Computer based systems in foot and ankle surgery at the beginning of the 21 st century

Abstract

At the beginning of the 21st century the computer has supplemented the possibilities of orthopedic surgery. This article analyzes the current feasibility and potential clinical benefit of computer use for foot and ankle surgery. The experimental evaluation and clinical use of the following different options of computer use for foot and ankle in a level one trauma center were analyzed: intraoperative threedimensional imaging with a mobile motorized C-arm (ISO-C-3D), CT-based Computer Assisted Surgery (CAS), ISO-C-3D-based CAS, C-arm-based CAS, and Intraoperative Pedography (IP). ISO-C-3D: Intraoperative three-dimensional imaging with an ISO-C-3D was used in 101 cases. In 39% of the cases, reduction and/or implant position was corrected after ISO-C-3D-scan during the same procedure. The operation was interrupted for ISOC-3D use for 430 seconds on average. CAS: CAS was used for retrograde drillings in osteochondral defects of the talus and for correction of ankle and hindfoot deformities. CAS-guided retrograde drilling in osteochondral defects worked without problems and accurate in all ten cases that were included. The CAS-guided correction of posttraumatic deformities of the ankle and hindfoot region was feasible and provided very high accuracy and a fast correction process in the ten cases so far. IP: For an intraoperative introduction of standardized forces to the footsole, a device named “Kraftsimulator Intraoperative Pedographie” (KIOP, manufacuted in the Workshop of the Hannover Medical School, Hannover, Germany; Registered Design No. 20 2004 007 755.8 by the German Patent Office, Munich, Germany) was developed. During a validation process, no statistically significant differences were found between the measurements of the introduced method for IP in anesthesized individuals and the standard dynamic and static pedography. The introduced method is valid for IP. The ISO-C-3D provides important information which could not be obtained from plain films or C-arm alone. The benefit of the introduced CAS methods is high when improved accuracy can lead to an improved clinical outcome. IP will be useful for all those cases in which intraoperative biomechanical assessment may lead to an immediate improvement of the achieved surgical result. In the future, computerized methods for improved intraoperative imaging, guidance and biomechanical assessment will help to realize the planned operative result. The integration of the different computerized systems into one Integrated Computer System for Operative Procedures (ICOP) will improve the handling and clinical feasibility.