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Scheele CB, Kinast C, Lenze F, Wimmer J, Beischl S, Harrasser N. Radiographic Evaluation of First Tarsometatarsal Joint Arthrodesis for Hallux Valgus Deformity: Does the Fusion of the First to the Second Metatarsal Base Reduce the Radiological Recurrence Rate? Foot Ankle Spec 2023:19386400231164209. [PMID: 37148151 DOI: 10.1177/19386400231164209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Modified Lapidus arthrodesis (MLA) is a well-established treatment option for symptomatic hallux valgus deformity (HVD). However, recurrence of the deformity remains a concern. The goal of this study was to evaluate the effect of an additional intermetatarsal fusion on the radiographic recurrence rate after first tarsometatarsal (TMT-I) arthrodesis. METHODS This is a retrospective evaluation of 56 feet that underwent TMT-I arthrodesis for moderate to severe HVD. Twenty-three feet received an isolated arthrodesis of the TMT-I joint (TMT-I), whereas 33 feet received an additional fusion between the base of the first and the second metatarsal bone (TMT-I/II). Various radiological parameters were determined preoperatively, 6 weeks and at a mean of 2 years postoperatively. RESULTS The intermetatarsal angle (IMA) and the hallux valgus angle (HVA) were significantly lowered at both follow-up evaluations in both groups. In the TMT-I/II group, the initial reduction of HVA was significantly higher (29.3° vs 21.1°). This difference disappeared by the second follow-up, leaving no significant differences between both techniques at final follow-up. Radiological recurrence rates of HVD were comparable in both groups. CONCLUSIONS Isolated TMT-I arthrodesis provides reliable radiological results in the correction of HVD. Whether additional fusion of the first and second metatarsal base should be routinely performed remains unclear. LEVELS OF EVIDENCE Level 3.
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Affiliation(s)
- Christian B Scheele
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Christian Kinast
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Florian Lenze
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Julia Wimmer
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Simone Beischl
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
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Nishikawa DRC, Duarte FA, Saito GH, Pontin PA, Mendes AAM, Prado MP. Intraoperative Technical Tips to Improve Fusion Between the First and Second Metatarsals in the Original Lapidus Procedure. Foot Ankle Spec 2022; 16:159-167. [PMID: 35993303 DOI: 10.1177/19386400221118884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The modified Lapidus procedure (MLP), which consists of fusion between the first metatarsal (M1) and medial cuneiform, has been widely performed with satisfactory clinical outcomes, but it has a variable nonunion rate ranging between 4% and 10% and loss of correction in up to 5.8% of the cases. Excessive motion around the site of tarsometatarsal arthrodesis, specially at the intercuneiform joint, is probably the reason. The original Lapidus procedure (OLP), which includes fusion of the M1 to second metatarsal (M2), may be beneficial in preventing nonunion and recurrence. The objective of this study was to describe intraoperative technical tips in the OLP to improve M1 to M2 fusion, which may prevent complications. Since the Lapidus procedure continues to gain popularity, it is the authors opinion that the OLP requires special attention because it is a more technically demanding surgery compared to the MLP.Level of Evidence: Level V: Expert opinion.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Fernando Aires Duarte
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Guilherme Honda Saito
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Pedro Augusto Pontin
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Alberto Abussamra Moreira Mendes
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Marcelo Pires Prado
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
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