Secondary Surgery Following Lapidus Bunionectomy.

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.