Is intraoperative pedography helpful in clinical use--preliminary results of 100 cases from a consecutive, prospective, randomized, controlled clinical study

Robotic-assisted foot and ankle surgery: a review of the present status and the future

The surgical application of robotics has increased significantly since its first application in 1985 for a brain biopsy acquisition. Robotic-assisted surgery has been one of the viable options in various surgical areas, and also in orthopaedic surgery. Robotic-assisted orthopaedic surgery has gained popularity as a mean of improving accuracy, reducing complications and achieving better patient satisfaction. Numerous clinical research studies have demonstrated advantages of robotic-assisted orthopaedic surgery, however, most of that researches were about the total knee arthroplasty, total hip arthroplasty and spine surgery. The application of robotic technology in foot and ankle surgery is in a very nascent stage. Furthermore, there has been little research on intraoperative use of robotics in foot and ankle surgery in literature. A review of previous preclinical studies in foot and ankle robotics and clinical research studies in various fields of robot-assisted orthopaedic surgery shows that its potential application and benefits over conventional techniques, such as total ankle arthroplasty, minimally invasive surgery for foot and ankle trauma or other corrective procedure, and intraoperative biomechanical testing. More studies on practical application of robotic technology to surgical procedure in the field of foot and ankle surgery are needed to confirm its clinical usefulness and cost effectiveness.

In Vivo Plantar Pressures in Adult-Acquired Flatfoot Compared to Control Using an Intraoperative Pedobarographic Device

BACKGROUND

Intraoperative pedobarography has the potential to aid surgical decisions, but no parameters exist to guide its use.

QUESTIONS/PURPOSES

This study compared supine plantar pressures between flatfoot patients and controls using a previously validated intraoperative pedobarographic device and examined associations between supine, walking, and standing plantar pressures.

METHODS

Ten preoperative patients with stage II adult-acquired flatfoot deformity (AAFD) were compared to ten healthy controls. Supine plantar pressures were assessed using the pedobarographic device. Standing and walking plantar pressures were assessed with an EMED-XT sensor array (Novel). Maximum force (MF) and peak pressure (PP) were calculated for nine anatomical foot regions adjusting for age and BMI.

RESULTS

No differences in plantar pressures were found between flatfoot patients and controls in the supine or standing positions. During walking, flatfoot patients had greater MF of the first, second, and third metatarsals (p ≤ 0.018) and greater PP of the first and second metatarsals than controls (p ≤ 0.010). Supine MF and PP were both strongly positively correlated with their respective pressure measurements for both standing and walking in multiple foot regions (p ≤ 0.05, all analyses). Correlations in the first metatarsal region were generally weak and not statistically significant.

CONCLUSION

This device did not show differences in supine plantar pressures of flatfoot patients and healthy subjects, highlighting the limitations of intraoperative devices in guiding flatfoot correction. The differences between flatfoot and controls during walking and the correlations between supine and walking conditions suggest that dynamic plantar pressures are a more useful parameter in guiding flatfoot reconstruction.

[Pedobarographic results of Girdlestone-Taylor tendon transfer in flexible small toe deformity]

AIM

The aim of the study was to analyze the biomechanical effects of flexible claw toe correction by tendon transfer with the Girdlestone-Taylor approach using dynamic pedobarography.

MATERIAL AND METHODS

In the study 12 patients were examined preoperatively and 12 months postoperatively. The results obtained by pedobarography 12 months postoperatively were compared with those of a healthy control group of matched age and body mass index (BMI). For clinical evaluation the American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue pain scale (VAS) were evaluated.

RESULTS

The results showed a significant increase in the average AOFAS score from 72 (range 63-79) preoperatively to 92 (84-96) points 12 months postoperatively. The pedobarography revealed significantly increased values in the force-time integral and the maximum force for the second and third toes 12 months postoperatively. Compared with preoperative measurement values a significantly increased peak pressure could be assessed for the third toe only. It is assumed that the combination of functional arthrodesis of the proximal interphalangeal (PIP) joint and the strain shift by tendon transfer causes this increase in peak pressure.

CONCLUSION

Atter Girdlestone-Taylor tendon transfer reestablishment of floor contact of flexible claw toes could be demonstrated by dynamic pedobarography.

Computer aided surgery in foot and ankle: applications and perspectives

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.

Leonard J. Goldner Award 2009. Intraoperative pedobarography leads to improved outcome scores: a Level I study

BACKGROUND

The purpose was to compare the clinical outcome scores after additional use of intraoperative pedobarography (IP) in comparison with patients treated without IP.

MATERIALS AND METHODS

Patients with arthrodesis and/or correction of the foot and/or ankle were randomized for use of IP or no IP. American Orthopaedic Foot and Ankle Society (AOFAS) score, Short-Form 36 (SF-36), and Visual Analogue Scale Foot and Ankle (VAS FA) were analyzed.

RESULTS

One hundred patients were included. Fifty-two were randomized for the use of IP, and in 24 of those (46%), the correction was modified after IP during the same operation. At mean followup of 2 years, the average scores were higher in the group with IP than in the group without IP (IP/no IP: AOFAS 89.7/78.2; SF-36 90.3/76.3; VAS FA 90.3/76.3; t-test, all p < 0.05).

CONCLUSION

The use of IP led to improved clinical outcome scores at a mean followup of 2 years.