Early Weight-bearing Following Modified Lapidus Arthrodesis: A Retrospective Review of 104 Cases & Postoperative Protocol.

IF 1.3 4区 医学 Q2 Medicine
Mr Akram Uddin, Mr John W Bramall, Dr Keng LeongNG, Dr Kajetan Klos, Dr Edgar Roth, Prof Derek Santos
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引用次数: 0

Abstract

Background: Lapidus arthrodesis is indicated for the treatment of first ray dysfunction or hypermobility, hallux valgus (HV) and functional hallux limitus (FHL). Postoperative weightbearing protocols vary amongst surgeons.

Purpose: To report radiographic osseous healing and patient-reported outcome measures (PROMS) following a single early weightbearing protocol.

Study design: Retrospective review of 104 adults (≥18 years) (104 feet) who underwent open modified Lapidus arthrodesis (without bone graft) by single compression screw and medial locking plate by two surgeons at one centre (between January 2019 to May 2023).

Methods: Pre- and postoperative radiographs and electronic records were reviewed for evidence of osseous healing and return to full weightbearing. Secondary measures included deformity reduction and PROMS.

Results: At 6-weeks follow-up 98 patients (94%) were confirmed of osseous healing and returned to full weightbearing. Six patients (6%) had delayed osseous healing at 6-weeks but showed signs of osseous healing by 3-months follow-up. Postoperative HV and intermetatarsal angle (IMA) showed significant reduction (mean difference: -12 (SD=8) and -5 (SD=4) degrees respectively; p<0.001 for both). Ten patients (10%) had postoperative complications: hardware irritation 5 (5%), sesamoiditis 2 (2%), hypertrophic scar 2 (2%) and joint stiffness 1 (1%). Eight patients (8%) required further surgery (5 required fixation removal due to hardware irritation. Three underwent either; 1st MTPJ open-mobilization, excision of scar or distal metatarsal osteotomy with tibial sesamoid planning). Manchester-Oxford Foot Questionnaire (MOXFQ) showed significant improvement across all domains (mean difference (SD): -51 (SD=22); walking/standing -49 (SD=24); pain -52 (SD=22); and social interaction -51 (SD=28); (p<0.001 for all) with clinically significant effect size (Cohen's d: 2.37; 2.01; 2.37; and 1.84 respectively). Patient satisfaction questionnaire (PSQ-10) score was high mean of 91 (SD=8). 5 patients (5%) were lost by 6-months follow-up.

Conclusion: Early weightbearing achieved consistent osseous healing and high PROMS. Larger controlled studies are required to validate these results.

Level of evidence: Retrospective study.

Level iii:

改良Lapidus关节融合术后早期负重:104例回顾性分析及术后方案。
背景:Lapidus关节融合术适用于治疗一线功能障碍或活动过度,拇外翻(HV)和功能性拇受限(FHL)。术后负重方案因外科医生而异。目的:报告单一早期负重治疗方案后的放射学骨愈合和患者报告的结果测量(PROMS)。研究设计:回顾性分析在2019年1月至2023年5月期间,由两名外科医生在一个中心(2019年1月至2023年5月)通过单个压缩螺钉和内侧锁定钢板接受开放式改良Lapidus关节融合术(无骨移植)的104名成年人(≥18岁)(104英尺)。方法:回顾术前和术后x线片和电子记录,以寻找骨愈合和完全负重的证据。次要措施包括畸形复位和PROMS。结果:随访6周,98例(94%)患者骨愈合,恢复完全负重。6例患者(6%)在6周时骨愈合延迟,但在3个月的随访中显示骨愈合迹象。术后HV和跖间角(IMA)均显著降低(平均差值分别为-12 (SD=8)度和-5 (SD=4)度;后MTPJ开放活动,切除疤痕或远端跖骨截骨与胫骨籽骨计划)。曼彻斯特-牛津足部问卷(MOXFQ)在所有领域均有显著改善(平均差(SD): -51 (SD=22);行走/站立-49 (SD=24);疼痛-52 (SD=22);社会互动-51 (SD=28);结论:早期负重可获得一致的骨愈合和高PROMS。需要更大规模的对照研究来验证这些结果。证据水平:回顾性研究。第三级:
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来源期刊
Journal of Foot & Ankle Surgery
Journal of Foot & Ankle Surgery ORTHOPEDICS-SURGERY
CiteScore
2.30
自引率
7.70%
发文量
234
审稿时长
29.8 weeks
期刊介绍: The Journal of Foot & Ankle Surgery is the leading source for original, clinically-focused articles on the surgical and medical management of the foot and ankle. Each bi-monthly, peer-reviewed issue addresses relevant topics to the profession, such as: adult reconstruction of the forefoot; adult reconstruction of the hindfoot and ankle; diabetes; medicine/rheumatology; pediatrics; research; sports medicine; trauma; and tumors.
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