Abstract
The modified Lapidus arthrodesis involves fusion of the first tarsometatarsal, which
typically takes about 6 weeks to consolidate. Postoperative protocols typically involve
non-weight bearing until bone consolidation occurs, however, with a stable fixation
construct, protected weight bearing can be initiated earlier than 6 weeks into the
postoperative period. Studies specifically evaluating an early weight bearing protocol
after lapidus arthrodesis do not exist; such a protocol is the focus of this investigation.
A multicenter retrospective review of 80 feet in 76 patients who underwent a Lapidus
arthrodesis by 2 different surgeons, involving a similar fixation technique and an
early weight-bearing protocol, was performed. All patients were allowed protected
weight bearing after the first postoperative visit, at approximately 2 weeks into
the postoperative course. Patients began protected weight bearing at a mean 14.8 (95%
CI 14.0, 15.6) days postoperative. All 80 feet proceeded to successful union (100%
union), and the mean time to union was 44.5 days (95% CI 43.0, 46.0). No hardware
was broken, and no complications requiring surgical revision were observed before
solid boney fusion was achieved. Statistically significant (P < .001) improvements in the first intermetatarsal, hallux abductus, and lateral metatarsal
angles were observed; and no cases of pathological first ray elevatus were encountered.
The duration of time to bone healing in the cohort described in this article was similar
to the rates described in previous reports describing Lapidus arthrodesis managed
with a considerably longer duration of initial postoperative non–weight bearing. This
study demonstrates that early weight bearing of the Lapidus arthrodesis can be performed
without compromising correction or the rate of osseous union. This is the first study
that specifically evaluates the early weight bearing protocol after lapidus arthrodesis.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The author's bunion operation from 1931 to 1959.Clin Orthop. 1960; 16: 119-135
- The modified Lapidus procedure for hallux valgus: a clinical and radiographic analysis.Foot Ankle Int. 2005; 26: 913-917
- Modified Lapidus procedure for hallux valgus.Foot Ankle. 1989; 9: 262-266
- The Lapidus procedure for primus metatarsus adductus.J Am Podiatry Assoc. 1974; 64: 581-584
- Critical evaluation of the modified Lapidus procedure.J Foot Ankle Surg. 2001; 40: 71-90
- Considerations for the Lapidus operation.J Foot Surg. 1986; 25: 133-138
- The Lapidus procedure as salvage after failed surgical treatment of hallux valgus.J Bone Joint Surg Am. 2004; 86-A: 30-36
- First metatarsocuneiform joint arthrodesis: a five year retrospective analysis.J Foot Surg. 1989; 28: 459-465
- Lapidus: when and why?.Clin Podiatr Med Surg. 1989; 6: 197-208
- Metatarsocuneiform arthrodesis for management of hallux valgus and metatarsus primus varus.Foot Ankle. 1992; 13: 107-115
- The modified Lapidus arthrodesis: a retrospective analysis.J Foot Ankle Surg. 1999; 38: 322-332
- Modified Lapidus procedure for the treatment of hypermobile hallux valgus.Foot Ankle Int. 2000; 21: 816-821
- Hypermobility of the first ray.Foot Ankle Clin. 2000; 5: 469-484
- Comparison of oblique closing base wedge osteotomies of the first metatarsal: stripping versus nonstripping of the periosteum.J Foot Surg. 1991; 30: 107-113
- Adolescent bunions treated by the modified Lapidus procedure.Bull Hosp Jt Dis Orthop Inst. 1987; 47: 109-122
- Hallux valgus surgery. Morton and Lapidus were right!.Clin Podiatr Med Surg. 1996; 13: 347-354
- The modified lapidus arthrodesis: technical maneuvers and pearls.J Foot Ankle Surg. 2000; 39: 258-264
- Lapidus bunionectomy: early evaluation of crossed lag screws versus locking plate with plantar lag screw.J Foot Ankle Surg. 2009; 48: 170-179
- First metatarsocuneiform arthrodesis: technical considerations and technique modification.J Foot Ankle Surg. 2002; 41: 260-272
- Observations on hallux valgus; based on a controlled series.J Bone Joint Surg Br. 1951; 33: 376-391
- Modified Lapidus arthrodesis: rate of nonunion in 227 cases.J Foot Ankle Surg. 2004; 43: 37-42
Hansen ST. First tarsometatarsal joint arthrodesis. In Functional Reconstruction of the Foot and Ankle, pp 335-340, edited by ST Hansen, Lippincott Williams & Wilkins, Philadelphia, 2000.
- Modified Lapidus procedure for the treatment of hypermobile hallux valgus.Foot Ankle Int. 2000; 21: 816-821
- The Lapidus procedure.Clin Podiatr Med Surg. 1996; 13: 485-496
- Biomechanical analysis of the first metatarsocuneiform arthrodesis.J Foot Ankle Surg. 1998; 37: 376-385
- Correction of hallux valgus with metatarsocuneiform stabilization.Foot Ankle. 1990; 11: 59-66
Coetzee JC. The lapidus procedure for correction of moderate and severe metatarsus primus varus and hallux valgus deformities. In Advanced Reconstruction – Foot and Ankle, 1st ed, pp. 35-39, edited by J Nunley, American Academy of Orthopedic Surgeons, Rosemont, Il, 2004.
- Metatarsocuneiform arthrodesis for treatment of hallux valgus and metatarsus primus varus.Orthopedics. 1990; 13: 1025-1031
- Correction of hallux valgus with metatarsocuneiform stabilization.Foot Ankle. 1990; 11: 59-66
- The Lapidus procedure: a prospective cohort outcome study.Foot Ankle Int. 2004; 25: 526-531
- Lapidus arthrodesis for management of hallux valgus—a retrospective review of 106 cases.J Foot Ankle Surg. 2004; 43: 290-295
- Revision lapidus arthrodesis: rate of union in 17 cases.J Foot Ankle Surg. 2007; 46: 447-450
- Lapidus arthrodesis. A different perspective.J Am Podiatr Med Assoc. 1994; 84: 281-288
- Screw fixation compared to H-locking pate fixation for first metatarsocuneiform arthrodesis: a biomechanical study.Foot Ankle Int. 2005; 26: 984-989
- Physical and biological aspects of fracture healing with special reference to internal fixation.Clin Orthop Relat Res. 1979; 138: 175-196
- Thermal properties of first metatarsal osteotomies.J Foot Ankle Surg. 2009; 48: 432-438
Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
