A researcher in Germany has found that there are benefits to using intraoperative three-dimensional imaging (3D), computer assisted surgery (CAS) and intraoperative pedography during foot and ankle surgery. An analysis of several ongoing experimental and prospective studies showed that the use of 3D resulted in reduction/correction and/or the correction of implant position in roughly one third of cases. The analysis also showed that CAS guidance for the correction of deformities of the ankle, hindfoot, and midfoot/tarsometatarsal joint (TMT) joint resulted in greater accuracy, a faster correction process and better scores after a minimum follow up period of two years compared to surgeries where CAS as not used. Finally, the analysis found that the additional use of IP as the only difference between two groups with correction and/or arthrodesis at the foot and/or ankle led to better improvements in outcome scores after an average follow up period of two years.Â
Abstract
Purpose
At the beginning of the twenty-first century, the computer has supplemented the possibilities of orthopaedic surgery. This article analyses the feasibility and potential clinical benefit of intraoperative three-dimensional imaging (3D), computer assisted surgery (CAS) and intraoperative pedography (IP) in foot and ankle surgery.
Methods
The feasibility, accuracy and clinical benefit of 3D, CAS and IP were analysed in ongoing experimental and prospective studies at the institution in which the inventor of IP and principal user of 3D and CAS in foot and ankle surgery operates.
Results
Three dimensional imaging: In approximately one third of the cases, reduction/correction and/or implant position was corrected after intraoperative 3D scan during the same procedure in different prospective, consecutive, non-controlled studies (Level III). CAS: CAS guidance for the correction of deformities of the ankle, hindfoot and midfoot/tarsometatarsal (TMT) joint provided higher accuracy, a faster correction process and better scores at a minimum follow-up of two years in comparison without CAS guidance in a single-centre matched-pair follow-up study (Level II). IP: Additional use of IP as the only difference between two groups with correction and/or arthrodesis at foot and/or ankle led to improved clinical outcome scores at a mean of two years follow-up in a prospective randomised controlled study (Level I).
Conclusions
Three dimensional imaging provides important information which could not be obtained from two-dimensional C-arm alone. The benefit of CAS is high when improved accuracy may lead to an improved clinical outcome. Intraoperative pedography is useful when intraoperative biomechanical assessment may lead to an immediate improvement of the achieved surgical result.
Computer aided surgery in foot and ankle: applications and perspectives – Springer.