The Center for Podiatric Care and Sports Medicine

4 Possible Complications with Lapidus Bunion Surgery That Every Patient Should Know

Posted by on Monday, April 18th, 2016

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While there are over 100 different types of bunion surgery, the Lapidus bunionectomy has become probably the most talked-about method for hallux valgus deformity correction in recent years. As Podiatry Today points out, the Lapidus procedure corrects the deformity at its root, preserves big toe joint function, helps prevent issues like hypermobility and excessive loading, allows for postoperative weight bearing, and improves rear foot alignment.

bunion surgery complications
At the NYY Center For Podiatric Care and Sports Medicine, we take measures to avoid bunion surgery complications. (Image Source: Flickr CC user Jessica Jasper)

Complications with Bunion Surgery

While the American Association of Orthopaedic Surgeons reports that fewer than 10 percent of patients experience bunion surgery complications, even the most experienced surgeons can run into challenges. While perfection is impossible, the best surgeons know how to keep patients satisfied by minimizing common postoperative issues like infection, excessive shortening, nonunion, and recurrence.

If you’re scheduling a Lapidus procedure, educate yourself by learning more about these four common complications with bunion surgery:

1. Infection

Infection is a complication of any surgery, but Harvard Health estimates your risk of infection from bunion surgery at less than 1 percent. When infections do occur, they are likely to be superficial, rather than deep bone or hardware-related.

Risk factors for infection include advanced age, obesity, diabetes, and immune system suppression. As a result, patient interviews and counseling are an important part of the preoperative process. These risk conditions do not necessarily rule out a patient for surgery, but they are indications that greater care must be taken to prevent infection.

As a precaution, we routinely administer antibiotic prophylaxis to head off the possibility of infection. We counsel patients to be on the lookout for any signs of infection in the few days following surgery, such as increased pain, warmth, fever, chills, night sweats, or nausea. Patients may need screening for certain types of bacteria before proceeding with surgery.

2. Nonunion

Nonunion occurs when the toe bone fails to heal properly. One study found seven instances of nonunion among 92 bunionectomy patients, and it’s generally accepted that the Lapidus bunionectomy nonunion rate is as high as 10 percent. However, researchers note that surgeries using the plate-and-screw fixation method have successfully lowered this rate. Proper preparation work by the surgeon is also key to a successful union.

One reason that a bone fusion may be unsuccessful is that the patient does not comply with the surgeon’s instructions. We ask that patients avoid smoking and second-hand smoke, as nicotine interferes with bone healing. If you are overweight, we may recommend weight loss prior to surgery to avoid putting too much stress on the hardware. You will also want to avoid NSAID medications and follow postoperative weight bearing instructions to the letter.

If x-rays reveal less-than-optimal progress at the three-month mark, we may recommend the use of a pulsed electromagnetic field bone stimulator.

3. Excessive Shortening

All Lapidus procedures involve some degree of toe shortening because the first tarsometatarsal joint requires resectioning to remove the deformity. Ideally, the surgeon will remove no more than 0.5 cm. When the joint is excessively shortened, the patient may suffer from pain in the ball of the foot (called metatarsalgia).

To avoid this particular bunion surgery complication, we take our time – especially when dealing with the cartilage – as an overzealous cleaning is the most obvious culprit behind over-shortening the bone. Instead of using a large saw (as podiatric surgeons were forced to do in the past), we use the curettage method and, at most, a small sagittal saw to sculpt the joint in a more delicate fashion.

In a few cases, autografting and allografting will be done to rectify a naturally short metatarsal. More often, a procedure called a callus distraction is done to properly lengthen and fix the joint.

4. Bunion Recurrence

Since the Lapidus bunionectomy addresses the cause of the deformity, recurrence rates are very low (1-2%). The hallux tends to drift outward again only if the issue of hypermobility has not been properly addressed in the first place. We conduct a thorough preoperative examination of your feet to determine the best course of action. During the surgery, we also perform a hypermobility test to see if additional fusion procedures for the intercuneiform joint are warranted.

 

Contact The Center For Podiatric Care and Sports Medicine to find experienced Lapidus bunion surgeons in NYC.
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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.