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Modified Lapidus Arthrodesis With Crossed Screw Fixation: Early Weightbearing in 136 Patients

Published:October 31, 2014DOI:https://doi.org/10.1053/j.jfas.2014.09.034

      Abstract

      Modified Lapidus arthrodesis is a versatile and powerful procedure for correcting the hallux valgus deformity typically associated with significant metatarsus primus varus or increased first ray mobility. Traditionally, patients have remained non-weightbearing until the arthrodesis has consolidated. More recently, numerous studies have evaluated the outcomes of early postoperative weightbearing using a variety of fixation constructs. The present retrospective cohort study evaluated 136 consecutive patients who had undergone modified Lapidus arthrodesis for hallux valgus deformity with conventional, crossed, solid core, screw fixation, were enrolled in an early weightbearing protocol, and were followed for 12 months. All the patients were partial weightbearing in a protective boot a mean of 12.2 (SD ± 4.36) days after surgery, with full weightbearing at 34.4 (SD ± 11.89) days. Union was achieved in 133 patients (97.8%). Of the 3 (2.2%) patients with nonunion, 2 (1.5%) remained asymptomatic. The mean time to radiographic union was 65 (SD ± 37.24) days. Significant improvement was seen in the first intermetatarsal angle and hallux abductus angle after surgery (p < .0001). Deformity correction was not compromised by early weightbearing and was well maintained over time. These results support early weightbearing with traditional crossed screw fixation for modified Lapidus arthrodesis with outcomes and complication rates comparable to those previously published.

      Level of Clinical Evidence

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      References

        • Lapidus P.W.
        The operative correction of the metatarsus primus varus in hallux valgus.
        Surg Gynecol Obstet. 1934; 58: 183-191
        • Bacardi B.E.
        • Boysen T.J.
        Considerations for the lapidus operation.
        J Foot Surg. 1986; 25: 133-138
        • Clark H.R.
        • Veith R.G.
        • Hansen Jr., S.T.
        Adolescent bunions treated by the modified Lapidus Procedure.
        Bull Hosp Joint Dis Ortho Inst. 1987; 47: 109-122
        • Sangeorzan B.J.
        • Hansen S.T.
        Modified Lapidus procedure for hallux valgus.
        Foot Ankle. 1989; 9: 262-266
        • Saffo G.
        • Wooster M.F.
        • Stevens M.
        • Desnoyers R.
        • Catanzariti A.R.
        First metatarsocuneiform joint arthrodesis: a five-year retrospective analysis.
        J Foot Surg. 1989; 28: 459-465
        • Mauldin D.M.
        • Sanders M.
        • Whitmer W.W.
        Correction of hallux valgus with metatarsocuneiform stabilization.
        Foot Ankle. 1990; 11: 59-66
        • Myerson M.
        • Allon S.
        • McGarvey W.
        Metatarsocuneiform arthrodesis for management of hallux valgus and metatarsus primus varus.
        Foot Ankle. 1992; 13: 107-115
        • Grace D.
        • Delmonte R.
        • Catanzariti A.R.
        • Hofbauer M.
        Modified Lapidus arthrodesis for adolescent hallux abducto valgus.
        J Foot Ankle Surg. 1999; 38: 8-13
        • Cantanzariti A.R.
        • Mendicino R.W.
        • Lee M.S.
        • Gallina M.R.
        Modified lapidus arthrodesis: a retrospective analysis.
        J Foot Ankle Surg. 1999; 38: 322-332
        • Bednarz P.A.
        • Manoli II, A.
        Modified Lapidus procedure for the treatment of hypermobile hallux valgus.
        Foot Ankle Int. 2000; 21: 816-821
        • McInnes B.D.
        • Bouche R.T.
        Critical evaluation of the modified Lapidus procedure.
        J Foot Ankle Surg. 2001; 40: 71-90
        • Patel S.
        • Ford L.A.
        • Etcheverry J.
        • Rush S.M.
        • Hamilton G.A.
        Modified lapidus arthrodesis: rate of nonunion in 227 cases.
        J Foot Ankle Surg. 2004; 43: 37-42
        • Coetzee J.C.
        • Wickum D.
        The Lapidus procedure: a prospective cohort outcome study.
        Foot Ankle Int. 2004; 25: 526-531
        • Rink-Brüne O.
        Lapidus arthrodesis for management of hallux valgus—a retrospective review of 106 cases.
        J Foot Ankle Surg. 2004; 43: 290-295
        • Kopp F.J.
        • Patel M.M.
        • Levine D.S.
        • Deland J.T.
        The modified Lapidus procedure for hallux valgus: a clinical and radiographic analysis.
        Foot Ankle. 2005; 26: 913-917
        • Thompson I.M.
        • Bohay D.R.
        • Anderson J.G.
        Fusion rate of first tarsometatarsal arthrodesis in the modified Lapidus procedure and flatfoot reconstruction.
        Foot Ankle. 2005; 26: 698-703
        • Saxena A.
        • Nguyen A.
        • Nelsen E.
        Lapidus bunionectomy: early evaluation of crossed lag screws versus locking plate with plantar lag screw.
        J Foot Ankle Surg. 2009; 48: 170-179
        • Blitz N.
        The versatility of the lapidus arthrodesis.
        Clin Podiatr Med Surg. 2009; 26: 427-441
        • Cottom J.M.
        • Vora A.M.
        Fixation of lapidus arthrodesis with a plantar interfragmentary screw and medial locking plate: a report of 88 cases.
        J Foot Ankle Surg. 2013; 52: 465-469
        • Klaue K.
        • Hansen S.T.
        • Masquelet A.C.
        Clinical, quantitative assessment of first tarsometatarsal mobility in the sagittal plane and its relation to hallux valgus deformity.
        Foot Ankle Int. 1994; 15: 9-13
        • Hansen Jr., S.T.
        Hallux valgus surgery: Morton and Lapidus were right!.
        Clin Podiatr Med. 1996; 13: 347-354
        • Myerson M.S.
        • Badekas A.
        Hypermobility of the first ray.
        Foot Ankle Clin. 2000; 5: 469-484
        • Neylon T.A.
        • Johnson B.A.
        • Laroche R.A.
        Use of the Lapidus bunionectomy in first ray insufficiency.
        Clin Podiatr Med. 2001; 18: 365-375
        • Faber F.W.
        • Mulder P.G.
        • Verhaar J.A.
        Role of first ray hypermobility in the outcome of the Hohman and the Lapidus procedure: a prospective, randomized trial involving one hundred and one feet.
        J Bone Joint Surg. 2004; 86: 486-495
        • Albrecht G.H.
        The pathology and treatment of hallux valgus.
        Russ Vrach. 1911; 10: 14-19
        • Kazzaz S.
        • Singh D.
        Postoperative cast necessity after a Lapidus arthrodesis.
        Foot Ankle Int. 2009; 30: 746-751
        • Blitz N.M.
        • Lee T.
        • Williams K.
        • Barkan H.
        • DiDimenico L.A.
        Early weight bearing after modified lapidus arthrodesis: a multicenter review of 80 cases.
        J Foot Ankle Surg. 2010; 49: 357-362
        • Basile P.
        • Cook E.A.
        • Cook J.J.
        Immediate weight bearing following modified Lapidus arthrodesis.
        J Foot Ankle Surg. 2010; 49: 459-464
        • Sorensen M.D.
        • Hyer C.F.
        • Berlet G.C.
        Results of lapidus arthrodesis and locked plating with early weight bearing.
        Foot Ankle Spec. 2009; 2: 227-233
        • DeVries J.G.
        • Granata J.D.
        • Hyer C.F.
        Fixation of first tarsometatarsal arthrodesis: a retrospective comparative cohort of two techniques.
        Foot Ankle Int. 2011; 32: 158-162
        • Gutteck N.
        • Wohlrab D.
        • Zeh A.
        • Radetzki F.
        • Delank K.S.
        • Lebek S.
        Comparative study of Lapidus bunionectomy using different osteosynthesis methods.
        Foot Ankle Surg. 2013; 19: 218-221
        • Klos K.
        • Wilde C.H.
        • Lange A.
        • Wagner A.
        • Gras F.
        • Skulev H.K.
        • Mückley T.
        • Simons P.
        Modified Lapidus arthrodesis with plantar plate and compression screw for treatment of hallux valgus with hypermobility of the first ray: a preliminary report.
        Foot Ankle Surg. 2013; 19: 239-244
        • Menke C.R.
        • McGlamry M.C.
        • Camasta C.A.
        Lapidus arthrodesis with a single lag screw and a locking H-plate.
        J Foot Ankle Surg. 2011; 50: 377-382
        • Klos K.
        • Gueorguiev B.
        • Mückley T.
        • Fröber R.
        • Hofmann G.
        • Schwieger K.
        • Windolf M.
        Stability of medial locking plate and compression screw versus two crossed screws for Lapidus arthrodesis.
        Foot Ankle Int. 2010; 31: 158-163
        • Scranton P.E.
        • Coetzee C.
        • Carreira D.
        Arthrodesis of the first metatarsocuneiform joint: a comparative study of fixation methods.
        Foot Ankle Int. 2009; 30: 341-345
        • Mann R.A.
        • Donatto K.C.
        The chevron osteotomy: a clinical and radiographic analysis.
        Foot Ankle Int. 1977; 18: 255-261
        • Ray R.G.
        • Ching R.P.
        • Christensen J.C.
        • Hansen S.T.
        Biomechanical analysis of the first metatarsocuneiform arthrodesis.
        J Foot Ankle Surg. 1998; 37: 376-385
        • Donnenwerth M.P.
        • Borkosky S.L.
        • Abicht B.P.
        • Plovanich E.J.
        • Roukis T.S.
        Rate of nonunion after first metatarsal-cuneiform arthrodesis using joint curettage and two crossed compression screw fixation: a systematic review.
        J Foot Ankle Surg. 2011; 50: 707-709
        • Johnson J.T.
        • Schuberth J.M.
        • Thornton S.D.
        • Christensen J.C.
        Joint curettage arthrodesis technique in the foot: a histological analysis.
        J Foot Ankle Surg. 2009; 48: 558-564