Preoperative Guidance With Weight-Bearing Computed Tomography and Patient-Specific Instrumentation in Foot and Ankle Surgery

2021 ◽  
pp. 155633162110263
Author(s):  
Jacob Zeitlin ◽  
Jensen Henry ◽  
Scott Ellis
Keyword(s):  
Computed Tomography ◽  
3D Imaging ◽  
Weight Bearing ◽  
Patient Specific ◽  
Foot And Ankle ◽  
Review Of The Literature ◽  
3 Dimensional ◽  
Implant Positioning ◽  
Patient Specific Instrumentation ◽  
Ankle Surgery

The use of preoperative and intraoperative guidance in foot and ankle surgery has grown substantially in recent years. Weight-bearing computed tomography (WBCT) and patient-specific instrumentation (PSI) are used in total ankle arthroplasty (TAA) to achieve precise bone cutting and implant positioning, and intraoperative 3-dimensional (3D) imaging has been used to reduce complications and improve clinical outcomes in other foot and ankle surgical procedures. This narrative review of the literature focuses on the evidence supporting the use of WBCT and PSI in TAA and looks at other promising technologies used to guide foot and ankle surgery.

Intraoperative 3-Dimensional Computed Tomography and Navigation in Foot and Ankle Surgery

Orthopedics ◽  
2016 ◽  
Vol 39 (5) ◽  
pp. e1005-e1010 ◽  
Author(s):  
Ashwin Chowdhary ◽  
Lisca Drittenbass ◽  
Victor Dubois-Ferrière ◽  
Richard Stern ◽  
Mathieu Assal
Keyword(s):  
Computed Tomography ◽  
Foot And Ankle ◽  
3 Dimensional ◽  
Ankle Surgery

scholarly journals Weight-bearing cone-beam computed tomography in the foot and ankle specialty: where we are and where we are going - an update

2021 ◽  
Vol 54 (3) ◽  
pp. 177-184
Author(s):  
Alexandre Leme Godoy-Santos ◽  
Alessio Bernasconi ◽  
Marcelo Bordalo-Rodrigues ◽  
François Lintz ◽  
Carlos Felipe Teixeira Lôbo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Weight Bearing ◽  
Three Dimensional ◽  
Ct Scans ◽  
Cone Beam ◽  
Foot And Ankle ◽  
Ankle Surgery ◽  
Dimensional Measurements ◽  
Three Dimensional Models

Abstract Cone-beam computed tomography (CBCT) has been applied in dentistry and medicine for nearly two decades. Its application in the foot and ankle specialty has grown exponentially in recent years. Weight-bearing CBCT allows clinicians to obtain weight-bearing images that can be viewed in all three planes and to construct three-dimensional models, similar to those constructed from traditional CT scans, as well as exposing patients to less radiation than do traditional CT scans. This technology has revolutionized diagnoses, improving the understanding of various lesions and surgical planning in the foot and ankle specialty. Ongoing studies of the use of weight-bearing CBCT in foot and ankle surgery are focused on fully automated and semi-automated three-dimensional measurements, as well as bone segmentation, mapping of the distances/orientation of the joints, and the production of customized implants. The aims of this review article are to show the evolution of this emerging tool in the foot and ankle specialty, to update those in related specialties on its use in current clinical practice, and to indicate where the research community is heading.

Computed Tomography-Based Patient-Specific Instrumentation Loses Accuracy with Significant Varus Preoperative Misalignment

2020 ◽  
Author(s):  
Vicente Jesús León-Muñoz ◽  
Mirian López-López ◽  
Alonso José Lisón-Almagro ◽  
Francisco Martínez-Martínez ◽  
Fernando Santonja-Medina
Keyword(s):  
Computed Tomography ◽  
Deformity Correction ◽  
Patient Specific ◽  
Control Group ◽  
X Rays ◽  
Varus Alignment ◽  
Patient Specific Instrumentation ◽  
Conventional Instrumentation ◽  
The Mean ◽  
Valgus Alignment

AbstractPatient-specific instrumentation (PSI) has been introduced to simplify and make total knee arthroplasty (TKA) surgery more precise, effective, and efficient. We performed this study to determine whether the postoperative coronal alignment is related to preoperative deformity when computed tomography (CT)-based PSI is used for TKA surgery, and how the PSI approach compares with deformity correction obtained with conventional instrumentation. We analyzed pre-and post-operative full length standing hip-knee-ankle (HKA) X-rays of the lower limb in both groups using a convention > 180 degrees for valgus alignment and < 180 degrees for varus alignment. For the PSI group, the mean (± SD) pre-operative HKA angle was 172.09 degrees varus (± 6.69 degrees) with a maximum varus alignment of 21.5 degrees (HKA 158.5) and a maximum valgus alignment of 14.0 degrees. The mean post-operative HKA was 179.43 degrees varus (± 2.32 degrees) with a maximum varus alignment of seven degrees and a maximum valgus alignment of six degrees. There has been a weak correlation among the values of the pre- and postoperative HKA angle. The adjusted odds ratio (aOR) of postoperative alignment outside the range of 180 ± 3 degrees was significantly higher with a preoperative varus misalignment of 15 degrees or more (aOR: 4.18; 95% confidence interval: 1.35–12.96; p = 0.013). In the control group (conventional instrumentation), this loss of accuracy occurs with preoperative misalignment of 10 degrees. Preoperative misalignment below 15 degrees appears to present minimal influence on postoperative alignment when a CT-based PSI system is used. The CT-based PSI tends to lose accuracy with preoperative varus misalignment over 15 degrees.

scholarly journals Clinical Outcomes of 3D Printed Titanium Cage Implantation for Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0008
Author(s):  
Bijan Abar ◽  
Nicholas B. Allen ◽  
Ken Gall ◽  
Samuel B. Adams
Keyword(s):  
Surgical Outcomes ◽  
Patient Specific ◽  
Salvage Procedure ◽  
Foot And Ankle ◽  
Device Failure ◽  
Titanium Cage ◽  
Ankle Surgery ◽  
3D Printed ◽  
Specific Factors ◽  
Titanium Cages

Category Ankle; Trauma Introduction/Purpose: Critical Sized Defects (CSD) defined as bone loss greater than 1-2 cm in length or greater than 50% loss in circumference of bone remains a significant challenge in orthopaedic surgery. Patients can acquire these defects through trauma, nonunion post fracture, tumor removal, avascular necrosis, and congenital abnormalities. Custom 3D printed porous Titanium scaffolds are increasingly being used to treat CSD in Foot and Ankle Surgery. Implantation of 3D printed cages is considered a salvage procedure offered after the patient has failed other procedures. Implants fill the space of the defect, provide mechanical strength and provide opportunity for osseous integration. As implementation of this surgical technique is relatively new, further research is needed to assess surgical outcomes and inform future surgical decision making. Methods: This is a retrospective chart review study which examines surgical outcomes after using 3D printed Titanium cages. Patients who received a 3D printed Titanium cage between 1/1/2013 and 11/01/2018 with at least 1 year follow-up were included in this study. Primary outcome is device failure defined as removal of implant for any reason. If applicable, mechanism of failure was recorded for each case. Patient specific factors such as age, gender, race, BMI, diabetes status, Charlson Comorbidity Index, tobacco use, number of foot and ankle surgeries, prior limb infections and laterality of defect were recorded in addition to surgical variables including geometry of implant, duration of surgery, and perioperative antibiotics Results: 18 patients who received custom 3D printed Titanium cages were included in this study. Of the 18 patients, 5 patients (27.8%) had device failure, defined as removal of implant. Of the 5 failures, 2 were removed due to infection while the other 3 were removed due to hardware failure including fractured cage, broken screw and loose fixation. Conclusion: Custom 3D printed Titanium was successfully implemented in 72.2% of patients. Implants were only removed due to infection (2 patients) or mechanical failure of device (3 patients). Future studies need to be powered to determine if certain patient specific factors are associated with device failure. Data from this study and subsequent studies can be used to design better implants, decide who is a good surgical candidate, and create preoperative therapies to improve modifiable risk factors

Effect of pelvic tilt and rotation on cup orientation in standing anteroposterior radiographs

2019 ◽  
Vol 30 (1) ◽  
pp. 48-55 ◽  
Author(s):  
Ho Hyun Yun ◽  
William S Murphy ◽  
Daniel M Ward ◽  
Guoyan Zheng ◽  
Brett Hayden ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pelvic Tilt ◽  
Patient Specific ◽  
Pelvic Rotation ◽  
3 Dimensional ◽  
Radiographic Measurements ◽  
Wide Variability ◽  
The Difference ◽  
The Right ◽  
Cup Positioning

Background: Individual pelvic tilt and rotation have wide variability that can affect the measurement of cup orientation in anteroposterior (AP) radiographs. The purpose of this study was to analyse the effect of pelvic tilt and rotation on radiographic measurements of cup orientation. Methods: A total of 53 patients (63 hips) were included in this study. The patients underwent a computed tomography study with standing AP pelvis radiographs taken both preoperatively and approximately 3 months postoperatively. We used 2-dimensional/3-dimensional matching to measure the pelvic tilt and rotation, and the non-standardised and standardised cup orientation. Results: There was no difference in the pelvic tilt and rotation between the preoperative and postoperative radiographs. The distribution of the differences between the non-standardised and standardised cup anteversion exhibited a change within 5° in only 34/63 (54%) hips. The pelvic tilt correlated with the difference between the non-standardised and standardised cup anteversion, but the pelvic rotation did not. When all 63 hips were separated into the right and left sides, the pelvic rotation inversely correlated with the pelvic tilt-adjusted difference between the non-standardised and standardised cup anteversion of the right side but directly correlated with that of the left side. Conclusions: The current study demonstrated that the measurement of cup anteversion in standing AP radiographs is significantly affected by both the pelvic tilt and pelvic rotation. An improved understanding of the pelvic orientation may eventually allow for desired cup positioning on a patient-specific basis to potentially reduce complications associated with the malposition of the cup.

scholarly journals Antibiotic prophylaxis in foot and ankle surgery: a systematic review of the literature

2018 ◽  
Vol 11 (1) ◽  
Author(s):  
Mr Ravi Krishān Modha ◽  
Chris Morriss-Roberts ◽  
Madeleine Smither ◽  
Jonathan Larholt ◽  
Ian Reilly
Keyword(s):  
Systematic Review ◽  
Antibiotic Prophylaxis ◽  
Foot And Ankle ◽  
Review Of The Literature ◽  
Ankle Surgery

Weight Bearing Cone Beam Computed Tomography (WBCT) in the Foot and Ankle

2020 ◽  
Author(s):  
Martinus Richter ◽  
Francois Lintz ◽  
Cesar de Cesar Netto ◽  
Alexej Barg ◽  
Arne Burssens ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Weight Bearing ◽  
Cone Beam ◽  
Foot And Ankle

Relevance of SPECT-CT in Complex Cases of Foot and Ankle Surgery: A Comparison With MRI

2019 ◽  
Vol 13 (6) ◽  
pp. 451-462 ◽  
Author(s):  
Leif Claassen ◽  
Daiwei Yao ◽  
Sarah Ettinger ◽  
Matthias Lerch ◽  
Kiriakos Daniilidis ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Retrospective Study ◽  
Osteochondral Lesion ◽  
Treatment Decision ◽  
Emission Computed Tomography ◽  
Foot And Ankle ◽  
Intrarater Reliability ◽  
Final Treatment ◽  
Adjacent Structures ◽  
Ankle Surgery

Background. Finding the right diagnoses in patients with complex foot and ankle disorders can be challenging. Single-photon emission computed tomography and computed tomography (SPECT-CT) has shown to be feasible in foot and ankle surgery. The aim of this study was to evaluate the reliability and accuracy of SPECT-CT and thereby its impact on final treatment decision compared with magnetic resonance imaging (MRI). Methods. A retrospective study was performed on 49 patients treated at our institution. Experienced foot and ankle surgeons independently, and blinded, analyzed clinical data and radiographs together with MRI, SPECT-CT, or a combination of both. Based on the determined final treatment decision Cohen’s kappa values were calculated to illustrate interrater and intrarater reliability. Results. The kappa values for interrater reliability were higher for SPECT-CT at .68 and MRI + SPECT-CT at .71 compared to 0.38 for MRI alone (P < .05). The kappa values for intrarater reliability of MRI + SPECT-CT were higher at .75 compared with SPECT-CT alone at .67 (P < .05) and MRI at .35 (P < .01). Conclusion. We found a higher interrater and intrarater reliability for SPECT-CT compared with MRI alone for diagnosing complex foot and ankle pathologies. SPECT-CT has a high impact on final treatment decision. The main indications are bony pathologies with diagnostic uncertainty especially in closely adjacent structures as the joints of the midfoot, occult coalitio, stress fractures, verification or exclusion of nonfusion, periprosthetic disorders after total ankle replacement and osteochondral lesion in cases of combined pathologies. Levels of Evidence: Level IV: Retrospective study

scholarly journals Correction to: Weight Bearing Cone Beam Computed Tomography (WBCT) in the Foot and Ankle

2020 ◽  
pp. C1-C1
Author(s):  
Martinus Richter ◽  
Francois Lintz ◽  
Cesar de Cesar Netto ◽  
Alexej Barg ◽  
Arne Burssens ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Weight Bearing ◽  
Cone Beam ◽  
Foot And Ankle

scholarly journals PO 18235 - New tomographic method for measuring metatarsal rotation in hallux valgus

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 52S
Author(s):  
Bruno Rodrigues de Miranda ◽  
Rui Dos Santos Barroco ◽  
Leticia Zaccaria Prates de Oliveira ◽  
Mahmoud Beerens Abdul Ghani Abdul Ghani ◽  
Antonio Candido de Paula Neto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hallux Valgus ◽  
Weight Bearing ◽  
Alpha Angle ◽  
Metatarsal Bone ◽  
3 Dimensional ◽  
First Metatarsal ◽  
Computed Tomography Scans ◽  
Tomographic Method ◽  
The Relationship

Introduction: Hallux valgus is a 3-dimensional deformity involving an increased intermetatarsal I/II angle and a rotational deformity of the first metatarsal bone. Kim et al. developed a method for measuring the tibial sesamoid position relative to the coronal rotation of the first metatarsal bone in computed tomography scans under simulated weight-bearing conditions. Objective: To describe a method for the topographic assessment of the correction of tibial sesamoid and metatarsal pronation using computed tomography scans under simulated weight-bearing and active toe extension. Method: We performed computed tomography under simulated weight-bearing conditions with and without active toe dorsiflexion, observing the degree of metatarsal pronation and sesamoid subluxation. For measurement purposes, we used the classifications of Kim et al. and Smith et al. Results: We observed tomographic correction, both angular and rotational, by measuring the intermetatarsal angle and tibial sesamoid position, which were confirmed by the change in the alpha angle suggested by Kim et al. Discussion: Toe extension was described as a peroneus longus tendon activation test by Klemola et al., who used this maneuver to demonstrate clinical rotational correction of hallux valgus. We described the use of a tomographic technique that followed this principle to preoperatively observe the underlying factors that may affect the rotational correction of the deformity. Conclusion: The method has the capacity for correction in various planes involving derotation of the first metatarsal bone and the relationship between such derotation and the change in sesamoid position in relation to the coronal plane of the foot.

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