Early Postoperative Coronal Alignment Predicts Recurrence and Patient-Reported Outcomes After the Modified Lapidus Procedure.

Abstract

Recurrence remains a relevant complication after hallux valgus surgery, even following the modified Lapidus procedure. To investigate the association between early postoperative radiographic alignment and final hallux valgus recurrence using routine weight-bearing radiographs. Retrospective cohort study. This retrospective study included 52 feet in 43 patients who underwent the modified Lapidus procedure for severe hallux valgus. Weight-bearing radiographs were evaluated preoperatively, at 3 months postoperatively, and at final follow-up (minimum 12 months). Feet were classified into non-recurrence (final hallux valgus angle [HVA] ≤20°) and recurrence groups (final HVA >20°). Coronal and sagittal plane radiographic parameters were assessed. Clinical outcomes were evaluated using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and the Japanese Society for Surgery of the Foot (JSSF) hallux scale. Hallux valgus recurrence was observed in 7 feet (13.5%). At 3 months postoperatively, the recurrence group demonstrated significantly poorer coronal alignment, with higher HVA and intermetatarsal angle values than the non-recurrence group (p < 0.05). Severe sesamoid displacement was more frequent in the recurrence group. In contrast, sagittal plane parameters showed no significant between-group differences. A strong correlation was observed between 3-month postoperative HVA and final HVA (ρ = 0.944, p < 0.001). Poorer early coronal alignment was also associated with inferior patient-reported outcomes at final follow-up. Early postoperative coronal alignment assessed on routine weight-bearing radiographs is closely associated with hallux valgus recurrence and patient-reported clinical outcomes following the modified Lapidus procedure. Adequate early coronal correction may be important for optimizing long-term surgical outcomes.