Having completed five years of experience with the Lapiplasty® 3d Bunion Correction, I have been reflecting on the impact of the procedure on how I approach bunion correction. Prior to Lapiplasty®, my surgical treatment of bunions was initially determined by my residency training and later by personal practice experience. I have always preferred to adopt procedures and products that, while advanced or state-of-the-art, had either already been through a period of scrutiny to identify shortcomings or unintended consequences or were based on long proven options that were modified in some way to offer additional benefits.
During the early 1990s, while at my surgical residency in New York City, I was well trained in traditional bunion surgery treatment. Most mild bunions were treated with a simple bunionectomy such as a Modified McBride bunionectomy where the “bump” behind the big toe was removed and ligaments around the joint were balanced, pulling the toe straight. Moderate bunions were addressed via the addition of osteotomies – procedures where bones were cut in one fashion or another to either remove wedges or shift the bones to change their angulation or position. The realignment usually required pins or screws to hold the bones in their new positions as well as protection in a special surgical boot for several weeks post-operatively. If the bunions were more severe, the osteotomies would be performed further down the 1st metatarsal bone – closer to the arch than to the big toe. These procedures allowed for more correction but also required the inconvenience of a cast or splint and most significantly, a period of non-weight bearing of up to eight weeks following surgery.
Upon entering private practice in 1993, with the above procedures in my “tool belt”, I used a combination of several x-ray angle measurements to evaluate a patient and determine the optimal procedure to correct their bunion. For bunions that did not have a high degree of arthritis involved, I mostly relied on the “intermetatarsal angle” as the primary measurement to determine the severity of a bunion, and thus determine the proper procedure. Bunions that have significant arthritis have a different treatment algorithm. After considering a patient’s medical history and performing a physical and radiographic evaluation, a recommendation was made. Bunion surgery soon became the most common type of surgery I performed.
Traditional Bunion Correction Surgery
For the next 14 or so years, I performed bunion correction surgery on thousands of patients using the above-mentioned procedures and had good to excellent results in most cases. Occasionally, I would have a patient that had a less than optimal result. When scrutinizing those cases, the disappointing results were usually due to the use of what I would describe as a compromised approach. In most cases this occurred when a patient had a severe bunion that ideally required a procedure that necessitated a period of post-operative non-weight bearing. The patient indicated that they could not comply with the requirement and opted for the use of a less extensive procedure that would permit postoperative weight bearing with the understanding that the chosen procedure was limited in its ability to fully correct the deformity but offered some degree of improvement. In these cases, the patient had been advised that there would be an increased risk for additional surgery in the future. As a result, there were times when a patient would experience recurrence of their bunion deformity. This was the problem with traditional bunion surgery.
Fast forward to approximately 5-6 years ago. I first became aware of the Lapiplasty® 3D bunion correction when a surgical sales representative introduced it to me at my local surgery center. It sounded intriguing. My initial opinion was that the Lapiplasty® was essentially the evolution of a procedure that was first described in the 1930s – The Lapidus procedure. Like an osteotomy procedure, it involved cutting a wedge of bone away that would reduce the 1st-2nd intermetatarsal angle in a foot with a bunion. However, the wedge was taken out so that it encompassed the joint at the base of the first metatarsal – the 1st tarsometatarsal joint. By fusing this joint, it would address hypermobility – abnormal motion that occurred to allow the formation of a bunion – often a severe bunion. The benefits were obvious, a Lapidus procedure could reduce the likelihood of bunion recurrence after surgery by eliminating instability at that joint as well as better correct the most severe bunions as the wedge being closer to the arch would provide more “leverage” for the correction.
But, if the Lapidus procedure was so great, why had I not embraced it yet? The truth lies in that it is a very powerful procedure. Whether written in scripture, spoken by Winston Churchill or used by Spider-man, “With great power comes great responsibility.” While the Lapidus is capable of producing large corrections, when there are complications or if it is performed incorrectly, it can produce or result in considerable problems or deformity. Unfortunately, during my entire residency, I only had the opportunity to witness a single procedure and the result of that procedure did little to inspire confidence. The Lapidus procedure also required 6-8 weeks of non-weight bearing for healing.
Lapiplasty® Bunion Surgery Benefits
However, as I learned more about the Lapiplasty® procedure, I began to appreciate that it was much more than a modernized Lapidus. Like the Lapidus, it addressed hypermobility and was more than capable of correcting severe bunion deformities. But it also had several critical advantages over the old procedure. However, when comparing Lapidus vs Lapiplasty®, the later was more than just a procedure, it included a well thought out (and continuously evolving and improving) system of instruments and techniques that made the results much more reproducible across a wide range of deformities making it an option for almost all non-arthritic bunion deformities. The technique was designed to correct all three dimensions of a bunion deformity and thus provided the most complete correction possible. All this greatly reduced the chance of the bunion returning after surgery. Finally, the plates and screws used in the procedure were specially designed to be low profile and so effective that early weightbearing was permitted. This enabled a reduced recovery time for Lapiplasty® making it the solution in my search for an ideal bunion correction surgery.
I was intrigued. I had a few patients in mind for the procedure when I was trained on it. Treace Medical Concepts, the company behind the Lapiplasty® procedure assisted me in getting up to speed by facilitating an experience where I was able to perform several procedures on cadaveric specimens. (Would you really want your surgeon’s first time ever handling the instruments and doing a procedure to be when they are doing YOUR case?) Some of my first cases were those where I had to correct either residual or recurring deformities following prior surgery. I am glad to say that those types of cases have been amongst the most rewarding and demonstrated the versatility of this procedure.
In fact, while I initially planned on using the Lapiplasty® as my procedure of choice for severe bunions only, I have found that the correction produced by it is so powerful, the potential long-term stability so robust and the early weight bearing freedom so convenient that it is now my bunion correction procedure of choice and makes up roughly 80% of the bunion procedures I currently perform. In short, Lapiplasty® bunion surgery benefits are obvious when addressing bunions of a wide range of severities – as I like to say, from mild to wild.
That leaves approximately 20 % of my non-arthritic bunions that I chose to treat, in consultation with my patients, via another method. Surgery is ultimately an individual choice. I see it as my responsibility to share options, explain the pros and cons, and work with my patients to help them make an informed decision that is in their best interests.
Lapiplasty® Bunion Surgery in The Woodlands, TX
I am grateful to be able to provide this outstanding procedure to my patients. However, I would be remiss if I did not give credit to others that have been vital to our success with The Lapiplasty® 3D Bunion Correction. Treace Medical Concepts provides great resources to surgeons performing the Lapiplasty®, whether it is continuous procedure and instrumentation improvement, ongoing training or the availability of design surgeons to talk over challenging cases. It is with their educational support and commitment to excellence that I have become a Lapiplasty® bunion surgery expert. I am also blessed to have a great team to work with. Dr. Fernando Fernandez and I work together in the operating room. Along with the best operating room team at Memorial Hermann Surgery Center The Woodlands and Memorial Hermann The Woodlands Medical Center, I believe we provide our patients with the finest of care when they choose us to perform their Lapiplasty® 3D bunion correction in The Woodlands, Texas.