SLR - January 2023 - Lex Barte DPM, MHSA
Title: Effectiveness of the Lapidus plate system in foot surgery: A PRISMA compliant systematic reviewReference: Lopez-Lopez D, Larrainzar-Garijo R, De-Bengoa-Vallejo RB, Losa- Iglesias ME, Bayod-Lopez J. Effectiveness of the Lapidus plate system in foot surgery: A PRISMA compliant systematic review. Int Wound J. 2022;19 (3):507-514. https://doi.org/10.1111/iwj.13649
Level of Evidence: Level III Evidence
Reviewed by:
Lex Barte DPM, MHSA
Residency:
LECOM/ Millcreek Hospital Erie, PA
Podiatric relevance:
The Lapidus is a prevalent procedure that correct deformities which include: a hypermobile 1st ray, hallux abductovalgus, hallux limitus, lesser metatarsal pain and at times, flat foot reconstruction. Research and literature have suggested the best approach for a maximal outcome, but this is the first article to review all relevant data collected on this technique spanning over the last 10 years.
Methods:
Web search was carried out by two expert reviewers utilizing Medline and Web of Science using the keywords: arthrodesis, hallux, foot, bone-implant interface and treatment terms Lapidus plate system, Lapidus procedure, foot surgery and first metatarsocuneiform arthrodesis. Manuscripts included randomized and controlled clinical trials that were published regionally and internationally. The exploration took place over 10 years from February 2011-2021. Exclusion criteria consisted of observational studies with sawbones, low evidence articles, and articles that were not either in English or Spanish.
Results:
There were 14 studies that fulfilled all inclusion criteria. The selected cases were broken down into a table that consisted of: foot problem type, intervention, type of system, insertion placement, outcome measures, follow up and level of the fixation.
Conclusion:
The Lapidus procedure is a common procedure of choice for first ray alignment in three cardinal planes. Not addressing this deformity has been correlated to a poor quality of life that is effects down the kinetic chain consisting of the low back, hip, knee, balance and danger of falls.
The purpose of this study was to possibly evaluate which approach would be most effective for the fusion of the 1st metatarsocuneiform joint. It was found that the most surgeons chose to use a fixation consisting of a compression plate with screws in conjunction with early and immediate weight bearing. The majority of the studies displayed optimal placement of the plates to be plantarly or dorsomedial. It shows that these elements combined provide excellent control of the first ray and prevent dorsiflexion of the first metatarsal joint. The authors also concluded that this method produce the best outcomes both clinically and radiographically.
However, this journal had several limitations. For example, the sample size from which they evaluated was small. They were only able to include 14 total articles to evaluate. This could be attributed to the fact that there simply were not enough peer reviewed articles on the Lapidus procedure.
In spite of this, it was an interesting topic to highlight as it showed that much more research should be focused on the common podiatric procedure. There has been a greater demand for this surgery as the commercialization of different systems has begun to grow in popularity. It would be prudent to evaluate what is most effective so that we, as a specialty, can meet the growing demand with good patient outcomes and care.