SLR- February 2014- Mark Bullock
Reference: Faber F.W.M., van Kampen P.M., Bloembergen M.W., Long-term Results of the Hohmann and Lapidus Procedure for the Correction of Hallux Valgus. J Bone Joint Surg Br.95B:1222-6; 2013.
Scientific Literature Review
Reviewed By: Mark Bullock, DPM
Residency Program: St John Hospital and Medical Center, Detroit, MI
Podiatric Relevance: Hypermobility of the first tarsometatarsal joint is associated with hallux valgus deformity. Reduction in hypermobility has been observed post-operatively following correction of the first intermetarsal angle with metatarsal osteotomy and distal soft tissue release. For this reason the need to treat hypermobility with a tarsometatarsal arthrodesis is debated. The authors compared a Lapidus with distal soft tissue release to a Hohmann osteotomy to determine if a first tarsometatarsal arthrodesis reduces recurrence of hallux valgus in patients with first ray hypermobility.
Methods: In this prospective study, 101 feet were randomized to receive a Lapidus or Hohmann for hallux valgus correction between October 1997 and July 2000. Forty-six feet in the Lapidus group and 45 feet in the Hohmann group were available for long-term follow-up at eight to eleven years to assess clinical and radiographic recurrence. Less than or equal to 8mm of excursion of the first metatarsal head in the sagittal plane with the Klaue device was defined as clinical hypermobility. Thirty-four feet in the Lapidus group and 29 feet in the Hohmann group with clinical hypermobility were placed in a hypermobile subgroup and compared separately at two year and long-term follow-up.
Results: At long-term follow-up there was no significant difference in clinical or radiographic recurrence between the treatment groups. The results extended to patients with clinical hypermobility. In the hypermobile subgroup pre-operative intermetatarsal (IM) angles averaged 13.6 in the Hohmann group and 13.9 in the Lapidus group with severe hallux valgus deformity present in both groups. In the Lapidus group IM angle increased from 5.5 to 6.9. In the Hohmann group IM angle increased from 6.1 to 7. In the Lapidus group the first MTPJ angle increased from 13.3 to 14.4. In the Hohmann group first MTPJ angle increased from 10.7 to 11.0. With both procedures IM angles slightly increased and AOFAS scores slightly decreased reaching statistical significance. IM angles and AOFAS scores were significantly improved compared to pre-operative levels in both groups.
Conclusions: Arthrodesis of the first tarsometatarsal joint did not decrease long-term recurrence of hallux valgus in patients with first ray hypermobility in this prospective randomized study. The study supports the theory that hypermobility develops secondary to the increased intermetatarsal angle associated with hallux valgus.Confounding variables which could reduce recurrence include reduction in PASA with the Hohmann procedure and distal soft tissue release with the Lapidus procedure. The authors admit the accuracy and reproducibility of their clinical test for hypermobility is open to debate.