Early weight bearing after modified lapidus arthodesis: a multicenter review of 80 cases

The modified Lapidus arthrodesis involves fusion of the first tarsometatarsal, which typically takes about 6 weeks to consolidate. Postoperative protocols typically involve non-weight bearing until bone consolidation occurs, however, with a stable fixation construct, protected weight bearing can be initiated earlier than 6 weeks into the postoperative period. Studies specifically evaluating an early weight bearing protocol after lapidus arthrodesis do not exist; such a protocol is the focus of this investigation. A multicenter retrospective review of 80 feet in 76 patients who underwent a Lapidus arthrodesis by 2 different surgeons, involving a similar fixation technique and an early weight-bearing protocol, was performed. All patients were allowed protected weight bearing after the first postoperative visit, at approximately 2 weeks into the postoperative course. Patients began protected weight bearing at a mean 14.8 (95% CI 14.0, 15.6) days postoperative. All 80 feet proceeded to successful union (100% union), and the mean time to union was 44.5 days (95% CI 43.0, 46.0). No hardware was broken, and no complications requiring surgical revision were observed before solid boney fusion was achieved. Statistically significant (P < .001) improvements in the first intermetatarsal, hallux abductus, and lateral metatarsal angles were observed; and no cases of pathological first ray elevatus were encountered. The duration of time to bone healing in the cohort described in this article was similar to the rates described in previous reports describing Lapidus arthrodesis managed with a considerably longer duration of initial postoperative non-weight bearing. This study demonstrates that early weight bearing of the Lapidus arthrodesis can be performed without compromising correction or the rate of osseous union. This is the first study that specifically evaluates the early weight bearing protocol after lapidus arthrodesis.