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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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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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4
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Narain AS, Curtin PB, Carroll TJ, Swart E, Leeman JJ, Patel AR. Determination of the Inter- and Intra-rater Reliability of Fusion Assessment in First Tarsometatarsal Joint Arthrodesis Using CT Scan: An Observational Study. Indian J Orthop 2024; 58:62-67. [PMID: 38161407 PMCID: PMC10754801 DOI: 10.1007/s43465-023-01033-y] [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: 05/19/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024]
Abstract
Background First tarsometatarsal joint arthrodesis is a common procedure performed by podiatrists and orthopedic surgeons. There remains debate on how useful CT scans are in assessing fusion status in the post-operative patient. The purpose of our study was to determine the reliability among both orthopedic surgeons and radiologists in reviewing both postoperative radiographs and CT in order to determine if fusion had occurred in patients undergoing 1st tarsometatarsal arthrodesis. A secondary purpose of this study was to determine if CT offered improved inter- and intra-rater reliability when compared to plain radiographs. Methods Patients who underwent 1st tarsometatarsal arthrodesis were retrospectively reviewed and those who underwent CT post-operatively for persistent pain were identified. Orthopedic surgeons and radiologists then analyzed the radiographs and CT of these patients for union with a threshold for union being set at 50% of the joint being fused. Imaging was then re-evaluated by the same provider 6 months later. Results 24 patients were identified meeting inclusion criteria. Inter-rater reliability and intra-rater reliability for assessment of 1st tarsometatarsal arthrodesis were better with CT compared to radiographs; however, this association was not deemed reliable. Both imaging modalities were not able to assess union status confidently and reliably across reviewers, although CT scan had better intra-rater reliability. Conclusions While CT is frequently used to assess fusion in patients who have underwent 1st tarsometatarsal arthrodesis, it was not found to be better than radiographs. Practitioners should reconsider the use CT as the gold standard when assessing fusion in this population.
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Affiliation(s)
- Ankur S. Narain
- Department of Orthopaedic Surgery, University of Massachusetts Medical Center, 55 Lake Ave. North, Worcester, MA 01655 USA
| | - Patrick B. Curtin
- Department of Orthopaedic Surgery, University of Massachusetts Medical Center, 55 Lake Ave. North, Worcester, MA 01655 USA
| | - Thomas J. Carroll
- Department of Orthopaedic Surgery, University of Massachusetts Medical Center, 55 Lake Ave. North, Worcester, MA 01655 USA
| | - Eric Swart
- Department of Orthopaedic Surgery, University of Massachusetts Medical Center, 55 Lake Ave. North, Worcester, MA 01655 USA
| | - Joshua J. Leeman
- Department of Radiology, University of Massachusetts Medical Center, 55 Lake Ave. North, Worcester, MA 01655 USA
| | - Abhay R. Patel
- Department of Orthopaedic Surgery, University of Massachusetts Medical Center, 55 Lake Ave. North, Worcester, MA 01655 USA
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Watanabe K, Kubota M, Tanaka H, Nishiyama T, Hirao M, Fukushi JI, Kakihana M, Nozawa D, Okuda R. Japanese Orthopaedic Association (JOA) Clinical Practice Guidelines on the Management of Hallux Valgus - Secondary publication. J Orthop Sci 2024; 29:1-26. [PMID: 37451976 DOI: 10.1016/j.jos.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Kota Watanabe
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Japan.
| | - Makoto Kubota
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirofumi Tanaka
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Hyakutake Orthopedic Surgery and Sports Clinic, Saga, Japan
| | - Takayuki Nishiyama
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Makoto Hirao
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jun-Ichi Fukushi
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masataka Kakihana
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Japan
| | - Daisuke Nozawa
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryuzo Okuda
- Committee of Clinical Practice Guideline on Hallux Valgus, Japan; Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, Kyoto, Japan
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Schilde S, Arbab D, Felsberg M, Kielstein H, Delank KS, Gutteck N. Open vs Minimally Invasive Resection of the First Metatarsocuneiform Joint: An Anatomical Study. Foot Ankle Int 2023; 44:1287-1294. [PMID: 37964442 DOI: 10.1177/10711007231200022] [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: 11/16/2023]
Abstract
BACKGROUND The modified Lapidus arthrodesis is a standard procedure to correct middle to severe hallux valgus (HV) deformities. Recently, minimally invasive techniques of first metatarsocuneiform joint (MCJ) resection using a Shannon burr were described. The primary goal of this study is to compare the anatomical efficacy and safety of first MCJ resection using a straight 2 × 13-mm Shannon burr and minimally invasive technique (MIS) vs an open technique using an oscillating saw. METHODS Ten pairs of fresh frozen cadaveric feet were randomly assigned to open or MIS first MCJ resection with subsequent systematic dissection. For the MIS procedure, a dorsomedial approach was used and for the open procedure a medioplantar approach was used. Cartilage removal was investigated by analyzing standardized scaled photographs of the resected articular surfaces with ImageJ software. Nearby structures at risk were analyzed for iatrogenic violation: tibialis anterior (TA), extensor hallucis longus (EHL) and peroneus longus (PL) tendons, and the Lisfranc ligament complex (LLC). RESULTS In the MIS group, the median cartilage resection was 85.9% at the cuneiform and 85.6% at the metatarsal bone compared to 100% cartilage resection in open technique (P < .01). Iatrogenic damage of the LLC, EHL, and TA tendons was not found in any group. The PL tendon was thinned out (<25% of tendon thickness) in 4 cases (40%) in the open group and in 1 case (10%) in the MIS group. A safe zone of 3.0 mm between the articular surface of the cuneiform bone and the LLC was identified, which can be resected without putting the LLC at risk when performing lateral-based wedge resections. CONCLUSION In this cadaver study with the procedures performed by an experienced foot and ankle surgeon, and using 2 different surgical approaches, we found general parity between the Shannon burr MIS technique vs oscillating saw open technique techniques with more risk to the PL with our open technique and approximately 15% less cartilage resection with our MIS technique. LEVEL OF EVIDENCE Level V, cadaver study.
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Affiliation(s)
- Sebastian Schilde
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Dariusch Arbab
- Department of Orthopaedic and Trauma Surgery, St. Elisabeth-Hospital Herten, Herten, Germany
| | - Maria Felsberg
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Heike Kielstein
- Institute of Anatomy and Cell Biology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Karl-Stefan Delank
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Natalia Gutteck
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Abben KW, Sakow CF, Sorensen T, Chang HC, Boffeli TJ. First Tarsometatarsal Joint Fusion for Hallux Valgus Deformity: A Retrospective Comparison of Two Fixation Constructs Regarding Initial Maintenance of Correction and Complications: Traditional Crossing Screw Fixation Versus Dorsomedial Locking Plate and Intercuneiform Compression Screw. J Foot Ankle Surg 2023; 62:347-354. [PMID: 36272952 DOI: 10.1053/j.jfas.2022.09.002] [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: 01/11/2022] [Revised: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 02/03/2023]
Abstract
Various fixation constructs exist to address hallux valgus when performing a first tarsometatarsal joint arthrodesis. The goal of this present study is to compare complication rates, and degree and maintenance of angular correction between a dorsomedial locking plate with intercuneiform compression screw construct versus traditional crossing solid screw fixation construct. The plate plus intercuneiform compression screw construct fixation utilized a combined sagittal saw and curette method of joint preparation while the crossed screw fixation group utilized a curette and bur technique. A retrospective review was conducted of consecutive patients who underwent a midfoot fusion using either constructs. Sixty four total feet in 56 patients were enrolled in the study. Twenty four consecutive patients (32 feet) who underwent a midfoot arthrodesis using the locking plate and intercuneiform fixation were fully fused (100%) by 10 weeks postoperatively, with no incidents of nonunion and one deep vein thrombosis event. Thirty two consecutive patients (32 feet) who underwent midfoot arthrodesis with crossing screw fixation had 2 nonunion events, one that was asymptomatic and the other that required a revision midfoot fusion. There was a statistically significant improvement from the pre-operative intermetatarsal angle, hallux abductus angle compared to the 10 week and 1 year radiographs (p < .05) for the entire cohort for both fixation constructs. There was a statistically significant increase in American College of Foot and Ankle Surgery first ray scores from pre-op to 1 year follow-up for both fixation constructs. Overall, the dorsomedial locking plate plus intercuneiform compression screw fixation construct better maintains Intermetatarsal angle (IMA) correction at midterm follow-up compared to the traditional crossing screw construct. Both cohorts overall demonstrate similar fusion rates at 10 weeks, nonunion events, incidences of broken hardware, hardware removal, deep vein thrombosis, neuritis at 1 year postoperatively, and hallux varus.
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Affiliation(s)
- Kyle W Abben
- Foot & Ankle Surgical Residency Program, Regions Hospital/HealthPartners Institute, TRIA Orthopedics Maple Grove, Maple Grove, MN
| | - Chloe F Sakow
- Foot & Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, Saint Paul, MN.
| | - Tyler Sorensen
- Foot & Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, Saint Paul, MN
| | - Howard C Chang
- Foot & Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, Saint Paul, MN
| | - Troy J Boffeli
- Foot & Ankle Surgery Residency Program, Regions Hospital/HealthPartners Institute for Education & Research, Saint Paul, MN
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Heifner JJ, Materón SR, Zhang L, Giovanni TPS. Union Rates With the Use of Structural Allograft in Lapidus Arthrodesis: A Comparison Between Two Fixation Constructs. J Foot Ankle Surg 2022; 62:91-95. [PMID: 35752550 DOI: 10.1053/j.jfas.2022.05.004] [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: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 02/03/2023]
Abstract
Although structural allograft has been previously described as acceptable practice for reconstructive foot and ankle surgery, results for an allograft bone wedge in Lapidus arthrodesis are unknown. Additionally, there is no consensus on the superiority of a single fixation construct in Lapidus cases. Our objective was (1) to report union rates for Lapidus arthrodesis with and without the use of an allograft bone wedge and (2) to determine if fixation construct impacts rates of union when using structural allograft. A review was performed for Lapidus cases with fixation constructs of 2 crossed compression screws (CS) and a medial locking plate with single transarticular screw (MPS), both with and without use of an allograft bone wedge. Inclusion required a CT scan to evaluate bony union. There was no significant difference in union rates (p = .41) between the use (90%) and the nonuse (97%) of an allograft bone wedge. Union rates were significantly different (p = .04) when comparing CS fixation (85%) and MPS fixation (98%). The comparative results between the fixation constructs highlight the importance of compression across the arthrodesis site as part of a robust fixation construct. Our findings demonstrate that the use of an allograft bone wedge in Lapidus arthrodesis may mitigate complications due to metatarsal shortening while providing satisfactory rates of union.
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Affiliation(s)
- John J Heifner
- St George's University School of Medicine, Great River, NY.
| | | | - Linglin Zhang
- Kennesaw State University Analytics and Data Science Institute, Kennesaw, GA
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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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Ettinger S, Hemmersbach LC, Schwarze M, Stukenborg-Colsman C, Yao D, Plaass C, Claassen L. Biomechanical Evaluation of Tarsometatarsal Fusion Comparing Crossing Lag Screws and Lag Screw With Locking Plate. Foot Ankle Int 2022; 43:77-85. [PMID: 34351215 PMCID: PMC8772252 DOI: 10.1177/10711007211033541] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tarsometatarsal (TMT) arthrodesis is a common operative procedure for end-stage arthritis of the TMT joints. To date, there is no consensus on the best fixation technique for TMT arthrodesis and which joints should be included. METHODS Thirty fresh-frozen feet were divided into one group (15 feet) in which TMT joints I-III were fused with a lag screw and locking plate and a second group (15 feet) in which TMT joints I-III were fused with 2 crossing lag screws. The arthrodesis was performed stepwise with evaluation of mobility between the metatarsal and cuneiform bones after every application or removal of a lag screw or locking plate. RESULTS Isolated lag-screw arthrodesis of the TMT I-III joints led to significantly increased stability in every joint (P < .05). Additional application of a locking plate caused further stability in every TMT joint (P < .05). An additional crossed lag screw did not significantly increase rigidity of the TMT II and III joints (P > .05). An IM screw did not influence the stability of the fused TMT joints. For TMT III arthrodesis, lag-screw and locking plate constructs were superior to crossed lag-screw fixation (P < .05). TMT I fusion does not support stability after TMT II and III arthrodesis. CONCLUSION Each fixation technique provided sufficient stabilization of the TMT joints. Use of a lag screw plus locking plate might be superior to crossed screw fixation. An additional TMT I and/or III arthrodesis did not increase stability of an isolated TMT II arthrodesis. CLINICAL RELEVANCE We report the first biomechanical evaluation of TMT I-III arthrodesis. Our results may help surgeons to choose among osteosynthesis techniques and which joints to include in performing arthrodesis of TMT I-III joints.
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Affiliation(s)
- Sarah Ettinger
- Department of Orthopedic Surgery, Hannover Medical School at Diakovere Annastift, Hannover, Germany,Sarah Ettinger, MD, Department of Orthopedic Surgery, Hannover Medical School at Diakovere Annastift, Anna-von-Borries-Street 1-7, Hannover, 30625, Germany.
| | | | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | | | - Daiwei Yao
- Department of Orthopedic Surgery, Hannover Medical School at Diakovere Annastift, Hannover, Germany
| | - Christian Plaass
- Department of Orthopedic Surgery, Hannover Medical School at Diakovere Annastift, Hannover, Germany
| | - Leif Claassen
- Department of Orthopedic Surgery, Hannover Medical School at Diakovere Annastift, Hannover, Germany
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11
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McCabe FJ, McQuail PM, Turley L, Hurley R, Flavin RA. Anatomical reconstruction of first ray instability hallux valgus with a medial anatomical TMTJ1 plate. Foot Ankle Surg 2021; 27:869-873. [PMID: 33353832 DOI: 10.1016/j.fas.2020.11.007] [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: 09/02/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND First tarsometatarsal joint (TMTJ1) arthrodesis is a powerful tool for hallux valgus correction. Past criticism of the TMTJ1 arthrodesis has focused on high non-union rates, and consequent need for delayed weightbearing as prevention. In this study we present a selection and treatment protocol to minimise non-union while allowing early weightbearing. METHODS All TMTJ1 arthrodesis procedures for hallux valgus performed by the senior surgeon over the period June, 2016 to July, 2019 were included. An anatomically-designed, medial TMTJ1 plate and screw compression was utilised for TMTJ1 arthrodesis. The construct was augmented with synthetic intermetatarsal stabilisation. All patients were kept non-weightbearing for 2 weeks, followed by progressive weightbearing as tolerated for 4 weeks. Minimum follow-up was 1 year. RESULTS 300 modified Lapidus procedures were performed for hallux valgus with mean IMA 17° (Range: 14-29). Mean age was 58 years, with 93% female. 284 (94%) had an Akin osteotomy, while 222 cases (74%) were associated with another forefoot procedure. Patients began progressive weight bearing as tolerated from 2 weeks. All were fully weight bearing by 8 weeks post-operatively. There was a 100% union rate in this group. Mean AOFAS Hallux MTP-IP scores rose from 59 pre-operatively to 97 post-operatively. One plate was removed due to tibialis anterior impingement. There were no recurrences at final follow-up. CONCLUSIONS We describe a selection and treatment protocol for TMTJ1 arthrodesis for hallux valgus. This yields high union rates while allowing early weight bearing. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- F J McCabe
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland.
| | - P M McQuail
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland
| | - L Turley
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland
| | - R Hurley
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland
| | - R A Flavin
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland
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12
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López-López D, Larrainzar-Garijo R, De-Bengoa-Vallejo RB, Losa-Iglesias ME, Bayod-López J. Effectiveness of the Lapidus plate system in foot surgery: A PRISMA compliant systematic review. Int Wound J 2021; 19:507-514. [PMID: 34255939 PMCID: PMC8874064 DOI: 10.1111/iwj.13649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022] Open
Abstract
Lapidus arthrodesis is an established standard procedure to correct various foot surgery problems and hallux limitus, hypermobility of the first ray, hallux abductus valgus, and symptomatic lesser metatarsal. After decades, many fixation methods in the orthopaedic surgery industry have been developed for decreasing complications and improving this technique. The aim of this PRISMA compliant systematic review is to analyse the effectiveness of several lapidus plate systems in foot surgery. We have carried out the first systematic review of the relevant published literature so as to systematically evaluate the scientific knowledge available now on this association, assigning predefined eligibility criteria. Fourteen studies were selected which had an overall of 738 cases. The first tarsal metatarsal joint and hallux valgus were treated by the application of different types of Lapidus plate system. The optimal level of the fixation in these procedures is related with the type and system insertion place of the plate with or without screw in each specific foot disease. There is an insufficient number of studies about the effectiveness of the different types of Lapidus plate system in foot surgery, and there is a need to increase outcomes knowledge on the level of the fixation, sort of the system, and insert place in foot surgery.
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Affiliation(s)
- Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | - Ricardo Larrainzar-Garijo
- Orthopaedics and Trauma Department, Medicine School, Universidad Complutense, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | - Javier Bayod-López
- Biomedical Research Networking center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Group of Applied Mechanics and Bioengineering (AMB), Aragon Institute of Engineering Research (I3A), Universidad de Zaragoza, Zaragoza, Spain
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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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Abstract
"Lapidus arthrodesis is becoming more of a common procedure for treatment of hallux valgus deformities. Like other procedures, complications are possible. The common complications associated with Lapidus arthrodesis procedures include nonunion and malunion. Malunion is typically broken down into recurrence, elevated first ray, shortened first ray, or plantarflexed first ray. This article discusses these common complications after Lapidus arthrodesis.
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Affiliation(s)
| | - Eric R Reese
- Unitypoint Health - Iowa Methodist Medical Center, 1200 Pleasant Street, Des Moines, IA 50309, USA
| | - Ryan D Prusa
- Unitypoint Health - Iowa Methodist Medical Center, 1200 Pleasant Street, Des Moines, IA 50309, USA
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16
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Bioabsorbable vs. titanium screws for first tarsometatarsal joint arthrodesis: An in-vitro study. J Clin Orthop Trauma 2020; 11:448-452. [PMID: 32405207 PMCID: PMC7211808 DOI: 10.1016/j.jcot.2019.08.017] [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: 04/11/2019] [Accepted: 08/27/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The TMT-1 joint arthrodesis is a common repair for severe hallux valgus. Two crossing interfragmental screws, usually titanium or steel, and a locking plate or a plate with a compression screw are the most common fixation methods for first TMT joint arthrodesis. The qualities of an ideal fixation material include adequate strength and rigidity, biocompatibility, lack of interference with bone healing, lack of visibility and palpability, and a low risk of surgical removal. We sought to determine whether bioabsorbable cannulated screws would perform as well as titanium screws in anatomical models. METHODS Identical anatomical TMT-1 arthrodesis was created with a saw by making a straight cut in 30 anatomical models (Sawbone®). The bioabsorbable and titanium screws were placed one at a time in exactly the same location in each model according to careful measurements. All 30 models were analyzed with a material testing machine (MTS Insight 30, Eden Prairie, USA). Each model was oriented 15° to the platform to simulate its position to the ground during mid-stance. RESULTS In the single-cycle load-to-failure test, the mean yield load was 61.4 N ± 5.7 N (range, 50.1 N-70.3 N) in the bioabsorbable screw group and 81.2 N ± 12 N (range, 61.7 N-113.4 N) in the titanium screw group (P < .001). The respective values for the stiffness of the fixation were 8.1 N/mm ± 0.8 N/mm (range, 6.7 N/mm to 9.1 N/mm) and 9.7 N/mm ± 1.8 N/mm (range, 6.9 N/mm to 12.6 N/mm) for the bioabsorbable and titanium groups (P = .004). The mean maximum failure loads in the bioabsorbable group were 85.1 N ± 8.5 N (range, 67.1 N-97.2 N) and in the titanium group 120.6 N ± 13.2 N (range, 96.7 N-136.7 N), respectively (P < .001). Analysis of the failure models shows bioabsorbable fixation failures caused by bending occur more often than in the titanium group. CONCLUSION In biomechanical testing, titanium screws were stronger than bioabsorbable screws in the TMT-1 arthrodesis model tested, although bioabsorbable cannulated screws may be an alternative to titanium screws in the fixation Lapidus procedure.
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Claaßen L, Venjakob E, Yao D, Lerch M, Plaass C, Colsman CS, Ettinger S. The computed tomographybased anatomy of the ossa cuneiformia. Orthop Rev (Pavia) 2019; 11:7876. [PMID: 31210911 PMCID: PMC6551459 DOI: 10.4081/or.2019.7876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/22/2019] [Indexed: 11/04/2022] Open
Abstract
There is a lack of basic anatomic information regarding the ossa cuneiformia. The aim of the present descriptive study was the detailed evaluation of the anatomy of the ossa cuneiformia. We analyzed 100 computer tomography scans of feet without deformities or previous trauma. The length, height and width of each cuneiforme and their articular surfaces were assessed. We itemized the data to gender differences and to foot length. The medial cuneiforme os had a length of 24.0 mm ± 2.4 (mean ± standard deviation), a width of 17.3 mm ± 2.8 and a height of 28.0 mm ± 3.4. The respective values for the intermediate cuneiforme were 18.2 mm ± 2.1, 15.8 mm ± 2.1 and 22.5 ± 2.2 and for the lateral cuneiforme 26.4 mm ± 2.7, 17.2 mm ± 2.9 and 22.8 mm ± 2.9. We found statistical relevant differences regarding gender and foot length subgroups whereas not for all parameters. The present study illustrates basic anatomic data regarding the ossa cuneiformia. This information might be helpful for implant design and placement during midfoot surgery.
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Affiliation(s)
- Leif Claaßen
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Elina Venjakob
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Daiwei Yao
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Matthias Lerch
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Christian Plaass
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Christina Stukenborg- Colsman
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Sarah Ettinger
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
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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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