Hello. Thank you for joining. My name is Sarah Gally. I'm presenting on Radiographic Outcomes and Recurrence Following 146 Primary Lapidus Surgeries for Haloxalgas. These are my co-authors. I have nothing to disclose, and none of my co-authors have disclosures relevant to this class, but for completion, here are my co-authors' disclosures. Haloxalgas encompasses a spectrum of deformity ranging in severity with also various clinical nuances that guide surgeon decision about surgical treatment. The modified lapidus has emerged as a powerful tool for Haloxalgas correction, particularly for those with a wide intramedatarsal angle and first TMT joint instability. Various techniques of correction and arthrodesis fixation have been described with a still ongoing evolution of those techniques. Despite being well-recognized as effective tool for Haloxalgas correction, our experience has suggested that recurrence rates may be higher than previously reported in the literature. Our hypothesis based on this observation was that Haloxalgas recurrence, defined as a Haloxalgas angle greater than or equal to 20, following a modified lapidus procedure would be higher than reported in the literature, with ranges varying from 0 to 16% depending on the study. This was a retrospective cohort study with IRB approval. Patients were identified by CPT code and charts were reviewed for eligibility. Revision surgeries and larger midfoot hindfoot procedures were excluded. Only patients with one-year minimum post-op radiographs were included. Preoperative, first weight-bearing post-operative, and final post-op radiographs were reviewed, and standard Haloxalgas measurements taken, as well as lateral Taylor first metatarsal angle measured. Charts were reviewed for complications and subsequent operations. 146 eligible surgeries performed by four fellowship-trained surgeons were identified in 132 patients with a median age of almost 58 years old. Median radiographic follow-up was 3.8 years, and preoperative Haloxalgas angle and intrametatarsal angle were 35 and 15 degrees respectively. There were a total of 65 radiographic recurrences, or 45%, but only 15 reoperations for recurrence, 10%. There were eight non-union repairs, two of which recurred in our recurrence group, with a 5% non-union rate observed. Cohorts were defined by radiographic recurrence utilizing a Haloxalgas angle greater than or equal to 20 as the cutoff. We first looked at if preop deformity severity was associated with recurrence. A preop HVA, but not IMA, was associated with recurrence, and we used a receiver-operator curve to define the HVA cutoff of greater than or equal to 31, with an area under the curve of 74, indicating that in 74% of cases, a preop HVA of greater than or equal to 31 predicted recurrence. We also looked at if preop arch alignment was associated with recurrence. We looked at pes planus, cavus, or neutral alignment, defined by the lateral talofers metatarsal angle, respective to 7 and negative 7, and we found that no association was found. We then examined postop radiographs and compared the first weight-bearing radiograph and final radiograph. Follow-up was not different between groups, both for the first weight-bearing and final follow-up. In those that recurred, there was a higher halexalgis angle, 17 versus 8, and IMA 8 versus 6, indicating that undercorrection is a risk factor for recurrence. In those that recurred, the HVA increased by 10 as opposed to only 3 in group without recurrence, compared to changes only of 2 versus 0 as the IMA observed. Despite being acknowledged as a powerful procedure for halexalgis correction, the modified lapidus still had a higher rate of radiographic recurrence when used to treat deformity in our series, assessed at 46%. As has been determined in other halexalgis series evaluating metatarsal osteotomies, an increased halexalgis angle greater than or equal to 30 is a risk factor for recurrence. This is important when counseling patients before surgery, as the modified lapidus operation does not obviate the risk of recurrence, as has been previously suggested. In addition, while this is intuitive, it is important that we correct both the HVA and IMA at time of surgery. So from our series, it appears that greater degree of recurrence is occurring at the HVA rather than the IMA. An interesting observation from our series is that despite a high radiographic recurrence rate, only 10% underwent revision surgery for recurrence. This lower revision rate suggests that radiographic outcomes alone do not drive satisfaction. Further outcome measures are needed on this cohort to better identify surgical variables associated with maintained and or lost correction, other risk factors for recurrence, as well as patient-reported outcomes. A limitation of our study is that only patients with greater than one year radiographic follow-up were included, and our routine follow-up does not always extend to one year in our practice, so we could be missing patients as well as missing reoperations that were done elsewhere. To help in answering some of these questions, we have contacted all patients and are collecting patient-reported outcome measures to better understand determinants of satisfaction, as well as examining some of these mentioned variables that may help us prevent recurrence in the future. Thank you.

radiographic outcomes

recurrence rates

primary Lapidus surgeries

hallux valgus

modified Lapidus procedure