Modified Lapidus Procedure with Joint Compression, Meticulous Surface Preparation, and Shear-Strain-Relieved Bone Graft Yields Low Nonunion Rate

Abstract

Background

The modified Lapidus procedure is widely used to correct hallux valgus but has been reported with high nonunion rates. In this study, we retrospectively reviewed the nonunion rate of the modified Lapidus procedure performed with rigid cross screw fixation, meticulous joint preparation, and shear-strain-relieved calcaneal bone graft.

Questions/Purposes

Does the performance of the Lapidus procedure with rigid cross screw fixation, complete joint preparation, and shear-strain-relieved calcaneal bone graft achieve higher union rates than currently reported? If nonunion does occur, what is the clinical course?

Methods

We reviewed both radiographic and clinical results of the modified Lapidus procedure with the above technique in 171 patients (182 feet). Evaluation included age, gender, tobacco use, diabetic status, and radiographic analysis at least 3 months postoperatively.

Results

The modified Lapidus procedure described above resulted in a union rate of 97.3% (177 of 182 feet). Three of the five feet with radiographic nonunions were clinically symptomatic.

Conclusions

The union rate of the modified Lapidus procedure is higher than previously reported when performed with rigid cross screw fixation, meticulous joint preparation, and shear-strain-relieved bone graft. Nonunion of the first tarsometatarsal joint should be considered an infrequent occurrence.

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Disclosures

Conflict of Interest:

Sriniwasan B. Mani, BS, Eric W. Lloyd, MD, Aoife MacMahon, BA, Matthew M. Roberts, MD, David S. Levine, MD and Scott J. Ellis, MD have declared that they have no conflict of interest.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent:

Informed consent was waived from all patients for being included in the study.

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Correspondence to Scott J. Ellis MD.

Additional information

Level of Evidence: IV, Retrospective Case Series

Work performed at Hospital for Special Surgery in New York City, NY.

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Mani, S.B., Lloyd, E.W., MacMahon, A. et al. Modified Lapidus Procedure with Joint Compression, Meticulous Surface Preparation, and Shear-Strain-Relieved Bone Graft Yields Low Nonunion Rate. HSS Jrnl 11, 243–248 (2015). https://doi.org/10.1007/s11420-015-9462-8

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Keywords

  • hallux valgus
  • lapidus
  • bunion
  • fusion
  • arthrodesis
  • autograft