Cohort Comparison of Radiographic Correction and Complications Between Minimal Invasive and Open Lapidus Procedures for Hallux Valgus

Background: The Lapidus procedure corrects hallux valgus first ray deformity. First tarsometatarsal (TMT) fusion in patients with hallux valgus deformity using minimally invasive surgery (MIS) is a new technique, but comparative outcomes between MIS and open techniques have not been reported. This study compares the early radiographic results and complications of the MIS with the open procedure in a single-surgeon practice. Methods: 47 MIS patients were compared with 44 open patients. Radiographic measures compared preoperatively and postoperatively were the intermetatarsal angle (IMA), hallux valgus angle (HVA), foot width (FW), distal metatarsal articular angle (DMAA), sesamoid station (SS), metatarsus adductus angle (MAA), first metatarsal to second metatarsal length, and elevation of the first metatarsal. Early complications were recorded, as well as repeat surgeries. Results: The mean follow-up was 82 (range, 31-182) months for the open group and 29 (range, 14-47) months for the MIS group. In both techniques, postoperative measures (IMA, HVA, DMAA, FW, and sesamoid station) were significantly improved from preoperative measures. When comparing postoperative measures between both groups, the IMA was significantly lower in the open group (4.8 +/- 3.6 degrees vs 6.4 +/- 3.2 degrees, P < .05). Differential between pre- and postoperative measures for both techniques were compared, and the open group was associated with more correction than the MIS group for IMA (12.4 +/- 5.3 degrees vs 9.4 +/- 4.4 degrees, P = .004) and HVA (25.5 +/- 8.3 degrees vs 20 +/- 9.9 degrees, P = .005). Wound complication and nonunion rates trended higher in the open group (4 vs 0) (P = .051). Conclusion: Both techniques resulted in good to excellent correction. However, the open technique was associated with lower postoperative IMA values and more correction power for IMA and HVA, than the MIS.