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Computer-Assisted Surgery for Subtalar ArthrodesisA Study in Cadavers
Mark Easley, MD1; Bavornrit Chuckpaiwong, MD1; Nathan Cooperman, BA1; Reinhard Schuh1; Tahir Ogut, MD1; Ian L.D. Le, MD1; John Reach, MD1
1 Duke Health Center, 3116 North Duke Street, Room 243, Durham, NC 27704. E-mail address for M. Easley: easle004@mc.duke.edu
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (BrainLAB) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.
Investigation performed at the Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Aug 01;90(8):1628-1636. doi: 10.2106/JBJS.G.00513
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Background: Despite considerable recent interest in computer navigation for orthopaedic surgery, few investigations of computer-assisted surgery for foot and ankle operations have been reported. The purpose of the present study was to compare subtalar arthrodesis with and without computer navigation in a cadaver model.

Methods: Subtalar arthrodesis was performed on thirty-six matched-pair cadaver lower extremities with intact soft tissues, with an attempt being made to orient two screws in the optimal configuration based on unpublished data from a preceding biomechanical study. Each matched pair was randomly assigned either to a group of surgeons who were experienced in subtalar arthrodesis or to a group of inexperienced operators. Neither surgical group was experienced in computer-assisted surgery. We compared optimal first-pass guidewire placement, fluoroscopic time, total operative time, screw placement accuracy, and adverse screw placement events between conventional (fluoroscopically guided) and computer-assisted subtalar arthrodesis.

Results: The number of passes needed to achieve optimal guidewire placement decreased with the use of computer assistance for both experienced surgeons and inexperienced operators (p < 0.001), with ideal placement occurring on the first attempt in 95% of the procedures performed with use of computer assistance. While the experienced surgeons required less time and fewer guidewire passes during conventional subtalar arthrodesis than the inexperienced operators did (p < 0.001), both groups used less fluoroscopy with computer assistance (p < 0.001). There was no significant difference in operative time between the two techniques when performed by the inexperienced operators, yet the total procedure time doubled for the experienced surgeons when the procedure was performed with use of computer assistance (p < 0.001). There was no significant difference between experienced surgeons and inexperienced operators or between conventional and computer-assisted subtalar arthrodesis with respect to adverse screw placement events or the ability to accurately place both screws.

Conclusions: 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 inexperienced in subtalar arthrodesis.

Clinical Relevance: The present study supports the use of computer assistance for subtalar arthrodesis, particularly for surgeons who are less experienced in the procedure.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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