Experimental Comparison Between Computer Assisted Surgery (CAS) Based and C-Arm Based Correction of Hind- and Midfoot Deformities

Abstract

This experimental study compares the accuracy of Computer Assisted Surgery (CAS) based correction of hind- and midfoot deformities, and C-arm based correction. Five specimens of three different deformity models (Sawbone™) were corrected with each method and the results were compared. The specimen visualization during correction was exclusively provided by the C-arm or CAS screen.
The shape was graded normal in all corrected specimens (n=15) in the CAS group, and in eight of the specimens in the C-arm group (Chi²-test, p=0.05). Parameters (t-test utilized): time entire procedure, CAS, 782 (450-1 020) s, C-arm, 410 (210-600) s, p < 0.001; fluoroscopy time, CAS, 0s, C-arm, 11 (8-19) s, p < 0.001; measurement differences between corrected specimens and normal specimen model: foot length, CAS, -1.7 ± 1.9 mm, C-arm, -4.1 ± 3.8 mm, p=0.03; length longitudinal arch, CAS, -0.9 ± 0.9 mm, C-arm, -5.6 ± 4.9 mm, p =0.001; height longitudinal arch, CAS, -0.1 ± 0.5 mm, C-arm, 1.7 ± 4.3 mm, p=0.14; calcaneus inclination, CAS, 0.1 ± 1.4°, C-arm, 2.7 ± 4.8°, p=0.05; calcaneus length, CAS, -0.5 ± 0.4 mm, C-arm, -2.8 ± 1.3 mm, p=0.005; Boehler's angle, CAS, 0.4 ± 1.1°, C-arm, 4.1 ± 8.6°, p=0.37.
CAS promises to be a valuable tool for higher accuracy for correction or reduction in the hind- or midfoot region. Clinical studies must show if this higher accuracy can be achieved in real operations also, and if this leads to better clinical results.

Key words

Correction - Deformity - Midfoot - Hindfoot - Fluoroscopy - Navigation System

References

• 1 Adelaar R S. The treatment of complex fractures of the talus.  Orthop Clin North Am. 1989;  20 (4) 691-707
• 2 Adelaar R S, Kyles M K. Surgical correction of resistant talipes equinovarus: observations and analysis - preliminary report.  Foot Ankle. 1981;  2 (3) 126-137
• 3 Amon K. Luxationsfraktur der kuneonavikularen Gelenklinie. Klinik, Pathomechanismus und Therapiekonzept einer sehr seltenen Fußverletzung.  Unfallchirurg. 1990;  93 (9) 431-434
• 4 Bailey E J, Waggoner S M, Albert M J, Hutton W C. Intraarticular calcaneus fractures: a biomechanical comparison or two fixation methods.  J Orthop Trauma. 1997;  11 (1) 34-37
• 5 Bargar W L, Bauer A, Borner M. Primary and revision total hip replacement using the Robodoc system.  Clin Orthop. 1998;  (354) 82-91
• 6 Bechtold J E, Powless S H. The application of computer graphics in foot and ankle surgical planning and reconstruction.  Clin Podiatr Med Surg. 1993;  10 (3) 551-562
• 7 Birkfellner W, Huber K, Larson A, Hanson D, Diemling M, Homolka P. et al . A modular software system for computer-aided surgery and its first application in oral implantology [In Process Citation].  IEEE Trans Med Imaging. 2000;  19 (6) 616-620
• 8 Brutscher R. Frakturen und Luxationen des Mittel- und Vorfußes.  Orthopäde. 1991;  20 (1) 67-75
• 9 Claes J, Koekelkoren E, Wuyts F L, Claes G M, Van Den H L, Van De Heyning P H. Accuracy of computer navigation in ear, nose, throat surgery: the influence of matching strategy [In Process Citation].  Arch Otolaryngol Head Neck Surg. 2000;  126 (12) 1462-1466
• 10 Coetzee J C, Hansen S T. Surgical management of severe deformity resulting from posterior tibial tendon dysfunction.  Foot Ankle Int. 2001;  22 (12) 944-949
• 11 Delp S L, Stulberg S D, Davies B, Picard F, Leitner F. Computer assisted knee replacement.  Clin Orthop. 1998;  354 49-56
• 12 DiGioia A M III, Jaramaz B, Colgan B D. Computer assisted orthopaedic surgery. Image guided and robotic assistive technologies.  Clin Orthop. 1998;  (354) 8-16
• 13 DiGioia A M III, Jaramaz B, Plakseychuk A Y, Moody J E Jr, Nikou C, Labarca R S. et al . Comparison of a mechanical acetabular alignment guide with computer placement of the socket.  J Arthroplasty. 2002;  17 (3) 359-364
• 14 Foley K T, Smith M M. Image-guided spine surgery.  Neurosurg Clin N Am. 1996;  7 (2) 171-186
• 15 Gebhard F, Kinzl L, Arand M. [Computer-assisted surgery].  Unfallchirurg. 2000;  103 (8) 612-617
• 16 Gebhard F, Kinzl L, Arand M. [Limits of CT-based computer navigation in spinal surgery].  Unfallchirurg. 2000;  103 (8) 696-701
• 17 Hansen S TJ. Functional reconstruction of the foot and ankle. Lippincott Williams & Wilkins, Philadelphia, Baltimore, New York 2000
• 18 Hassfeld S, Muhling J. Navigation in maxillofacial and craniofacial surgery.  Comput Aided Surg. 1998;  3 (4) 183-187
• 19 Hildebrand K A, Buckley R E, Mohtadi N G, Faris P. Functional outcome measures after displaced intra-articular calcaneal fractures.  J Bone Joint Surg [Br]. 1996;  78 (1) 119-123
• 20 Jaramaz B, DiGioia A M III, Blackwell M, Nikou C. Computer assisted measurement of cup placement in total hip replacement.  Clin Orthop. 1998;  354 70-81
• 21 Kamimura M, Ebara S, Itoh H, Tateiwa Y, Kinoshita T, Takaoka K. Accurate pedicle screw insertion under the control of a computer-assisted image guiding system: laboratory test and clinical study.  J Orthop Sci. 1999;  4 (3) 197-206
• 22 Kato A, Yoshimine T, Hayakawa T, Tomita Y, Ikeda T, Mitomo M. et al . [Computer assisted neurosurgery: development of a frameless and armless navigation system (CNS navigator)].  No Shinkei Geka. 1991;  19 (2) 137-142
• 23 Kerschbaumer F. [”Numerical imaging, operation planning, simulation, navigation, robotics”. Do the means determine the end? (editorial)].  Orthopade. 2000;  29 (7) 597-598
• 24 Klos T V, Banks S A, Habets R J, Cook F F. Sagittal plane imaging parameters for computer-assisted fluoroscopic anterior cruciate ligament reconstruction.  Comput Aided Surg. 2000;  5 (1) 28-34
• 25 Klos T V, Habets R J, Banks A Z, Banks S A, Devilee R J, Cook F F. Computer assistance in arthroscopic anterior cruciate ligament reconstruction.  Clin Orthop. 1998;  354 65-69
• 26 Koczewski P, Shadi M, Napiontek M. Foot lengthening using the Ilizarov device: the transverse tarsal joint resection versus osteotomy.  J Pediatr Orthop B. 2002;  11 (1) 68-72
• 27 Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D. Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients [In Process Citation].  Eur Spine J. 2000;  9 (3) 235-240
• 28 Langlotz F, Bachler R, Berlemann U, Nolte L P, Ganz R. Computer assistance for pelvic osteotomies.  Clin Orthop. 1998;  354 92-102
• 29 Marti R K, de Heus J A, Roolker W, Poolman R W, Besselaar P P. Subtalar arthrodesis with correction of deformity after fractures of the os calcis.  J Bone Joint Surg [Br]. 1999;  81 (4) 611-616
• 30 Merloz P, Tonetti J, Cinquin P, Lavallee S, Troccaz J, Pittet L. [Computer-assisted surgery: automated screw placement in the vertebral pedicle].  Chirurgie. 1998;  123 (5) 482-490
• 31 Merloz P, Tonetti J, Pittet L, Coulomb M, Lavallee S, Troccaz J. et al . Computer-assisted spine surgery.  Comput Aided Surg. 1998;  3 (6) 297-305
• 32 Mosier-LaClair S, Pomeroy G, Manoli A. Operative treatment of the difficult stage 2 adult acquired flatfoot deformity.  Foot Ankle Clin. 2001;  6 (1) 95-119
• 33 Ploder O, Wagner A, Enislidis G, Ewers R. [Computer-assisted intraoperative visualization of dental implants. Augmented reality in medicine ].  Radiologe. 1995;  35 (9) 569-572
• 34 Radermacher K, Portheine F, Anton M, Zimolong A, Kaspers G, Rau G. et al . Computer assisted orthopaedic surgery with image based individual templates.  Clin Orthop. 1998;  354 28-38
• 35 Richter M, Wippermann B, Krettek C, Schratt E, Hufner T, Thermann H. Fractures and Fracture Dislocations of the Midfoot - Occurence, Causes and Long-Term Results.  Foot Ankle Int. 2001;  22 (5) 392-398
• 36 Sammarco G J, Conti S F. Surgical treatment of neuroarthropathic foot deformity.  Foot Ankle Int. 1998;  19 (2) 102-109
• 37 Schiffers N, Schkommodau E, Portheine F, Radermacher K, Staudte H W. [Planning and performance of orthopedic surgery with the help of individual templates].  Orthopade. 2000;  29 (7) 636-640
• 38 Schlenzka D, Laine T, Lund T. [ Computer-assisted spine surgery: principles, technique, results and perspectives].  Orthopade. 2000;  29 (7) 658-669
• 39 Schlenzka D, Laine T, Lund T. Computer-assisted spine surgery.  Eur Spine J. 2000;  9 Suppl 1 S57-64
• 40 Stephens H M, Walling A K, Solmen J D, Tankson C J. Subtalar repositional arthrodesis for adult acquired flatfoot.  Clin Orthop. 1999;  365 69-73
• 41 Suren E G, Zwipp H. Luxationsfrakturen im Chopart- und Lisfranc-Gelenk.  Unfallchirurg. 1989;  92 (3) 130-139
• 42 Thoma W, Schreiber S, Hovy L. [Computer-assisted implant positioning in knee endoprosthetics. Kinematic analysis for optimization of surgical technique].  Orthopade. 2000;  29 (7) 614-626
• 43 Tonetti J, Carrat L, Blendea S, Merloz P, Troccaz J, Lavallee S. et al . Clinical results of percutaneous pelvic surgery. Computer assisted surgery using ultrasound compared to standard fluoroscopy.  Comput Aided Surg. 2001;  6 (4) 204-211
• 44 Tonetti J, Carrat L, Lavallee S, Pittet L, Merloz P, Chirossel J P. Percutaneous iliosacral screw placement using image guided techniques.  Clin Orthop. 1998;  354 103-110
• 45 Toolan B C, Sangeorzan B J, Hansen Jr S T. Complex reconstruction for the treatment of dorsolateral peritalar subluxation of the foot. Early results after distraction arthrodesis of the calcaneocuboid joint in conjunction with stabilization of, and transfer of the flexor digitorum longus tendon to, the midfoot to treat acquired pes planovalgus in adults.  J Bone Joint Surg Am. 1999;  81 (11) 1545-1560
• 46 Trnka H J, Easley M E, Lam P W, Anderson C D, Schon L C, Myerson M S. Subtalar distraction bone block arthrodesis.  J Bone Joint Surg Br. 2001;  83 (6) 849-854
• 47 Wei S Y, Sullivan R J, Davidson R S. Talo- navicular arthrodesis for residual midfoot deformities of a previously corrected clubfoot.  Foot Ankle Int. 2000;  21 (6) 482-485
• 48 Weihe S, Wehmoller M, Schliephake H, Hassfeld S, Tschakaloff A, Raczkowsky J. et al . Synthesis of CAD/CAM, robotics and biomaterial implant fabrication: single-step reconstruction in computer aided frontotemporal bone resection [In Process Citation ].  Int J Oral Maxillofac Surg. 2000;  29 (5) 384-388
• 49 Zwipp H. Chirurgie des Fußes. Springer-Verlag, Wien, New York 1994
• 50 Zwipp H, Dahlen C, Randt T, Gavlik J M. Komplextrauma des Fußes.  Orthopade. 1997;  26 (12) 1046-1056