The Results of Modified Lapidus Procedure on Moderate-to-Severe Hallux Valgus with First Tarso-Metatarsal Joint Hypermobility / 대한족부족관절학회지

ABSTRACT

PURPOSE: The objective of this study was to confirm the results of the modified Lapidus procedure on moderate to severe hallux valgus patients with first tarso-metatarsal joint hypermobility. MATERIALS AND METHODS: A retrospective study was conducted on 42 cases of 35 patients who underwent the modified Lapidus procedure between March 2006 and December 2014. A comparative analysis was performed on the preoperative and postoperative subjective satisfaction of patients and radiologic index. Moreover, the correlation between the follow-up time and patient's operative satisfaction, as well as between the proficiency of the operator and patient's operative satisfaction was analyzed. Complications were also evaluated. RESULTS: Out of the total of 35 patients, 3 were male and 32 were female. The mean age was 61.3 years (range, 34∼79 years), and the mean follow-up time was 22.1 months (range, 6∼90 months). The overall satisfaction level was 67.6% and the mean hallux valgus angle improved from preoperative 40.5° to postoperative 12.2° (p<0.001). The mean 1, 2 intermetatarsal angle improved from preoperative mean of 16.9° to postoperative mean of 7.6° (p<0.001), and the sesamoid position improved significantly, from preoperative 2.7 to postoperative 0.9 (p<0.001). Furthermore, there was no correlation between the follow-up time and the American Orthopaedic Foot and Ankle Society (AOFAS) hallux scale; also no correlation between the year the operation took place and the AOFAS hallux scale. In terms of complications, we observed screw irritation in 6 cases, hallux varus in 2 cases, and recurrence of hallux valgus and nonunion in one case. CONCLUSION: Contrary to our concerns, the level of complications was not high; however, the satisfaction level of patients was also not very high. Therefore, careful selecting of patients and sufficient consultation time is needed before surgery. In addition, since the causes of postoperative dissatisfaction still remain unclear, further studies are necessary.