Radiographic Outcomes And Recurrence Following 126 Primary Lapidus Surgeries For Hallux Valgus

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Treatment for symptomatic hallux valgus encompasses a spectrum of surgical options to appropriately address the degree of deformity. The modified Lapidus has emerged as a powerful surgical option to address moderate to severe deformity as well as hallux valgus with 1st ray hypermobility. Unlike metatarsal osteotomies, the literature is lacking in clinical and radiographic outcomes. Previous retrospective series have reported recurrence rates less than 15%, but our experience suggested recurrence rates were higher. Methods: After obtaining institutional board review approval, patients were identified by procedural billing codes from 2012- 2016. Only patients who underwent a primary Lapidus surgery with greater than 1 year radiographic follow-up were included. Larger midfoot fusions and flatfoot reconstructions were excluded. Charts were reviewed to identify complications and reoperations. Radiographs were reviewed and HVA, IMA, sesamoid position (0-4), and Meary’s angle measured on preoperative, 1st weigh-bearing post-operative, and final follow-up radiographs. Data was analyzed utilizing statistical analysis software (SAS v9.4). Results: 114 patients were identified with 12 undergoing bilateral surgery (126 surgeries). There were 106 females and 8 males, and median age was 57.5 years at time of surgery. Median follow-up from index surgery was 2.9 years. Using HVA>=20 as cutoff for recurrence, 58 (46%) recurrences were identified, but only 15 (12%) underwent revision surgery. There were 32 total reoperations, including 8 nonunions (table 1A). Median preoperative HVA was greater in group with recurrence than group without recurrence (38 vs 30, p