Incidence of Complications After Minimally Invasive Lapidus Surgery

In recent years, the Lapidus procedure has undergone adaptation to embrace the minimally invasive guidelines that are currently gaining traction in the United States. However, because of the steep learning curve associated with minimally invasive surgery and the lack of literature based on long-term outcomes, the procedure is still a long way from replacing open surgical techniques. To date, the incidence of complications with this updated technique has not been evaluated.

The purpose of this systematic review was to determine the incidence of complications for the Lapidus procedure. We conducted a systematic review of electronic databases and relevant peer-reviewed sources as outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the preparation of systematic reviews. Studies that included the minimally invasive surgical technique of Lapidus (or tarsometatarsal fusion), used fixation, had a minimum average follow-up of 6 months, and included complications were considered. Some of the studies included patients with concomitant procedures. The included studies did not report on comorbidities. Cadaveric studies, technique guides, and non-English studies were excluded.

A total of five studies were identified that met our inclusion criteria, with a total of 162 feet included. Total incidence of complications was 12.3% (n = 20) and the most commonly reported complications included hardware pain (n = 9), nonunion (n = 5), deformity recurrence (n = 3), and neurovascular injury (n = 3).

Our systematic review revealed that this updated minimally invasive surgical technique provides a safe and reproducible surgical option for correcting deformities of the first ray requiring tarsometatarsal fusion, with an incidence of complications lower than what is currently reported in the literature for open variations of the procedure.