Advertisement

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

Published:September 25, 2019DOI:https://doi.org/10.1053/j.jfas.2019.02.001

      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.

      Level of Clinical Evidence

      Key Words

      To read this article in full you will need to make a payment

      References

        • Ray RG
        • Ching RP
        • Christensen JC
        • Hansen ST
        Biomechanical analysis of the first metatarsocuneiform arthrodesis.
        J Foot Ankle Surg. 1998; 37: 376-385
        • Lapidus PW.
        Operative correction of the metatarsus varus primus in hallux valgus.
        Surg Gynecol Obstet. 1934; 54: 183-191
        • McInnes BD
        • Bouche RT.
        Critical evaluation of the modified Lapidus procedure.
        J Foot Ankle Surg. 2001; 40: 71-90
        • Patel S
        • Ford LA
        • Etcheverry J
        • Rush SM
        • Hamilton GA
        Modified Lapidus arthrodesis: rate of nonunion in 227 cases.
        J Foot Ankle Surg. 2004; 43: 37-42
        • Sangeorzan BJ
        • Hansen ST.
        Modified Lapidus procedure for hallux valgus.
        Foot Ankle Int. 1989; 9: 262-266
        • Thompson IM
        • Bohay DR
        • Anderson JG
        Fusion rate of first tarsometatarsal arthrodesis in the modified Lapidus procedure and flatfoot reconstruction.
        Foot Ankle Int. 2005; 26: 698-703
        • Mani SB
        • Lloyd EW
        • MacMahon A
        • Roberts MM
        • Levine DS
        • Ellis SJ
        Modified Lapidus procedure with joint compression, meticulous surface preparation, and shear-strain-relieved bone graft yields low nonunion rate.
        HSS J. 2015; 11: 243-248
        • Klos K
        • Wilde CH
        • Lange A
        • Wagner A
        • Gras F
        • Skulev HK
        • Muckley 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
        • Faber F
        • Mulder PGH
        • Verhaar JAN
        Role of first ray hypermobility in the outcome of the Hohmann and the Lapidus procedure: a prospective, randomized trial involving one hundred and one feet.
        J Bone Joint Surg Am. 2004; 86: 486-495
        • 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
        • Prissel MA
        • Hyer DF
        • 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: 226-229
        • Blitz NM
        • Lee T
        • Williams K
        • Barkan H
        • DiDimenico LA
        Early weightbearing after modified Lapidus arthrodesis: a multicenter review of 80 cases.
        J Foot Ankle Surg. 2010; 49: 357-362
        • Cottom JM
        • Vora AM.
        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
        • Hofstaetter SG
        • Moser G
        • Voerdermeier H
        • Schwertner A
        • Orthner E
        The Lapidus fusion with a locking screw plate and immediate weightbearing in 130 feet.
        J Bone Joint Surg Br. 2009; 91: 164
        • King CM
        • Richey J
        • Patel S
        • Collman DR
        Modified Lapidus arthrodesis with crossed screw fixation: early weightbearing in 136 patients.
        J Foot Ankle Surg. 2015; 54: 69-75
        • Sorensen MD
        • Hyer CF
        • Berlet GC
        Results of Lapidus arthrodesis and locked plating with early weight bearing.
        Foot Ankle Spec. 2009; 2: 227-233
        • Kopp FJ
        • Patel MM
        • Levine DS
        • Deland JT
        The modified Lapidus procedure for hallux valgus: a clinical and radiographic analysis.
        Foot Ankle Int. 2005; 26: 913-917
        • Rink-Brune O.
        Lapidus arthrodesis for management of hallux valgus—a retrospective review of 106 cases.
        J Foot Ankle Surg. 2004; 43: 290-295
        • Catanzariti AR
        • Mendicino RW
        • Lee MS
        • Gallina MR
        The modified Lapidus arthrodesis: a retrospective analysis.
        J Foot Ankle Surg. 1999; 38: 322-332
        • Saffo G
        • Wooster MF
        • Stevens M
        • Desnoyers R
        • Catanzariti AR
        First metatarsocuneiform arthrodesis: a five-year retrospective analysis.
        J Foot Surg. 1985; 28: 459
        • Fleming L
        • Savage TJ
        • Paden MH
        • Stone PA
        Results of modified Lapidus arthrodesis procedure using medial eminence as an interpositional autograft.
        J Foot Ankle Surg. 2011; 50: 272-275
        • Donnenwerth MP
        • Borkosky SL
        • Abicht BP
        • Plovanich EJ
        • Roukis TS
        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 JT
        • Schuberth JM
        • Thornton SD
        • Christensen JC
        Joint curettage arthrodesis technique in the foot: a histological analysis.
        J Foot Ankle Surg. 2009; 48: 558-564
        • Shinabarger AB
        • Ryan MT
        • Dzuri M
        • Burns PR
        Isolated first metatarsocuneiform joint fusion for correction of metatarsus primus varus deformity and literature review.
        J Foot Ankle Surg. 2014; 53: 624-627
        • Van Vo H
        • Safiedine AM
        • Short T
        • Merrill T
        A comparison of 4 common methods of hand-measured techniques with a computerized technique to measure the first intermetatarsal angle.
        J Foot Ankle Surg. 2004; 43: 395-399
        • Osher L
        • Mantini Blazer M
        • Buck S
        • Biernacki T
        Accurate determination of relative metatarsal protrusion with a small intermetatarsal angle: a novel simplified method.
        J Foot Ankle Surg. 2014; 53: 548-556
        • Fleming JJ
        • Kwaadu KY
        • Brinkley JC
        • Ozuzu Y
        Intraoperative evaluation of medial intercuneiform instability after Lapidus arthodesis: intercuneiform hook test.
        J Foot Ankle Surg. 2015; 54: 464-472
        • Frankel JP
        • Larsen DC.
        The misuse of the Lapidus procedure: re-evaluation of the preoperative criteria.
        J Foot Ankle Surg. 1996; 35: 355-361
        • Coetzee JC
        • Dickum D.
        The Lapidus procedure: a prospective cohort outcome study.
        Foot Ank Int. 2004; 25: 526-531
        • Dayton P
        • Kauwe M
        • DiDomenico L
        • Feilmeier M
        • Reimer R
        Quantitative analysis of frontal rotation required to anatomically align the first metatarsal phalangeal joint during modified tarsal-metatarsal arthrodesis without capsular balancing.
        J Foot Ankle Surg. 2016; 55: 220-225
        • Dayton P
        • Feilmeier M
        • Kauwe M
        • Hirschi J
        Relationship of frontal plane rotation of first metatarsal to proximal articular set angle and hallux alignment in patients undergoing tarsal metatarsal arthrodesis for hallux abducto valgus: a case series and critical review of the literature.
        J Foot Ankle Surg. 2013; 52: 384-454
        • Dayton P
        • Feilmeier M
        • Hirschi J
        • Kauwe M
        • Kauwe JS
        Observed changes in radiographic measurements of the first ray after frontal plane rotation of the first metatarsal in a cadaveric foot model.
        J Foot Ankle Surg. 2014; 52: 274-278
        • Dayton P
        • Feilmeier M
        • Kauwe M
        • Holmes C
        • McArdle A
        • Coleman N
        Observed changes in radiographic measurements of the first ray after frontal and transverse plane rotation of the hallux: does the hallux drive the metatarsal in a bunion deformity?.
        J Foot Ankle Surg. 2014; 53: 584-587
        • Smith WB
        • Santrock RD
        • Hatch DJ
        • Dayton P
        Intraoperative multiplanar alignment system to guide triplanar correction of hallux valgus deformity.
        Tech Foot Ankle Surg. 2017; 16: 175-182