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Secondary Surgery Following Lapidus Bunionectomy.

Lewis A Kane¹, Miranda L Ritterman Weintraub², Logan Mitchell³

¹Department of Podiatric Surgery, Kaiser Permanente Diablo Service Area, Walnut Creek, CA.

The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons

|June 24, 2024

Summary

The Lapidus bunionectomy for hallux valgus has low revision surgery rates. Using a screw for third point of fixation increases revision risk, while female sex and third point fixation increase hardware removal risk.

Keywords:

complication first metatarsal-cuneiform arthrodesis hallux valgus malunion nonunion radiographic results revision surgery

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Area of Science:

Orthopedic surgery
Foot and ankle surgery
Biomechanical analysis

Background:

The Lapidus bunionectomy is a common surgical procedure for correcting hallux valgus.
The incidence of secondary surgeries and hardware removal after Lapidus bunionectomy is not well-documented.
Identifying risk factors for these outcomes is crucial for patient counseling and surgical planning.

Purpose of the Study:

To determine the incidence of revision surgery and hardware removal following Lapidus bunionectomy.
To identify demographic, clinical, and radiographic risk factors associated with secondary surgery and hardware removal.
To provide data for informed patient discussions regarding potential complications.

Main Methods:

Retrospective nested case-control study.
Analysis of 2540 adult patients undergoing Lapidus bunionectomy over a 9-year period.
Calculation of incidence rates and odds ratios for revision surgery and hardware removal within 3 years post-procedure.

Main Results:

The incidence of revision surgery was 5.0% and hardware removal was 6.5%.
Initial risk factors for revision included hallux valgus angle, intermetatarsal angle, and tibial sesamoid position.
Adjusted analysis identified third point of fixation (using a screw) as an independent risk factor for revision (OR=3.01) and hardware removal (OR=2.92). Female sex was also a risk factor for hardware removal (OR=2.33).

Conclusions:

Lapidus bunionectomy has a low overall risk of revision surgery.
Specific fixation methods (third point of fixation with a screw) and patient characteristics (female sex) are associated with increased risk of secondary surgery and hardware removal.
These findings aid in risk stratification and patient consultation for Lapidus bunionectomy.