Alex, I'll Take Bunions for $1,000
Updated: Sep 1, 2021
One of the most common musculoskeletal surgeries performed, bunion treatment is big business in the US. There is little consensus, however, on the most effective treatment strategy. Osteotomies narrow the foot in a joint-sparing approach, whereas a 1st TMT approach achieves correction through fusion.
Rotation is making me think 3D
Newer concepts of rotational deformity of the medial column leading to hallux valgus are gaining momentum through research. It's not universal, though, and there are subsets where a rotational correction is neither needed nor appropriate.
Osteotomy vs Lapidus
The HHS group, using PROMIS scoring, compared traditional osteotomy for bunion correction with scarf osteotomy. They found that the X-ray correction was better in the Lapidus group, but the clinical outcomes scores were equivalent. This brings up the obvious question of whether the X-ray correction matters if we are interested in patients' perceptions of improvement.
Now that Treace Medical Concepts has closed an IPO with a market cap of over $1.5 billion, look for more push in the lapiplasty direction for research and clinical use.