The modified Lapidus procedure (MLP), which consists of fusion between the first metatarsal (M1) and medial cuneiform, has been widely performed with satisfactory clinical outcomes, but it has a variable nonunion rate ranging between 4% and 10% and loss of correction in up to 5.8% of the cases. Excessive motion around the site of tarsometatarsal arthrodesis, specially at the intercuneiform joint, is probably the reason. The original Lapidus procedure (OLP), which includes fusion of the M1 to second metatarsal (M2), may be beneficial in preventing nonunion and recurrence. The objective of this study was to describe intraoperative technical tips in the OLP to improve M1 to M2 fusion, which may prevent complications. Since the Lapidus procedure continues to gain popularity, it is the authors opinion that the OLP requires special attention because it is a more technically demanding surgery compared to the MLP.
ZambelliRBaumfeldD.Intraoperative and postoperative evaluation of hallux valgus correction. Foot Ankle Clin. 2020;25(1):127-139. doi:10.1016/j.fcl.2019.10.007.
4.
NishikawaDRCDuarteFASaitoGHde Cesar NettoCMirandaBRde PradoMP. Correlation of first metatarsal sagittal alignment with clinical and functional outcomes following the Lapidus procedure. Foot Ankle Surg. 2022;28(4):438-444. doi:10.1016/j.fas.2021.08.009.
5.
NishikawaDRCDuarteFASaitoGHde MirandaBRFenelonEJAPradoMP. Is first metatarsal shortening correlated with clinical and functional outcomes following the Lapidus procedure?Int Orthop. 2021;45(11):2927-2931. doi:10.1007/s00264-021-05199-8.
6.
WagnerPWagnerE.Role of coronal plane malalignment in hallux valgus correction. Foot Ankle Clin. 2020;25(1):69-77. doi:10.1016/j.fcl.2019.10.009.
7.
LapidusPW.The operative correction of metatarsus varus primus in hallux valgus. Surg Gynecol Obs. 1934;58:183-191.
SymeonidisPDAndersonJG.Original and modified Lapidus procedures. J Bone Jt Surg. 2021;103(4):e15. doi:10.2106/JBJS.20.01010.
10.
NishikawaDRCSaitoGHMendesAAMPradoMP. Management of the tarsometatarsal joint in the rotational correction of hallux valgus by the modified Lapidus procedure: intraoperative technical tips to prevent complications. Foot Ankle Spec. 2021;14(6):528-533. doi:10.1177/1938640020986686.
11.
JacksonJBKennedyBDealPGonzalezT. The surgical learning curve for modified Lapidus procedure for hallux valgus deformity [published online ahead of print July 11, 2021]. Foot Ankle Spec. doi:10.1177/19386400211029148.
12.
JonesJMSchleunesSDVackettaVG, et al. First tarsometatarsal joint arthrodesis for hallux valgus with and without intermetatarsal screw fixation: a comparison of correction and maintenance of correction [published online ahead of print February 27, 2022]. J Foot Ankle Surg. doi:10.1053/j.jfas.2022.02.014.
13.
PatelSFordLAEtcheverryJRushSMHamiltonGA.Modified Lapidus arthrodesis: rate of nonunion in 227 cases. J Foot Ankle Surg. 2004;43(1):37-42. doi:10.1053/j.jfas.2003.11.009.
14.
LanganTMGreschnerJMBrandãoRAGossDASmithCNHyerCF.Maintenance of correction of the modified Lapidus procedure with a first metatarsal to intermediate cuneiform cross-screw technique. Foot Ankle Int. 2020;41(4):428-436. doi:10.1177/1071100719895268.
15.
WilleggerMHolinkaJRistlRWanivenhausAHWindhagerRSchuhR.Correction power and complications of first tarsometatarsal joint arthrodesis for hallux valgus deformity. Int Orthop. 2015;39(3):467-476. doi:10.1007/s00264-014-2601-x.
16.
JagadaleVSThomasRL.A clinicoradiological and functional evaluation of Lapidus surgery for moderate to severe bunion deformity shows excellent stable correction and high long-term patient satisfaction. Foot Ankle Spec. 2020;13(6):488-493. doi:10.1177/1938640019890716.
17.
GalliMMMcAlisterJEBerletGCHyerCF.Enhanced Lapidus arthrodesis: crossed screw technique with middle cuneiform fixation further reduces sagittal mobility. J Foot Ankle Surg. 2015;54(3):437-440. doi:10.1053/j.jfas.2014.10.008.
18.
FlemingJJKwaaduKYBrinkleyJCOzuzuY.Intraoperative evaluation of medial intercuneiform instability after Lapidus arthrodesis: intercuneiform hook test. J Foot Ankle Surg. 2015;54(3):464-472. doi:10.1053/j.jfas.2014.12.019.
KimuraTKubotaMSuzukiNHattoriAMarumoK.Comparison of intercuneiform 1-2 joint mobility between hallux valgus and normal feet using weightbearing computed tomography and 3-dimensional analysis. Foot Ankle Int. 2018;39(3):355-360. doi:10.1177/1071100717744174.
21.
SoEVan DykeBMcGannMRBrandaoRLarsonDHyerCF.Structures at risk from an intermetatarsal screw for Lapidus bunionectomy: a cadaveric study. J Foot Ankle Surg. 2019;58(1):62-65. doi:10.1053/j.jfas.2018.08.010.
22.
FlemingLSavageTJPadenMHStonePA.Results of modified Lapidus arthrodesis procedure using medial eminence as an interpositional autograft. J Foot Ankle Surg. 2011;50(3):272-275. doi:10.1053/j.jfas.2011.02.012.
23.
RolingBAChristensenJCJohnsonCH.Biomechanics of the first ray. Part IV: the effect of selected medial column arthrodeses. A three-dimensional kinematic analysis in a cadaver model. J Foot Ankle Surg. 2002;41(5):278-285. doi:10.1016/S1067-2516(02)80045-X.
24.
RushSMChristensenJCJohnsonCH.Biomechanics of the first ray. Part II: metatarsus primus varus as a cause of hypermobility. A three-dimensional kinematic analysis in a cadaver model. J Foot Ankle Surg. 2000;39(2):68-77. doi:10.1016/S1067-2516(00)80030-7.
25.
FeilmeierMDaytonPKauweM, et al. Comparison of transverse and coronal plane stability at the first tarsal-metatarsal joint with multiple screw orientations. Foot Ankle Spec. 2017;10(2):104-108. doi:10.1177/1938640016666920.
26.
BuddeckeDEReeseERPrusaRD.Revision of malaligned Lapidus and nonunited Lapidus. Clin Podiatr Med Surg. 2020;37(3):505-520. doi:10.1016/j.cpm.2020.03.010.
27.
KimuraTKubotaMTaguchiTSuzukiNHattoriAMarumoK.Evaluation of first-ray mobility in patients with hallux valgus using weight-bearing CT and a 3-D analysis system a comparison with normal feet. J Bone Joint Surg Am. 2017;99(3):247-255. doi:10.2106/JBJS.16.00542.
28.
BiermanRAChristensenJCJohnsonCH. Biomechanics of the first ray. Part III. Consequences of Lapidus arthrodesis on peroneus longus function: a three-dimensional kinematic analysis in a cadaver model. J Foot Ankle Surg. 2001;40(3):125-131. doi:10.1016/S1067-2516(01)80077-6.
