PERCUTANEOUS LAPIDUS PROCEDURE FOR THE MANAGEMENT OF PRIMARY HALLUX VALGUS DEFORMITY: A RETROSPECTIVE COHORT ANALYSIS

Hallux valgus deformity remains one of the most common conditions seen in elective foot and ankle practice with an estimated prevalence of 35% in adults over the age of 65 years. When symptomatic and conservative measures have been exhausted a number of surgical osteotomy or fusion procedures may be utilized. The Lapidus procedure allows a large degree of correction to be obtained and involves fusion of the first tarsometatarsal joint. This has traditionally been performed with open incisions to prepare the first tarsometatarsal joint, release the first metatarsophalyngeal joint and insert hardware for fixation. Percutaneous techniques have been further developed in order to minimize soft tissue trauma, reduced postoperative pain and accelerated rehabilitation. Our technique involves percutaneous preparation of the first tarsometatarsal joint using a shannon burr for debridement, arthroscopy for visualization, and three full thread 4 mm non variable pitch headless chamfered cannulated screws for fixation. This technique retains subchondral bone for rigid fixation and stability. We aim to evaluate our complication rates following primary hallux valgus surgeries performed in our unit after the implementation of the percutaneous Lapidus procedure as the default surgical technique of the lead author. Patients over the age of 16 years undergoing percutaneous Lapidus procedure for primary hallux valgus deformity between 1st January 2018 and 1st April 2023 were retrospectively identified from our database. A minimum of 6-months postoperative follow-up was required for inclusion. Individual patient notes were retrospectively reviewed to assess for complications or requirements for further surgery to the foot for any reason. 149 percutaneous Lapidus procedures were performed in 130 patients. Twenty patients had bilateral procedures. Twelve patients were male (9.2%). All cases were performed by the lead author. Mean follow up was 34 months (Range 6 - 70 months). No patients were identified as developing deep infection or non-union requiring revision surgery within the follow-up period. Seventeen patients (11.4%) required removal of metalwork for soft tissue irritation at mean 17 months (Range 6 – 33 months). Three patients (2%) required subsequent first metatarsophalangeal joint fusion of the ipsilateral foot for symptomatic arthritis at mean 24 months (Range 8 – 40 months). In our experience percutaneous Lapidus fusion of the first tarsometatarsal joint appears to be safe and effective treatment for primary hallux valgus. We identified no cases of nonunion of the first tarsometatarsal joint in our cohort at minimum 6-month follow-up. Postoperative soft tissue irritation requiring removal of metalwork appears comparable to published open techniques for the treatment of primary hallux valgus.2