Lapidus has better long term results, less recurrence, etc than Austin. The downside is that it's a technically more complicated procedure which some surgeons were not or are not trained for, it necessitates longer nonweightbearing recovery time than Austin, and MC nonunion or elevatus is more problematic than usual Austin complications (delay union, recurrence, etc). You have to analyze the deformity, so common sense says Lapidus is for large and/or hypermobile bunions while the Austin is sufficient for mild to moderate ones with little or no hypermobility. The problem is that if you do an Austin for a big IM and/or hypermobile bunion in 18-45yo and the HAV painfully recurs at age 60+yo, then they're pretty high risk for a Lapidus nonunion at that age... and they probably would've healed the Lapidus if you'd done what was indicated initially.
Mau and Scarf are the middle ground IMO. They are the most stable diaphyseal osteotomies and (in skilled hands) they have potential for faster time to weightbearing than the Lapidus with more correction potential than the Austin. Nonetheless, they are a lot more dissection than the Austin, so you have to do a good eval, know your skills, and select each procedure when it's indicated. Also consider that any bunionectomy will fail to some degree if you don't adress any co-existing condition... equinus, pes planus, met adductus, hallux rigidus, PASA, etc.
The surgeons who are still routinely utilizing basal metatarsal osteotomies for large adult bunions, esp large hypermobile adult bunions, are probably still doing Silastic first MPJs for their hallux rigidus patients also. It might be how they were trained or "it works in my experience," but they're just not practicing evidence based medicine IMO. That may have been just fine for generations, but it's really not the way the future of medicine appears to be headed. Base wedges offer no difference in recovery time vs the Lapidus, and the published results are repeatedly proven to be inferior. The only real indication I see for a base procedure is maybe a base wedge + Riverdin in a big and problematic peds bunion where you can't do a Lapidus yet.
You can look up Graham Hamilton's JFAS articles on Lapidus vs CBWO results for maintaining IM correction and the comparison article on Austin, Lapidus, and proximal osteotomy revisional surgery rates. For the diaphyseal versus basal osteotomies, Hyer also has a good JFAS paper on Mau compared to proximal crescenteric osteotomy. Weil has published extensively on the Scarf technique and results.
