Does the lapidus bunionectomy have superior outcomes compared to the distal bunionectomy
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Comparative Outcomes of Lapidus Bunionectomy vs. Distal Bunionectomy
Introduction to Bunionectomy Procedures
Bunionectomy procedures are surgical interventions aimed at correcting hallux valgus deformities. Two common types are the Lapidus bunionectomy, which involves fusion of the first tarsometatarsal (TMT) joint, and distal bunionectomy procedures, such as the Chevron and Scarf osteotomies, which involve cutting and realigning the metatarsal bone. This article synthesizes recent research comparing the outcomes of these two surgical approaches.
Clinical and Radiographic Outcomes
Radiographic Correction
Studies have shown that both Lapidus and distal bunionectomy procedures achieve significant radiographic correction of hallux valgus deformities. For instance, a study comparing minimally invasive Chevron and Akin osteotomies to the modified Lapidus procedure found similar radiographic outcomes in terms of hallux valgus angle (HVA) and intermetatarsal angle (IMA) correction . Another study reported that the Lapidus procedure had the worst distal metatarsal articular angle (DMAA) correction compared to MTP fusion and distal metatarsal osteotomies.
Clinical Outcomes and Patient Satisfaction
Clinical outcomes, including pain relief and functional improvement, are crucial for evaluating the success of bunionectomy procedures. The American Orthopaedic Foot and Ankle Society (AOFAS) scores and Visual Analogue Pain Scale (VAS) are commonly used metrics. Research indicates that both Lapidus and distal procedures result in significant improvements in these scores postoperatively . However, there is no significant difference in patient satisfaction between the two approaches, as measured by PROMIS scores .
Complications and Reoperation Rates
Complication Rates
Complication rates are an important consideration when comparing surgical procedures. The Lapidus bunionectomy is associated with a pseudarthrosis rate of up to 12%. However, studies have shown no significant difference in infection rates between Lapidus and distal procedures. Additionally, the Lapidus procedure allows for earlier weight-bearing without an increase in complications when using a locking plate and plantar lag screw compared to crossed lag screws.
Reoperation Rates
Reoperation rates are another critical metric. Research indicates that there is no significant difference in reoperation rates between Lapidus and distal bunionectomy procedures . The most common reason for reoperation in both groups is hardware removal .
Conclusion
In summary, both Lapidus and distal bunionectomy procedures offer effective radiographic correction and significant clinical improvements for patients with hallux valgus deformities. While the Lapidus procedure may have a higher pseudarthrosis rate, it allows for earlier weight-bearing without increased complications. There is no significant difference in patient satisfaction or reoperation rates between the two approaches. Further research is needed to determine the long-term outcomes and to identify which deformities are best suited for each procedure.
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