title: Revision lapidus arthrodesis: rate of union in 17 cases.
abstract: This multicenter study retrospectively reviewed the medical records and radiographs of 15 consecutive patients (17 feet; mean patient age, 54.1 years), who underwent revision "bone-block" Lapidus arthrodesis for a symptomatic nonunion. In all cases but one, the procedure was performed with ipsilateral autogenous bone grafting. All cases used either screw fixation or a combination of screw and plate fixation. Patients were monitored for a minimum of 6 months postoperatively to assess clinical and radiographic union. Successful union was seen in 14 (82%) of the 17 feet that underwent revision. Nonunion was documented in 3 (18%) cases. These results support a favorable rate of union with the described surgical technique. Chi-square tests of association were used to determine whether gender, fixation, bone stimulation, and smoking were predictive of or associated with bone healing. Active smoking in the perioperative period was a predictor of nonunion (P = .05). Based on these findings, the authors recommend aggressive preoperative counseling, and smoking should be considered a relative contraindication to revision surgery.
authors.affiliation: Department of Orthopedics and Podiatric Surgery, Kaiser Permanente Medical Center, Oakland, CA 94801, USA. Graham.A.Hamilton@kp.org
authors.forename: Graham A
authors.initials: GA
authors.lastname: Hamilton
authors.forename: Samantha
authors.initials: S
authors.lastname: Mullins
authors.forename: John M
authors.initials: JM
authors.lastname: Schuberth
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Rush
authors.forename: Lawrence
authors.initials: L
authors.lastname: Ford
mesh_terms: D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000601:surgery; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D013639:Tarsal Bones / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology