Radiological Assessment of Postoperative Changes Following Lapidus Procedure for the Treatment of Hallux Valgus

Author(s): Abdulaziz Almaawi, Sara Albqami, Marwam Zamzami, Mohammed Aladhayani, Salem Alshahrani and Mohammed Alsahil

Context: Hallux valgus is considered the most common pathological cause of pain among adults. There are multiple surgical approaches for its treatment, Therefore, to know the effectiveness of each technique in accordance to our population, they have to be analysed. Aims: The aim of this study was to radiologically assess postoperative changes after the Lapidus procedure from weight-bearing anteroposterior and lateral radiographs. Settings & Design: To analyze the effectiveness of the Lapidus procedure in our setting, we will use a retrospective cohort design to collect the data. Outcomes are defined as reduced calculated angles on radiograph images in King Saud University Medical City. Methods & Material: Data of all patients who underwent a modified Lapidus procedure between 2015 and 2019 were collected from multiple centers. All angles (hallux valgus angle, intermetatarsal angle, calcaneal pitch angle, Meary’s angle, and tibial sesamoid position) were measured both preoperatively and postoperatively. Statistical Analysis Used: Data will be analyzed according to appropriate statistical methods via Statistical Package for Social Studies (SPSS 22; IBM Corp., New York, NY, USA). Results: A total of 100 Lapidus procedures in 89 patients were reviewed. There were 78 unilateral procedures and 11 bilateral procedures with a mean follow-up period of 2 years. The mean hallux valgus correction angle between the preoperative and postoperative follow-up radiographs was 21.7° (p<0.001). The average decrease in the intermetatarsal angle was 7.5° (p<0.001; 95% confidence interval (CI), (6.8–8.3)). The correction angle Meary’s angle mean was 0.2 (p<0.721; CI, (-1.3–0.9)). The average increase in the calcaneal pitch angle was 3.8° (p<.001). The average decrease in the LaPorta classification was 2.9 units (p<.001; CI, (2.6–3.3)). Postoperatively, no patients were in the LaPorta group 6 or 7. Conclusion: In the Lapidus procedure, the first tarsometatarsal joint derotational arthrodesis produced good radiologic correction on flexible Hallux Valgus. In addition, the LaPorta classification showed a significant decrease and proper positioning of sesamoids postoperatively, which is a predictor for good results and a decrease in recurrence.


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