana State University Health Science Center, Shreveport, LA.
| | - Travis Motley
- Associate Professor, Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, TX
| | - Victor Kosmopoulos
- Associate Professor, Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, TX
| | - Jordan Ernst
- Chief Resident, Foot & Ankle Surgery, Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX
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24
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Blackwood S, Gossett L. Hallux Valgus/Medial Column Instability and Their Relationship with Posterior Tibial Tendon Dysfunction. Foot Ankle Clin 2018; 23:297-313. [PMID: 29729803 DOI: 10.1016/j.fcl.2018.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Historically, bunions have focused on the coronal plane; however, there is tension and compression failure in the sagittal plane of the midfoot during arch collapse. Correction of all 3 planes of deformity, coronal, sagittal, and rotational, can be achieved in several ways. Taking a big picture of global foot mechanics by recognizing the common types of conditions associated with arch collapse, including hallux valgus deformities, can serve as a useful roadmap for navigating more complicated deformities where hallux valgus exists.
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Affiliation(s)
- Steven Blackwood
- Orthopaedic Associates of Michigan, 1111 Leffingwell Avenue NE, Grand Rapids, MI 49525, USA.
| | - Leland Gossett
- Spectrum Health - Michigan State University, 221 Michigan Street NE, Suite 402, Grand Rapids, MI 49503, USA
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25
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Yang L, Yang M. Early initiation of zoledronic acid does not impact bone healing or clinical outcomes of hallux valgus orthomorphia. J Int Med Res 2018; 46:3251-3261. [PMID: 29658353 PMCID: PMC6134676 DOI: 10.1177/0300060518760128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This prospective randomized controlled study was performed to determine whether early drug use for osteoporosis impacts bone healing after orthomorphic surgery for hallux valgus (HV) in menopausal patients with osteoporosis. Methods This study included 113 consecutive patients with osteoporosis who underwent a combination of Lapidus arthrodesis and Akin osteotomy for treatment of HV. The patients were randomly divided into a zoledronic acid (ZOL) group (5-mg intravenous injection of ZOL, n = 56) and a placebo group (n = 57); both ZOL and placebo were administered 1 week postoperatively. Radiographs were taken preoperatively and at 1, 6, 8, 10, and 12 weeks postoperatively to record the time of the first tarsometatarsal joint (FTJ) fusion and Akin osteotomy site healing. Clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scoring system 24 weeks after surgery. Results There were no statistically significant differences in the FTJ fusion time after Lapidus arthrodesis, healing time after Akin osteotomy, or postoperative AOFAS scores between the two groups. Conclusion Early initiation of ZOL does not impact the bone healing or clinical outcomes of orthomorphic surgery for HV in postmenopausal women diagnosed with osteoporosis after a combination of Lapidus arthrodesis and Akin osteotomy.
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Affiliation(s)
- Lei Yang
- 1 Department of Orthopedics, the First Hospital of China Medical University, Liaoning, China.,2 Department of Orthopedics, Shenjing Hospital of China Medical University, Shenyang, China
| | - Maowei Yang
- 1 Department of Orthopedics, the First Hospital of China Medical University, Liaoning, China
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26
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Knutsen AR, Fleming JF, Ebramzadeh E, Ho NC, Warganich T, Harris TG, Sangiorgio SN. Biomechanical Comparison of Fixation Devices for First Metatarsocuneiform Joint Arthrodesis. Foot Ankle Spec 2017; 10:322-328. [PMID: 27881829 DOI: 10.1177/1938640016679698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED Common surgical treatment of first tarsal-metatarsal arthritis is by first metatarsocuneiform joint arthrodesis. While crossed-screw and locking plate fixation are the most widely used methods, a novel construct was designed to alleviate soft tissue irritation while still providing stable fixation. Using anatomic first metatarsal and medial cuneiform composites, we compared 3 arthrodesis implants (crossed-screw, dorsal locking plate, and IO Fix) under 2 cyclic bending loading scenarios (cantilever and 4-point bending). Additionally, the optimal orientation (plantar-dorsal or dorsal-plantar) of the IO Fix construct was determined. Failure load, diastasis, joint space angle, and axial and angular stiffness were determined. Both crossed-screw fixation and the IO Fix constructs experienced significantly higher failure loads than the dorsal locking plate during both loading scenarios. Additionally, they had lower plantar diastasis and joint space angle at failure than the plate. Moreover, the plantar-dorsal IO Fix construct was significantly stiffer than the crossed-screw during cantilever bending. Finally, the plantar-dorsal orientation of the IO Fix device had higher failure load and lower diastasis and angle at failure than in the dorsal-plantar orientation. The results suggest that the IO Fix system can reduce motion at the interfragmentary site and ensure compression for healing comparable to that of the crossed-screw fixation. LEVELS OF EVIDENCE Level V: Bench testing.
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Affiliation(s)
- Ashleen R Knutsen
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center, Orthopaedic Institute for Children/UCLA, Los Angeles, California (ARK, EE, NCH, SNS).,Los Angeles County Harbor-UCLA Medical Center, Torrance, California (JFF, TW, TGH)
| | - John F Fleming
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center, Orthopaedic Institute for Children/UCLA, Los Angeles, California (ARK, EE, NCH, SNS).,Los Angeles County Harbor-UCLA Medical Center, Torrance, California (JFF, TW, TGH)
| | - Edward Ebramzadeh
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center, Orthopaedic Institute for Children/UCLA, Los Angeles, California (ARK, EE, NCH, SNS).,Los Angeles County Harbor-UCLA Medical Center, Torrance, California (JFF, TW, TGH)
| | - Nathan C Ho
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center, Orthopaedic Institute for Children/UCLA, Los Angeles, California (ARK, EE, NCH, SNS).,Los Angeles County Harbor-UCLA Medical Center, Torrance, California (JFF, TW, TGH)
| | - Tibor Warganich
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center, Orthopaedic Institute for Children/UCLA, Los Angeles, California (ARK, EE, NCH, SNS).,Los Angeles County Harbor-UCLA Medical Center, Torrance, California (JFF, TW, TGH)
| | - Thomas G Harris
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center, Orthopaedic Institute for Children/UCLA, Los Angeles, California (ARK, EE, NCH, SNS).,Los Angeles County Harbor-UCLA Medical Center, Torrance, California (JFF, TW, TGH)
| | - Sophia N Sangiorgio
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center, Orthopaedic Institute for Children/UCLA, Los Angeles, California (ARK, EE, NCH, SNS).,Los Angeles County Harbor-UCLA Medical Center, Torrance, California (JFF, TW, TGH)
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27
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[Lapidus arthrodesis]. DER ORTHOPADE 2017; 46:424-433. [PMID: 28361194 DOI: 10.1007/s00132-017-3411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The tarso-metatarsal 1 joint (TMT-I) arthrodesis is a treatment option or moderate to severe hallux valgus (HV) deformities. Instability of the TMT1 joint is still a debatable indication. Using stable osteosynthesis techniques allows early postoperative weight bearing. Plantar plating combined with a lag screw is the biomechanical most stable construct. An additional intermetatarsal screw can improve the horizontal stability. Clinical results are good and radiological parameters stay constant, even in the long term.
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28
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Meyr AJ, Mirmiran R, Naldo J, Sachs BD, Shibuya N. American College of Foot and Ankle Surgeons ® Clinical Consensus Statement: Perioperative Management. J Foot Ankle Surg 2017; 56:336-356. [PMID: 28231966 DOI: 10.1053/j.jfas.2016.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Indexed: 02/07/2023]
Abstract
A wide range of factors contribute to the complexity of the management plan for an individual patient, and it is the surgeon's responsibility to consider the clinical variables and to guide the patient through the perioperative period. In an effort to address a number of important variables, the American College of Foot and Ankle Surgeons convened a panel of experts to derive a clinical consensus statement to address selected issues associated with the perioperative management of foot and ankle surgical patients.
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Affiliation(s)
- Andrew J Meyr
- Committee Chairperson and Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | | | - Jason Naldo
- Assistant Professor, Department of Orthopedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Brett D Sachs
- Private Practice, Rocky Mountain Foot & Ankle Center, Wheat Ridge, CO; Faculty, Podiatric Medicine and Surgery Program, Highlands-Presbyterian St. Luke's Medical Center, Denver, CO
| | - Naohiro Shibuya
- Professor, Department of Surgery, Texas A&M, College of Medicine, Temple, TX
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29
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Lui TH. Revision Lapidus Arthrodesis by Bone Endoscopy. Arthrosc Tech 2016; 5:e699-e704. [PMID: 27709024 PMCID: PMC5039734 DOI: 10.1016/j.eats.2016.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/10/2016] [Indexed: 02/03/2023] Open
Abstract
Revision arthrodesis is indicated in symptomatic nonunion of the first tarsometatarsal joint. Revision by first tarsometatarsal arthroscopy cannot deal with the dilated screw tract and associated bone cysts. Revision by bone endoscopy is indicated in symptomatic nonunion of the first tarsometatarsal joint, which is previously fixed by transarticular screw along with loosening of the screw and bone cyst formation. The screw tract makes up the portal tract, with the proximal and distal ends of the tract corresponding to the proximal and distal portals, respectively. In this technical note, we describe zonal debridement and bone grafting of the bone cysts, nonunion site, and the screw tract via the bone endoscopy. This can resolve all the co-pathologies of nonunion of the first tarsometatarsal fusion.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China
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30
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Prissel MA, Hyer CF, Grambart ST, Bussewitz BW, Brigido SA, DiDomenico LA, Lee MS, Reeves CL, Shane AM, Tucker DJ, Weinraub GM. A Multicenter, Retrospective Study of Early Weightbearing for Modified Lapidus Arthrodesis. J Foot Ankle Surg 2016; 55:226-9. [PMID: 26763868 DOI: 10.1053/j.jfas.2015.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Indexed: 02/03/2023]
Abstract
The modified Lapidus arthrodesis is a long-established surgical technique for management of hallux valgus that provides reproducible results and quality patient outcomes. The data from 367 consecutive patients undergoing unilateral modified Lapidus arthrodesis from January 1, 2007 to December 31, 2008 at participating centers were retrospectively evaluated. The included patients were categorized into early weightbearing (≤ 21 days) and delayed weightbearing (> 21 days) groups. A total of 24 nonunions (6.5%) were identified, with 13 (7.1%) in the early weightbearing group and 11 (6.0%) in the delayed weightbearing group. To date, the present study is the largest multicenter investigation to evaluate early weightbearing after modified Lapidus arthrodesis and the only large study to directly compare early and delayed weightbearing. The findings of the present study have shown that early weightbearing for modified Lapidus arthrodesis does not increase the risk of nonunion when evaluating various fixation constructs.
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Affiliation(s)
- Mark A Prissel
- Fellow, Orthopedic Foot and Ankle Center, Westerville, OH
| | | | | | | | - Stephen A Brigido
- Fellowship Director, Foot and Ankle Center at Coordinated Health, Bethlehem, PA
| | | | - Michael S Lee
- Attending Physician, Capital Orthopedics and Sports Medicine, Clive, IA
| | | | - Amber M Shane
- Attending Physician, Orlando Foot and Ankle Clinic, Orlando, FL
| | - Daniel J Tucker
- Fellowship Director, The Southeast Permanente Medical Group, Atlanta, GA
| | - Glenn M Weinraub
- Attending Physician, Department of Orthopaedic Surgery, The Permanente Medical Group, San Leandro, CA
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