Current Concepts With Revisional Bunion Surgery

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Author(s): 
Neal Blitz, DPM, FACFAS

   Radiographic nonunions (or non-painful nonunions) should not require surgical intervention. Radiographic nonunions (from joint fusion) may progress onto full radiographic union one to two years after the index operation. In my practice, I have found that an electromagnetic field is very successful in attaining fusion with nonunion cases of the first tarsometatarsal joint.

   Nonunions from bunion surgery commonly respond to bone grafting and stable fixation. I prefer using autologous bone, which one can harvest from the heel bone. When length is needed, one can harvest a bicortical bone block.7

   As far as fixation goes, each case needs independent consideration. However, I find plating useful for nonunion revision in general. If the primary surgery involved screws and hardware removal occurs at the revision, then there may not be enough bony real estate to replace screws. Accordingly, plating solves that issue as the screws enter the bone tangentially. Sometimes internal bone stimulators may be useful tools, especially for patients with poor protoplasm.

In Summary

Revision bunion surgery is complex and can be successful. There are many variables that surgeons need to consider when revising a previous bunion surgery. There is no cookie cutter operation for a failed bunion surgery. Fusion of the big toe joint for revision bunion surgery should be a last resort option. Surgeons performing revision bunion surgery should focus on keeping the big toe joint functional. Fortunately, revision bunion surgery can be extremely successful for patients.

   Dr. Blitz is a Fellow of the American College of Foot and Ankle Surgeons, and is board-certified in Foot Surgery and Reconstructive Rearfoot Surgery by the American Board of Podiatric Surgery. Dr. Blitz is in private practice in Midtown Manhattan.

   For more information on Dr. Blitz, please visit www.BunionSurgeryNY.com .

References

1. Lagaay PM, Hamilton GA, Ford LA, Williams ME, Rush SM, Schuberth JM. Rates of revision surgery using Chevron-Austin osteotomy, Lapidus arthrodesis, and closing base wedge osteotomy for correction of hallux valgus deformity. J Foot Ankle Surg. 2008; 47(4):267-72.
2. Duan X, Kadakia AR. Salvage of recurrence after failed surgical treatment of hallux valgus. Arch Orthop Trauma Surg. 2012; 132(4):477-85.
3. Weinraub GM, Mejia O. Revision surgery of the first ray. Clin Podiatr Med Surg. 2009; 26(1):37-45.
4. Ellington JK, Myerson MS, Coetzee JC, Stone RM. The use of the Lapidus procedure for recurrent hallux valgus. Foot Ankle Int. 2011; 32(7):674-80.
5. Blitz NM. The versatility of the Lapidus arthrodesis. Clin Podiatr Med Surg. 2009; 26(3):427-41.
6. Blitz NM, Lee T, Williams K, Barkan H, DiDimenico LA. Early weight bearing after modified lapidus arthodesis: a multicenter review of 80 cases. J Foot Ankle Surg. 2010; 49(4):357-62.
7. Hamilton GA, Mullins S, Schuberth JM, Rush SM, Ford L. Revision lapidus arthrodesis: rate of union in 17 cases. J Foot Ankle Surg. 2007; 46(6):447-50.

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