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. 2022 Oct;43(10):1277-1284.
doi: 10.1177/10711007221112088. Epub 2022 Jul 26.

Cohort Comparison of Radiographic Correction and Complications Between Minimal Invasive and Open Lapidus Procedures for Hallux Valgus

Diogo Vieira Cardoso  1 , Andrea Veljkovic  2 , Kevin Wing  2 , Murray Penner  2 , Oliver Gagne  2 , Alastair Younger  2
Affiliations

Cohort Comparison of Radiographic Correction and Complications Between Minimal Invasive and Open Lapidus Procedures for Hallux Valgus

Diogo Vieira Cardoso et al. Foot Ankle Int. 2022 Oct.

Abstract

Background: The Lapidus procedure corrects hallux valgus first ray deformity. First tarsometatarsal (TMT) fusion in patients with hallux valgus deformity using minimally invasive surgery (MIS) is a new technique, but comparative outcomes between MIS and open techniques have not been reported. This study compares the early radiographic results and complications of the MIS with the open procedure in a single-surgeon practice.

Methods: 47 MIS patients were compared with 44 open patients. Radiographic measures compared preoperatively and postoperatively were the intermetatarsal angle (IMA), hallux valgus angle (HVA), foot width (FW), distal metatarsal articular angle (DMAA), sesamoid station (SS), metatarsus adductus angle (MAA), first metatarsal to second metatarsal length, and elevation of the first metatarsal. Early complications were recorded, as well as repeat surgeries.

Results: The mean follow-up was 82 (range, 31-182) months for the open group and 29 (range, 14-47) months for the MIS group. In both techniques, postoperative measures (IMA, HVA, DMAA, FW, and sesamoid station) were significantly improved from preoperative measures. When comparing postoperative measures between both groups, the IMA was significantly lower in the open group (4.8 ± 3.6 degrees vs 6.4 ± 3.2 degrees, P < .05). Differential between pre- and postoperative measures for both techniques were compared, and the open group was associated with more correction than the MIS group for IMA (12.4 ± 5.3 degrees vs 9.4 ± 4.4 degrees, P = .004) and HVA (25.5 ± 8.3 degrees vs 20 ± 9.9 degrees, P = .005). Wound complication and nonunion rates trended higher in the open group (4 vs 0) (P = .051).

Conclusion: Both techniques resulted in good to excellent correction. However, the open technique was associated with lower postoperative IMA values and more correction power for IMA and HVA, than the MIS.

Keywords: Lapidus; arthroscopy; first tarsometatarsal fusion; hallux valgus; minimally invasive surgery.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Figures

Figure 1.
Figure 1.
Arthroscopic portal placement and example of a compressor distractor device with 2.4-mm pins in the first and second metatarsal head holding correction.
Figure 2.
Figure 2.
Arthroscopic view of first tarsometatarsal joint after cartilage removal. C, cuneiform; M, metatarsal.
Figure 3.
Figure 3.
Left foot weightbearing radiographs of a patient undergoing minimally invasive tarsometatarsal fusion surgery. (A) Preoperative AP view. (B) Postoperative AP view. (C) Preoperative lateral view. (D) Postoperative lateral view. AP, anteroposterior.
Figure 4.
Figure 4.
Postoperative clinical aspect of skin incisions with the minimally invasive technique.
Figure 5.
Figure 5.
Left foot weightbearing radiographs of a patient undergoing open tarsometatarsal fusion surgery. (A) Preoperative AP view. (B) Postoperative AP view. (C) Preoperative lateral view. (D) Postoperative lateral view. AP, anteroposterior.
Figure 6.
Figure 6.
Kaplan-Meier survivorship analysis for major complications requiring revision surgery.
See this image and copyright information in PMC

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