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Updated: Aug 6, 2026
Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis
Published on: February 9, 2024
Minimally Invasive vs Open Lapidus Bunionectomy: 1-Year Patient-Reported Outcomes
Lance M Ward1, Isabel R Voellmicke1, Dwayne D Carney1
1Foot & Ankle Service, Hospital for Special Surgery, New York, NY, USA.
Background:
Hallux valgus is a common and potentially debilitating foot deformity, and the modified Lapidus is a prominent corrective procedure in the United States. The clinical distinctions between the minimally invasive surgery (MIS) and the established open techniques for modified Lapidus have not yet been well-described, particularly in the context of patient-reported outcomes. This study aims to systematically compare patient-reported outcomes between the 2 surgical approaches.
Methods:
One hundred forty moderate to severe hallux valgus patients who received modified Lapidus (66 MIS, 74 open) were identified via retrospective review. Patient-Reported Outcomes Measurement Information System (PROMIS) scores were used to assess clinical outcomes preoperatively and at 1 year postoperatively. Hallux valgus angle (HVA) and 1-2 intermetatarsal angle (IMA) were measured on radiographs. Meary angle, first-ray length, first-ray elevation, first-ray pronation, and sesamoid position were analyzed on weightbearing computed tomography (WBCT). Surgical complications were identified through chart review and radiographic assessments.
Results:
MIS and open Lapidus patients reported clinically meaningful improvements in PROMIS physical function, pain interference, pain intensity, and global physical health scores at 1 year postoperatively, along with modest changes in global mental health and depression scores. There were no statistically significant differences in PROMIS scores between groups (adjusted P > .05, 95% CIs excluding zero). Although both techniques reliably achieved excellent correction, there was greater correction of HVA (3.82°) and IMA (2.02°) in open Lapidus patients and greater correction of Meary angle (3.16°) in MIS patients (adjusted P < .05, 95% CIs excluding zero). Rates of nonunion, recurrence, infection, and hardware removal were not statistically significant between surgical cohorts.
Conclusion:
With the numbers available, no statistically significant difference was detected between the MIS and open Lapidus groups across all collected PROMIS measures, implying that the foot and ankle surgeon can expect to see similar patient-reported outcomes at 1 year postoperatively using either approach.
Level Of Evidence:
Level III, retrospective cohort study.
