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Conventional vs Augmented Reality-Guided Lateral Calcaneal Lengthening Simulated in a Foot Bone Model.

Maksym Polt1, Arnd F Viehöfer1, Fabio A Casari1

  • 1Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.

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|March 19, 2024
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Summary

Augmented reality (AR) guidance improved surgical accuracy for experienced surgeons performing Hintermann osteotomies on foot models. AR also helped prevent posterior facet violation, enhancing safety in treating acquired adult flatfoot deformity.

Keywords:
Acquired adult flatfoot deformityAugmented realityCalcaneusHintermann osteotomyHoloLensLateral column lengthening osteotomyOsteotomySubtalar facetsSurgery

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Area of Science:

  • Orthopaedic surgery
  • Surgical technology
  • Medical imaging

Background:

  • Acquired adult flatfoot deformity (AAFD) involves arch collapse and soft tissue dysfunction.
  • Hintermann osteotomy (H-O) treats stage II AAFD but faces challenges due to anatomical variations and limited visibility.
  • Subtalar facet injury is a significant concern during lateral column lengthening osteotomies.

Purpose of the Study:

  • To evaluate the impact of augmented reality (AR) guidance on surgical accuracy and facet violation rates during Hintermann osteotomy.
  • To compare the effectiveness of AR-guided versus conventional osteotomy techniques.
  • To assess the influence of surgeon experience on AR-guided procedure outcomes.

Main Methods:

  • Sixty foot bone models underwent AR-guided or conventional Hintermann osteotomies.
  • AR guidance involved superimposing holographic osteotomy planes via a headset.
  • Conventional osteotomies relied on direct anatomical landmarks.
  • Outcomes measured included facet joint violation (rate and severity) and entry/exit point accuracy.

Main Results:

  • Experienced surgeons demonstrated significantly improved osteotomy entry point accuracy with AR (1.6 mm deviation) compared to conventional methods (2.3 mm).
  • AR guidance helped experienced surgeons avoid full posterior facet violation (P=.011).
  • Inexperienced surgeons showed a trend towards improved accuracy with AR, but it was not statistically significant (P=.064).
  • Inexperienced surgeons had higher rates of middle and posterior facet injury regardless of the method used.

Conclusions:

  • AR guidance enhances surgical accuracy, particularly for experienced surgeons, in performing Hintermann osteotomies.
  • AR technology shows potential in preventing critical intraoperative complications like posterior facet violation.
  • Further research on cadaveric specimens is warranted to validate AR's benefits for patient and surgeon safety and potentially reduce radiation exposure.