Results of Lapidus Arthrodesis and Locked Plating With Early Weight Bearing

Abstract

In the endeavor toward Lapidus fusion, the authors have studied a new application of locked plating for the first tarsometatarsal joint. The goal was to assess the time to fusion, time to ambulation, rate of delayed union/nonunion, rate of revision, and need for hardware removal following the use of locked-plate technology in the fusion of the first tarsometatarsal joint. The findings denoted an average of 6.95 weeks to radiographic fusion, an average of 2 weeks to ambulation, a 9.52% rate of asymptomatic mal-union, a 0% rate of delayed union or nonunion, and a 0% rate of revision. The rate of need for hardware removal was 4.76%.

A Multicenter, Retrospective Study of Early Weightbearing for Modified Lapidus Arthrodesis

“…The modified Lapidus arthrodesis is a long established surgical technique for the management of hallux valgus that provides reproducible results and quality patient outcomes (1-26). Since originally described by Albrecht (1) in 1911 and popularized by Lapidus beginning in 1934, several investigators have proposed modified techniques and/or fixation constructs in an effort to decrease the incidence of complications, including nonunion for first tarsometatarsal arthrodesis (1)(2)(3)(4)(5)(6)(7)(8)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(23)(24)(25)(26). Historically, this procedure required extensive periods of non-weightbearing to limit the risk of nonunion or other complications, such as first metatarsal elevation (1,2,5,(8)(9)(10)(11)13,15,18,19,21,22,25,26).…”

“…However, the risks associated with prolonged non-weightbearing are also obvious and warrant consideration to achieve optimal patient outcomes (eg, deep vein thrombosis, disuse osteopenia, generalized deconditioning). With the advent of improved fixation modalities, foot and ankle surgeons have challenged the need for prolonged non-weightbearing after modified Lapidus arthrodesis (3,4,6,7,11,12,14,16,17,24). These modern fixation constructs might allow for early weightbearing without an increased risk of nonunion.…”

“…These modern fixation constructs might allow for early weightbearing without an increased risk of nonunion. This has been studied in several relatively small cohorts or when using a single fixation construct (3,4,6,7,11,12,14,16,17,24). To provide further insight to this concept, we performed a large multicenter retrospective study using various fixation constructs.…”

American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Perioperative Management

“…With respect to the first metatarsal-medial cuneiform joint arthrodesis, we identified a series of investigations that specifically incorporated early weightbearing into the study design (332)(333)(334)(335)(336)(337)(338)(339)(340)(341)(342)(343)(344)(345). The reported arthrodesis union rates observed in these investigations ranged from 90.2% to 100.0%.…”

Stage I and II Posterior Tibial Tendon Dysfunction

“…In case of degenerative disease at the first TMT-I joint or additional hypermobility of the first ray, the authors add a modified Lapidus procedure. [18][19][20][21] Flexible hindfoot valgus, forefoot abduction…”