A Patient Cohort Comparison of Radiographic Correction and Early Complications Between Percutaneous and Open Lapidus Procedures for Hallux Valgus

Abstract

Category: Bunion Introduction/Purpose: Hallux valgus can be corrected by a variety of procedures. The Lapidus procedure corrects the first ray position in three planes using a first tarsometatarsal fusion (TMTF) and distal release and realignment. In a single surgeon practice the procedure was performed open until 2017, when burrs became available to perform the procedure percutaneously. This study compares the early radiographic results and complications of the percutaneous procedure with the open procedure. Methods: 47 patients undergoing the percutaneous procedure were compared with 44 patients undergoing the open procedure prior to July 2017. Radiographic measures preoperatively were compared to the postoperative measures for intermetataral angle (IMA), Hallux valgus angle (HVA), foot width (FW), distal metatarsal articular angle (DMMA), sesamoid station, metatarsus adductus angle (MAA), first metatarsal to second metatarsal length, and elevation of the first metatarsal. Early 30 day complications were recorded, as well as repeat surgeries. Demographics: There were 81 female and 10 male patients; The average age was MIS 58+/- 13, open 62+/-13. BMI was 28.4 vs 25.1. 1% of patients had diabetes, and 15% were smokers. Statistical analysis was performed using ANOVA. Because of multiple comparisons p<0.005. Error is quoted as 95% standard deviation. Grouped statistics were compared with a chi square test. Results: There is less correction in the MIS group in HV angle. The IM angle reduced from 15.8o+/-4.6 o to 6.3 o +/- 3.3 o compared to 17.7 o to 4.8 o +/- 3.6 o for the open group (p<0.05 and p>0.005). The change was 9.5 o compared to 12.9 o. HVA in the MIS group went from 34.6 o +/- 9.1 o to 14.5 o +/- 7.9 o (20.1 o change) compared to the open group where HVA went from 40.7 o +/- 10.5 o down to 11.6 o +/- 6.1 o (29.1 o change) (p<0.001). The wound complication rate trended higher in the open group (4 versus 0) out of 51 in each group (p>0.05). The nonunion rate was higher in the open group (0 MIS vs 4). The revision rate for deformity correction was the same in both groups (2 versus 2). Conclusion: In this single surgeon series between the two cohorts the MIS group showed a trend towards less correction than the open group. In particular the correction of the Hallux valgus angle was less. At the current time the distal release and realignment may not be as effective as in the open surgery, so more Aitken osteotomies may be required.However there was a trend for less wound complications and less non unions in the MIS group. The comparison included the initial experience with MIS as so the correction may not be as good as the technique evolves.