Tension Side Fixation for Lapidus Arthrodesis: A Retrospective Analysis

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Surgery

Background:

• Moderate to severe hallux valgus often necessitates the Lapidus procedure (first-tarsometatarsal arthrodesis).
• Traditional dorsal approaches with dorsal or medial fixation are common.
• Plantar or tension-side fixation demonstrates superior biomechanical strength, yet patient outcomes data is limited.

Purpose of the Study:

• To report patient outcomes following tension-side fixation for the Lapidus procedure.

Main Methods:

• Retrospective analysis of 81 patients undergoing tension-side fixation Lapidus.
• Data collected included time to weight-bear, return to shoegear, hardware removal, revision, recurrence, metatarsal shortening, and nonunion rates.

Main Results:

• Mean time to weight-bearing was 10.4 days; mean return to regular shoegear was 6 weeks.
• Low rates of hardware removal (1.2%), revision (0%), and asymptomatic nonunion (1.2%).
• Recurrence rate was 8.6%, with most occurring before frontal-plane correction adoption; no patients were dissatisfied.

Conclusions:

• Tension-side fixation in Lapidus arthrodesis may facilitate safe early weight-bearing and return to shoegear.
• This technique is associated with a low incidence of complications, including hardware removal, revision, and nonunion.
• Despite a recurrence rate, patient satisfaction remains high, suggesting a favorable risk-benefit profile.