From the Research
Bone regrowth at the midfoot after an asymptomatic nonunion Lapidus procedure that has persisted for a year is unlikely to occur spontaneously, even in an active, healthy patient. The Lapidus procedure, which fuses the first metatarsocuneiform joint, typically forms a solid union within 6-12 weeks in most patients 1. When nonunion has been established for a year, biological healing processes have typically plateaued. If the nonunion is truly asymptomatic and stable, intervention may not be necessary. However, if bone regrowth is desired, surgical revision would likely be required, involving debridement of the nonunion site, possible bone grafting, and stable fixation. Non-surgical options like bone stimulation devices (ultrasonic or electromagnetic) might be considered but have limited evidence supporting their effectiveness in established nonunions. Certain medications that promote bone healing, such as teriparatide (Forteo) at 20mcg subcutaneously daily for 3-6 months, could potentially be discussed with an endocrinologist, though this would be an off-label use. Nutritional optimization with adequate calcium (1000-1200mg daily), vitamin D (1000-2000 IU daily), and protein intake can support bone health but alone won't likely resolve an established nonunion. The biological capacity for spontaneous healing diminishes significantly after 6-9 months post-surgery, making intervention necessary if fusion is the goal.
Some key points to consider:
- The incidence of nonunion after Lapidus arthrodesis using staple fixation is around 8.3% 1.
- The Lapidus procedure has been shown to be effective in treating hallux valgus deformities, with significant improvements in pain and function 2, 3.
- Complications such as nonunion and malunion can occur, and revision surgery may be necessary in some cases 4.
- The use of bone stimulation devices and medications that promote bone healing may be considered, but their effectiveness in established nonunions is limited 4.
In terms of management, surgical revision is likely the best option for achieving bone regrowth and fusion. This would involve debridement of the nonunion site, possible bone grafting, and stable fixation. Non-surgical options may be considered, but their effectiveness is limited, and nutritional optimization alone is unlikely to resolve an established nonunion. The decision to intervene should be based on the patient's symptoms, stability of the nonunion, and overall health status.