Mark E. Easley, MD and Nathan D. Cooperman, MD
Computer-assisted surgery has been used for various orthopaedic procedures since the early 1990s. This technology is being employed with greater frequency because of improved visualization, greater accuracy of implant placement, and reduced radiation exposure as compared with conventional orthopaedic surgery.
Optimal screw placement for subtalar arthrodesis is important in order to minimize intertarsal motion and to potentially increase the likelihood of fusion. On the basis of unpublished data from a previous biomechanical investigation, the authors believe that a double diverging screw configuration affords superior stability and compression for subtalar arthrodesis when compared with two parallel screws or several single screw configurations. Although an experienced surgeon occasionally may need only a single pass of a drill-bit or guidewire, the authors have noted that a less experienced surgeon typically requires more than one pass to achieve the desired implant position. Multiple attempts to reposition the screw or guidewire may lead to weakening of the osseous structure, thereby diminishing screw purchase and compression and potentially increasing the risk of nonunion. In addition, creating numerous channels in the bone with each pass attempt increases the difficulty of establishing a new, more accurate path for the guidewire. Finally, the required multiple-shot or real-time fluoroscopy exposes the patient, surgeon, and hospital staff to more radiation.
In the corresponding JBJS article to this video supplement, the authors found computer-assisted subtalar arthrodesis resulted in screw placement accuracy that was equivalent to that of conventional (fluoroscopically guided) subtalar arthrodesis while decreasing the number of suboptimal guidewire passes and fluoroscopic time. The computer-assisted surgery technique increased the operative time for surgeons who were more experienced in conventional subtalar arthrodesis, but there was no difference in operative time for the group of operators who were less experienced in subtalar arthrodesis.
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See the Corresponding JBJS Article:
- Mark Easley, MD, Bavornrit Chuckpaiwong, MD, Nathan Cooperman, BA, Reinhard Schuh, Tahir Ogut, MD, Ian L.D. Le, MD, John Reach, MD
- Computer-Assisted Surgery for Subtalar Arthrodesis: A Study in Cadavers
J. Bone Joint Surg. Am., Aug 2008; 90 (8); 1628-16 [Article]
- Total Run Time: 31:31 minutes
- Catalog Number: 1033
- VJO Publication Date: December, 2010