Lapidus Arthrodesis vs Intercarpal Arthrodesis Surgery

What Is Joint Arthrodesis and Why Does It Matter? 

Joint arthrodesis, commonly called joint fusion surgery, is a procedure in which two or more bones forming a joint are surgically joined together so they grow into one solid unit. The goal is to eliminate painful bone-on-bone contact, correct deformity, and restore functional stability. Once the bones fuse, the joint no longer moves, but the pain goes away and the patient can bear weight or use the limb normally again.

In India, the demand for arthrodesis procedures has grown significantly, particularly in urban centres like Bengaluru, Mumbai, and Chennai. This is partly due to increasing awareness about treatable foot and wrist conditions, and partly because more active adults and athletes are seeking definitive surgical solutions after conservative treatments fail.

Two of the most commonly discussed arthrodesis procedures are Lapidus arthrodesis and intercarpal arthrodesis. Though both involve fusing bones, they address completely different joints, pathologies, and patient groups. Understanding the distinction between the two helps patients and clinicians make informed decisions.

For a broader understanding of how fusion surgery compares with other joint interventions, read our detailed guide on Arthrodesis vs Arthroplasty vs Arthroscopy and our in-depth overview of Arthrodesis Surgery Types and Options.

What Is Lapidus Arthrodesis? 

Lapidus arthrodesis is a surgical procedure that fuses the first tarsometatarsal joint (TMT joint), which is the junction between the first metatarsal bone in the forefoot and the medial cuneiform bone in the midfoot. This procedure was originally described in the early 20th century and has since become one of the most reliable and powerful surgical options for correcting moderate to severe hallux valgus, commonly known as a bunion deformity.

The term "Lapidus" refers to Dr. Paul Lapidus, who popularised the procedure. Over the decades, significant modifications have been made to improve fusion rates, allow earlier weight bearing, and reduce the risk of complications such as nonunion and metatarsal shortening.

Why Is Lapidus Arthrodesis Performed?

The key reason surgeons choose Lapidus arthrodesis over simpler osteotomies (bone cuts) is its ability to correct the deformity at its root cause, which is instability or hypermobility of the first tarsometatarsal joint. When the first ray of the foot is unstable or has drifted significantly outward, distal metatarsal osteotomies cannot fully address the problem. Lapidus arthrodesis corrects the deformity in all three planes, including axial, sagittal, and coronal, making it the preferred option for complex or recurrent bunions.

Conditions Treated by Lapidus Arthrodesis

• Moderate to severe hallux valgus (bunion deformity) with a hallux valgus angle greater than 40 degrees

• Hypermobility of the first tarsometatarsal joint

• Recurrent hallux valgus after a failed distal osteotomy

• Hallux valgus with concurrent pes planovalgus (flat foot)

• Arthritis of the first metatarsocuneiform joint

• Hallux rigidus (stiffness of the big toe joint) in selected cases

In India, hallux valgus is frequently seen in women aged 40 to 60, especially those who have worn narrow or high-heeled footwear for many years. However, the condition also affects younger athletes and individuals with underlying ligamentous laxity.

To learn more about bunion surgeries and what recovery looks like, visit our article on Bunion Surgery Types: When It Is Needed, Procedure and Recovery and our Bunion Surgery Recovery: Week by Week Guide.

How Is Lapidus Arthrodesis Performed?

The surgeon makes an incision along the dorsomedial (top inner) aspect of the foot near the first TMT joint. The joint surfaces are prepared by removing cartilage, either through planar resection (removing a flat section of bone) or curettage (scraping the joint surface while preserving the subchondral plate). The bones are then repositioned in the corrected alignment and fixed with metal hardware, typically a combination of compression screws and a locking plate.

A medial locking plate combined with a plantar interfragmentary compression screw is currently the most commonly used fixation construct, offering strong stability that allows early weight bearing in a surgical boot for many patients.

Arthroscopic (minimally invasive) techniques for Lapidus arthrodesis have also been developed and offer the advantages of more thorough joint surface preparation, smaller incisions, and potentially lower rates of soft tissue complications.

What Is Intercarpal Arthrodesis? 

Intercarpal arthrodesis, also called limited wrist fusion or partial wrist arthrodesis, is a surgical procedure that fuses selected carpal bones of the wrist while leaving the remaining wrist joints mobile. The carpus consists of eight small bones arranged in two rows that form the wrist. When specific carpal bones are damaged due to injury or disease, selectively fusing them eliminates the source of pain while preserving as much wrist movement as possible.

Unlike Lapidus arthrodesis, which targets a specific anatomical joint in the foot, intercarpal arthrodesis encompasses a family of procedures depending on which carpal bones are fused. The most commonly performed types include:

• Four-corner fusion (4CF): fusion of the capitate, hamate, lunate, and triquetrum with removal of the scaphoid. This is performed for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) wrist.

• Scaphotrapeziotrapezoid (STT) fusion: fusing the scaphoid with the trapezium and trapezoid, used in cases of STT arthritis or scaphoid pathology.

• Scaphocapitate (SC) fusion: fusing the scaphoid to the capitate.

• Lunotriquetral (LT) fusion: fusing the lunate and triquetrum, used in lunotriquetral instability.

• Capitolunate fusion: fusing the capitate to the lunate, sometimes performed in midcarpal instability.

Why Is Intercarpal Arthrodesis Performed?

The wrist is a non-weight-bearing joint but one that is subjected to considerable mechanical load during daily activities and sports. When the internal architecture of the wrist is disrupted, whether due to scaphoid fracture nonunion, scapholunate ligament rupture, Kienböck's disease (avascular necrosis of the lunate), or degenerative arthritis, the carpal bones begin to collapse in predictable patterns. This leads to pain, stiffness, grip weakness, and eventually debilitating arthritis.

Intercarpal arthrodesis is considered a salvage procedure. The objective is to remove the painful arthritic joint surfaces, stabilise the carpal architecture, and restore enough function so the patient can manage daily work and activities. Importantly, since the entire wrist is not fused, some degree of wrist motion is preserved.

For patients with wrist conditions, our clinic also performs Wrist Arthroscopy TFCC Repair and provides detailed guidance on managing Wrist Pain. For patients deciding between wrist salvage options, our comparison of Scaphoid Excision vs 4 Corner Fusion vs PRC provides a detailed breakdown.

How Is Intercarpal Arthrodesis Performed?

A dorsal approach to the wrist is most commonly used. The surgeon identifies the carpal bones to be fused, removes the damaged articular cartilage from the joint surfaces to be fused, and packs bone graft (either taken from the distal radius or from the iliac crest) into the prepared fusion site. The bones are then fixed with hardware such as Kirschner wires, headless compression screws, or a variable-angle locking circular plate (often called an intercarpal fusion plate or ICF plate).

For four-corner fusion, the scaphoid is first excised (removed entirely), then the remaining four carpal bones are fused as a unit. The wrist is immobilised in a cast or splint for approximately six weeks, followed by a structured rehabilitation programme.

Lapidus Arthrodesis vs Intercarpal Arthrodesis: Key Differences 

Despite both being arthrodesis procedures, Lapidus arthrodesis and intercarpal arthrodesis differ in almost every clinical aspect.

Indications: Who Needs Which Procedure? {#indications}

Lapidus Arthrodesis Is Indicated When:

1. The patient has a symptomatic bunion that has failed conservative management including orthotics, wider footwear, physical therapy, and anti-inflammatory medications.

2. The hallux valgus angle (HVA) is greater than 30 to 40 degrees and the intermetatarsal angle (IMA) is greater than 13 to 15 degrees.

3. There is demonstrable hypermobility or instability of the first tarsometatarsal joint on clinical examination or weight-bearing X-rays.

4. The patient has a recurrent bunion after a previous distal metatarsal osteotomy.

5. The bunion is associated with flat foot (pes planovalgus), making correction at the proximal joint necessary.

6. Arthritis is present at the first metatarsocuneiform joint.

Contraindications include peripheral vascular disease affecting foot healing, active infection, severe osteoporosis, and in adolescents with open growth plates.

Intercarpal Arthrodesis Is Indicated When:

1. The patient has symptomatic SLAC (scapholunate advanced collapse) or SNAC (scaphoid nonunion advanced collapse) wrist that has failed conservative management.

2. Kienböck's disease (avascular necrosis of the lunate) has reached an advanced stage where the lunate has collapsed.

3. Localised carpal arthritis is present due to old injury or inflammatory arthritis.

4. Carpal instability (such as lunotriquetral dissociation or midcarpal instability) is causing pain and weakness.

5. Total wrist fusion is not appropriate because preserving some wrist motion is essential for the patient's occupation or daily activities.

Contraindications include generalised wrist arthritis affecting multiple joints (where total wrist arthrodesis may be more appropriate), active infection, and significant bone loss.

urgical Technique Comparison {#surgical-technique}

Lapidus Arthrodesis: Step by Step

1. The patient is positioned supine with a tourniquet applied to the ankle.

2. A dorsomedial or medial incision is made over the first TMT joint.

3. The medial cuneiform and first metatarsal joint surfaces are prepared, either by planar resection or curettage.

4. The subchondral bone is perforated (fenestrated) to promote bleeding and enhance fusion.

5. The first metatarsal is repositioned in corrected alignment, reducing both the hallux valgus angle and the intermetatarsal angle.

6. A plantar compression screw is placed from distal to proximal, followed by application of a dorsomedial or medial locking plate for supplementary fixation.

7. In a traditional Lapidus procedure, a temporary positioning screw may be placed from the base of the first metatarsal to the base of the second metatarsal, removed at approximately 12 weeks.

8. The wound is closed in layers and a surgical boot is applied.

Research published in prominent orthopaedic journals has demonstrated that planar resection achieves a union rate of approximately 97.8%, while curettage-based techniques achieve approximately 91.5% to 95% union rates. Both are clinically acceptable when proper fixation is used.

Intercarpal Arthrodesis (Four-Corner Fusion): Step by Step

1. The patient is positioned supine with the arm on a hand table.

2. A dorsal incision is made over the wrist, and the extensor tendons are retracted to expose the carpus.

3. The scaphoid is excised completely.

4. Articular cartilage is removed from the articulating surfaces of the capitate, hamate, lunate, and triquetrum.

5. The intercarpal ligaments on the dorsal surface are opened, and the decorticated bone surfaces are packed with cancellous bone graft.

6. The four carpal bones are compressed and fixed using a circular ICF plate with variable-angle locking screws or a combination of headless compression screws.

7. The wrist capsule and extensor retinaculum are repaired, and the wrist is immobilised in a plaster cast in a neutral or slight extension position.

8. Immobilisation continues for approximately six weeks, after which rehabilitation begins.

Arthroscopic assistance is increasingly used for intercarpal arthrodesis to minimise soft tissue trauma while ensuring thorough joint surface preparation.

Recovery and Rehabilitation 

Recovery After Lapidus Arthrodesis

Modern Lapidus arthrodesis protocols have evolved considerably. With locking plate and compression screw fixation, many patients can begin weight bearing in a surgical boot within 10 to 14 days of surgery, sometimes even earlier. Full weight bearing typically progresses over 6 to 8 weeks.

• Weeks 1 to 2: Rest with foot elevated, wound care, and heel-touch weight bearing in a surgical boot

• Weeks 2 to 6: Progressive weight bearing in the boot as pain allows

• Weeks 6 to 10: Transition to comfortable flat footwear, gentle range of motion exercises for the ankle and toes

• Months 3 to 4: Return to normal footwear and light recreational activities

• Months 4 to 6: Return to sports and physically demanding work depending on radiographic fusion

Swelling is expected for 3 to 6 months. Patients are advised against high heels for at least 12 months. Radiographic union is typically confirmed between 6 and 12 weeks.

Recovery After Intercarpal Arthrodesis

Recovery from intercarpal arthrodesis tends to be longer due to the need for solid bone union across multiple carpal bones.

• Weeks 1 to 6: Plaster cast immobilisation with the wrist elevated to control swelling

• Weeks 6 to 12: Transition to a removable splint; gentle range of motion exercises begin

• Months 3 to 4: Progressive strengthening and return to light activities

• Months 4 to 6: Return to full daily activities and most occupational tasks

• Months 6 to 12: Return to heavy manual work or contact sports, subject to radiographic confirmation of fusion

Patients can typically expect to retain approximately 50% to 60% of normal wrist flexion-extension and approximately 70% to 80% of grip strength compared to the non-operated side. Pain relief is the most consistent outcome and is achieved in the majority of patients.

For guidance on managing ankle and foot conditions during recovery, see our detailed Ankle Pain education page. For patients undergoing rehabilitation, our Sports Rehabilitation programme provides structured post-surgical support.

Outcomes and Complication Rates {#outcomes}

Lapidus Arthrodesis Outcomes

Research across large patient cohorts has documented the following outcomes for Lapidus arthrodesis:

• Fusion rate: 91.5% to 97.8% depending on the joint preparation technique (curettage vs planar resection) and the fixation construct used.

• Nonunion rate: Studies report nonunion in approximately 3.3% to 12% of cases in general populations. Premature weight bearing before adequate healing is a significant risk factor for nonunion.

• Hallux valgus angle correction: Typically improves from approximately 37 to 40 degrees preoperatively to 10 to 17 degrees postoperatively, a clinically significant improvement.

• Intermetatarsal angle correction: Improves from approximately 15 to 16 degrees preoperatively to 8 to 9 degrees postoperatively.

• Patient satisfaction: Studies using the Foot and Ankle Ability Measure (FAAM) and AOFAS scores show approximately 90% of patients are very satisfied or satisfied.

• Hardware removal: Approximately 17% of patients require subsequent hardware removal due to prominent screws or plate irritation.

Common complications include nonunion, hardware irritation requiring removal, hallux varus (overcorrection), dorsal elevation of the first metatarsal (plantarflexion loss), and wound complications.

Intercarpal Arthrodesis Outcomes

For four-corner fusion using locking ICF plates:

• Fusion rate: Approximately 85% to 97% in published series.

• Pain relief: Achieved in the majority of patients; most describe significant improvement in pain at rest and with activity.

• Wrist motion preservation: Patients typically retain 40% to 60% of normal wrist flexion and extension. Radial-ulnar deviation is also partially preserved.

• Grip strength: Returns to approximately 70% to 80% of the contralateral hand.

• DASH (Disabilities of Arm, Shoulder, and Hand) score: Studies show a clinically meaningful improvement of 14 to 32 points postoperatively.

• Return to work: Most patients in sedentary jobs return within 3 to 4 months. Manual labourers may require 6 to 12 months.

Complications include nonunion, hardware failure, carpal impingement from the plate, persistent pain, progression of arthritis to adjacent non-fused joints, and complex regional pain syndrome.

What Most Articles Don't Tell You 

Most online comparisons of these procedures fail to address two important considerations that are especially relevant for Indian patients.

1. The role of body weight and bone density: Indian patients, particularly post-menopausal women undergoing Lapidus arthrodesis and older men undergoing intercarpal arthrodesis for post-traumatic arthritis, may have reduced bone mineral density. Low bone density increases the risk of screw purchase failure and delayed union. Your surgeon should evaluate bone health before surgery and may recommend calcium, vitamin D, and in some cases, anti-osteoporosis medication preoperatively.

2. Occupational demands and footwear habits: In India, many patients work in physically demanding occupations or live in rural areas where prolonged standing and walking on uneven surfaces are common. This directly affects recovery timelines, the choice of fixation construct, and the protocols for return to activity. Additionally, patients who regularly wear traditional footwear such as chappals or walk barefoot require specific counselling about post-operative footwear transitions. Your orthopedic surgeon should factor these practical considerations into your individualised recovery plan.

Which Procedure Is Right for You? 

Lapidus arthrodesis and intercarpal arthrodesis are not interchangeable procedures. They address entirely different anatomical regions and pathologies.

You may be a candidate for Lapidus arthrodesis if you have a painful, progressive bunion with a large deformity angle, first ray instability, or a recurrent bunion after a prior surgery. The procedure corrects the alignment of the forefoot at its root cause and offers durable, long-term relief.

You may be a candidate for intercarpal arthrodesis if you have a painful wrist with collapse deformity, diagnosed as SLAC or SNAC wrist, Kienböck's disease, or symptomatic carpal instability that has not responded to splinting, physiotherapy, or other interventions. The procedure eliminates pain while preserving some wrist function.

The decision requires thorough clinical examination, weight-bearing X-rays of the foot or wrist, and in many cases, an MRI or CT scan to assess bone quality and joint involvement. Both procedures are best performed by an orthopaedic surgeon with specialised training in foot-and-ankle or hand-and-wrist surgery.

Expert Orthopedic Care in Bengaluru 

At the Sports Orthopedics Institute in HSR Layout, Bengaluru, Dr. Naveen Kumar L.V and his team bring over 24 years of international surgical experience to every patient encounter. Dr. Naveen holds advanced qualifications including FRCS (Orth) from England, MCh in Hip and Knee from the UK, and a diploma from FIFA Sports Medicine in Switzerland. The team is experienced in performing both Lapidus arthrodesis for complex bunion deformities and intercarpal arthrodesis for wrist salvage procedures, using the latest implants and surgical techniques.

Whether you are an athlete dealing with a foot deformity affecting your performance, or a working professional with a wrist injury limiting your daily function, the Institute offers personalised evaluation, accurate diagnosis, and a treatment plan tailored to your individual needs and lifestyle.

If you or a family member are dealing with foot, ankle, or wrist joint problems, explore our full range of Procedures and Surgeries or visit our Bone and Joint School for patient education resources.

Book an appointment with our specialists today and take the first step toward lasting relief.

Related Resources

• Arthrodesis Types Explained: Joint Fusion Surgery Guide

• Arthrodesis Surgery Types and Options: Full Guide

• Arthrodesis vs Arthroplasty vs Arthroscopy

• Scaphoid Excision vs 4 Corner Fusion vs PRC: A Wrist Guide

• Pantalar Arthrodesis vs Triple Arthrodesis

• Bunion Surgery Types: When It Is Needed, Procedure and Recovery

• Bunion Surgery Recovery: Week by Week Guide

• Wrist Arthroscopy TFCC Repair: Complete Recovery Guide

• Ankle Pain: Causes, Conditions and When to See a Doctor

• Subtalar Arthrodesis: Indications, Complications and Approach

External Reference Sources

• Patel S. et al. Modified Lapidus Arthrodesis: Rate of Nonunion in 227 Cases. Journal of Foot and Ankle Surgery, 2004.

• Athlani L. et al. Intercarpal Arthrodesis: A Systematic Review. Hand Surgery and Rehabilitation, 2023.

• Waehner M. et al. Lapidus Arthrodesis for Correction of Hallux Valgus Deformity: A Systematic Review and Meta-Analysis. Foot and Ankle Specialist, 2026.

• Eder C. et al. Four-corner Arthrodesis of the Wrist using Variable Angle Locking Compression Intercarpal Fusion Plate. GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW, 2019.

Frequently Asked Questions {#faq}

Q1. What is the difference between Lapidus arthrodesis and intercarpal arthrodesis?

Lapidus arthrodesis fuses the first tarsometatarsal joint in the foot, primarily to correct a bunion deformity (hallux valgus) and first ray hypermobility. Intercarpal arthrodesis is a family of wrist fusion procedures that fuse selected carpal bones to treat conditions such as SLAC wrist, SNAC wrist, Kienböck's disease, or carpal instability. The two procedures target completely different joints in different parts of the body.

Q2. Is Lapidus arthrodesis painful? What is the recovery time?

Most patients experience manageable post-operative pain that is controlled with medications for the first two weeks. The total recovery period ranges from 3 to 6 months depending on the individual. With modern locking plate fixation, many patients can bear weight in a surgical boot within 10 to 14 days, transitioning to regular footwear around 3 to 4 months post-surgery.

Q3. Can I walk normally after Lapidus arthrodesis?

Yes. Once the fusion heals completely (typically confirmed by X-ray at 6 to 12 weeks), most patients return to normal walking and daily activities. The fused joint does not bend, but because the first TMT joint normally has very little motion, most patients do not notice a functional deficit. The majority of patients report significant improvement in foot comfort and the ability to wear regular footwear.

Q4. How much wrist motion is retained after intercarpal arthrodesis?

After a four-corner fusion, most patients retain approximately 40% to 60% of their normal wrist flexion and extension. Grip strength returns to about 70% to 80% of the non-operated hand. While this represents a meaningful reduction in wrist motion, the key benefit is significant pain relief that allows patients to perform daily activities more comfortably.

Q5. What causes nonunion after Lapidus arthrodesis and how can it be prevented?

Nonunion (failure of the bones to fuse) after Lapidus arthrodesis occurs in approximately 3% to 12% of cases. The most common causes include premature full weight bearing before the fusion has matured, smoking (which impairs bone healing), poorly controlled diabetes, obesity, and inadequate fixation. Preventive measures include strict adherence to the post-operative weight-bearing protocol, smoking cessation at least 6 weeks before surgery, blood sugar optimisation in diabetic patients, and use of a stable fixation construct such as a locking plate with a compression screw.

Q6. Is intercarpal arthrodesis available in Bengaluru?

Yes. Specialised orthopaedic centres in Bengaluru, including the Sports Orthopedics Institute in HSR Layout, offer intercarpal arthrodesis performed by surgeons with training in upper limb and wrist surgery. The procedure requires specific expertise and implants, so patients should seek care from a specialist with experience in wrist salvage procedures.

Q7. Can Lapidus arthrodesis be done arthroscopically?

Yes, arthroscopic Lapidus arthrodesis is a minimally invasive approach that uses small incisions and a camera to prepare the joint surface and guide fixation. Studies have shown that arthroscopic technique allows more thorough joint surface preparation with less soft tissue damage and lower risk of wound complications. It is available at select advanced orthopaedic centres in India.

Q8. What is the cost of Lapidus arthrodesis or intercarpal arthrodesis in India?

The cost of these procedures in India varies based on the hospital, the surgeon's experience, the implants used, and whether general or spinal anaesthesia is required. Generally, costs at a specialised orthopaedic centre in Bengaluru are considerably more affordable than comparable procedures in Western countries, while maintaining international standards of care. Contact our clinic directly for a detailed estimate based on your specific case.

Q9. How do I know which arthrodesis procedure I need?

The choice of procedure depends entirely on your diagnosis. Lapidus arthrodesis is specifically for foot conditions, primarily hallux valgus with first ray instability. Intercarpal arthrodesis is for wrist conditions. A thorough consultation with an orthopaedic specialist, including clinical examination and imaging, is the only way to determine the right procedure for your situation.

Q10. Are these procedures covered under health insurance in India?

Many standard health insurance policies in India do cover surgical procedures for joint conditions when medically indicated. Coverage depends on your specific policy, the insurer, and whether the hospital is a network provider. We recommend checking with your insurance company prior to surgery and consulting our administrative team for assistance with pre-authorisation documentation.

This article is intended for educational purposes and does not constitute medical advice. Please consult a qualified orthopaedic specialist for diagnosis and treatment recommendations specific to your condition.