Three-dimensional navigation for talocalcaneal coalition resection: A comparative analysis

Talocalcaneal (TC) coalition is an abnormal connection between the talus and calcaneus, causing painful, restricted subtalar motion, recurrent ankle sprains, and rigid flatfoot. The purpose of this study was to compare 3D-navigation to traditional open techniques in resection of TC coalitions.

Patients who underwent TC coalition resection with the assistance of intra-operative 3-D navigation (study cohort = 12 patients, 14 feet) or the traditional non-navigated approach (control group = 4 patients, 5 feet) at a single tertiary referral center were reviewed. Operative time (OT), anesthesia time (AT), tourniquet time (TT), blood loss (EBL), length of hospital stay (LOS), complications, duration of immobilization postoperatively, and average effective dose of radiation in millisieverts (mSv) were reviewed.

OT (p = 0.97), EBL (p = 0.75), LOS (p = 0.58), AT (p = 0.46), and TT (p = 0.76) did not differ between groups. Mean duration of postoperative immobilization was 2 weeks shorter for the navigated group but not statistically significant (p = 0.11). Two complications occurred in the navigated group; one obese patient (BMI=34 kg/m²) had delayed wound healing, and another patient had a superficial skin infection. The average effective dose of radiation for all patients (n = 12) in the navigated group was 0.0081 mSv. The average dose for patients undergoing only one intraoperative CT spin (n = 9) was 0.0052 mSv.

Navigated TC coalition excision had comparable OT, EBL, LOS, AT, and TT to traditional non-navigated approach patients. The addition of intraoperative 3D navigation provides precise resection guidance without significantly increased surgical time with comparable total effective radiation dose to the traditional use of intra-operative fluoroscopy.