Comparing Traditional Lapidus to Newer Triplane Methods for Correction of Hallux Valgus

Abstract

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Correction of hallux valgus is a common procedure for foot and ankle specialists. Advances in the understanding of this deformity has shifted surgical correction back to the first tarsometatarsal joint. Traditional Lapidus methods had a low recurrence rate and 10% nonunion rate. Recent developments in the correction of hallux valgus have centered on triplane correction utilizing proprietary systems. These systems are effective at obtaining, and maintaining, correction. However, they are expensive and there is a paucity of unbiased literature comparing it to traditional methods. This study aims to evaluate radiographic outcomes and complications of patients undergoing traditional Lapidus fixation to triplane corrective procedures. Our hypothesis is that overall correction will be obtained and maintained at a similar rate, with no difference in overall complications. Methods: After IRB approval, a total of 275 patients over the age of 18 were identified who underwent a total of 294 procedures for first tarsometatarsal joint fusion for hallux valgus correction between February 2010 to August 2020. A retrospective chart review was then performed dividing patients into two groups: traditional Lapidus fixation and triplane correction methods. A total of 191 patients underwent traditional Lapidus, and 103 underwent triplane correction. Charts were evaluated for complications that required a return to the operating room, specifically nonunion, loss of correction, infection, and hardware removal. AP foot radiographs were then reviewed from the patient's preoperative visit, immediate postoperative, and final follow up. On each film, the first intermetatarsal angle (IMA) was then measured by two independent observers. Each IMA was recorded and overall surgical correction, final correction angle, and maintenance of correction were calculated. Results: Comparing triplane correction to traditional Lapidus cohorts, there was no difference in age (50.6 vs 48.9 years, p=0.39), initial deformity (14.66 vs 15.61 degrees, p=0.05), or x-ray follow up (229 vs 393 days, p=0.23). When comparing IMA correction, there was no difference in initial amount of correction (11.2 vs 11.4 degrees, p=0.58) or final correction angle (5.22 vs 5.66 degrees, p=0.05). Comparing complications, there was no difference in secondary surgery rates (9/103, 8.7% vs 11/191, 5.76%, p=0.34), especially nonunions/loss of correction (4.85% vs 2.62%, p=0.32). Comparing number of cases that experienced an increased IMA of more than 5 degrees from post-op to final, there was no difference (10/103, 9.71% vs 12/191, 6.29%, p=0.35). Finally, there was no difference in infection (p=0.13) or implant removal (p=0.43). Conclusion: When comparing radiographic correction of IMA, maintenance of correction, and secondary surgery rates, there appears to be no difference between triplane correction methods and traditional Lapidus procedures. Recent evidence in the literature supports correction of hallux valgus through the TMT joint, with a subsequent increase in proprietary reduction and fusion methods. These proprietary methods are expensive, and according to this study, offer no improvement over traditional, less expensive methods in terms of IMA correction and need for secondary surgery. Further study is needed to assess patient reported outcomes for each and potential radiographic findings that may suggest risk of recurrence.