Predicting Postoperative Sagittal Plane Alignment of the Foot Using Intraoperative Simulated Weightbearing Lateral Imaging During Flatfoot Reconstructive Surgery: A Short-Term Retrospective Analysis

Boffeli, Troy J.; Duelfer, Keegan A.

doi:10.1053/j.jfas.2021.01.007

Cited by 2 publications

(5 citation statements)

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“…Although navigation, pedobarography, and hindfoot alignment guide instruments were introduced to intraoperatively measure hindfoot alignment, these novel methods have not been widely applied because of their high costs, low applicability, and high radiation exposure. [1][2][3]13,15,16 HAV fluoroscopy with simulated weightbearing is still a potentially effective method in the operation room. Previous studies have shown that intraoperative HAV fluoroscopy is a valuable method to understand hindfoot alignment and predict postoperative sagittal alignment.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that intraoperative HAV fluoroscopy is a valuable method to understand hindfoot alignment and predict postoperative sagittal alignment. 1,8 However, there is a paucity of studies investigating the measurement consistency of hindfoot alignment between intraoperative simulated weightbearing fluoroscopy and postoperative weightbearing radiographs in reconstruction surgery.…”

Section: Discussionmentioning

confidence: 99%

“…6,[17][18][19] Thorough intraoperative evaluation may help to correct hindfoot alignment and achieve satisfactory surgical outcomes. 1,5,12 Intraoperative assessment of coronal hindfoot alignment includes visual inspection, anteroposterior (AP) fluoroscopy, hindfoot alignment view (HAV) fluoroscopy with simulated weightbearing, navigation, and pedobarography. [1][2][3]13,15,16 Visual inspection depends on the surgeons' experience and often lacks reliability.…”

Section: Introductionmentioning

confidence: 99%

“…1,5,12 Intraoperative assessment of coronal hindfoot alignment includes visual inspection, anteroposterior (AP) fluoroscopy, hindfoot alignment view (HAV) fluoroscopy with simulated weightbearing, navigation, and pedobarography. [1][2][3]13,15,16 Visual inspection depends on the surgeons' experience and often lacks reliability. Routine AP fluoroscopy of the ankle joint is limited because of the superimposition of bones, precluding the acquisition of distinct images for surgeons to determine hindfoot alignment.…”

Section: Introductionmentioning

confidence: 99%

“…They reported no significant difference in hindfoot alignment between the preoperative standing radiograph and intraoperative fluoroscopy findings. A short-term retrospective analysis by Boffeli et al 1 showed that intraoperative simulated weightbearing lateral fluoroscopy was a valuable method to predict postoperative sagittal plane alignment in patients undergoing flatfoot reconstructive surgery. However, few studies have investigated the consistency between intraoperative simulated weightbearing fluoroscopy and postoperative weightbearing radiographs in patients undergoing hindfoot alignment reconstruction surgery.…”

Section: Introductionmentioning

confidence: 99%

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Simulated Weightbearing Fluoroscopy to Assess Intraoperative Hindfoot Alignment

Sun

et al. 2023

Foot Ankle Int.

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Background: Intraoperative evaluation of hindfoot alignment is one of the factors that may affect outcomes for foot and ankle reconstructive surgery. The present study was performed to evaluate the effect of simulated weightbearing fluoroscopy on the intraoperative assessment of hindfoot alignment reconstruction. Methods: The medical records of patients diagnosed with disorders of the foot and ankle with abnormal hindfoot alignment were retrospectively reviewed from November 2014 to November 2021. Hindfoot alignment view (HAV) fluoroscopy in the simulated weightbearing position and HAV radiographs were routinely recorded during and after surgery, respectively. The hindfoot alignment angle (HAA) and hindfoot alignment ratio (HAR) were measured on intraoperative and postoperative images, respectively. Results: Seventy-two women and 82 men (155 ankles) with a mean age of 45.48 years were included in the present study. The intraobserver and interobserver reliabilities of the HAA and HAR measurements were satisfactory. The intraoperative and postoperative HAA was −0.7 ± 4.8 degrees and −0.2 ± 5.0 degrees, respectively. The mean HAR on intraoperative fluoroscopy and postoperative radiographs was 37.4% ± 19.7% and 40.4% ± 18.2%, respectively. Simple regression analysis revealed a correlation between the intraoperative and postoperative HAA ( R2 = 0.631, P < .001) and HAR ( R2 = 0.262, P < .001). Univariate analysis suggested that the difference between the intraoperative and postoperative HAA was positively affected by the body mass index ( P < .001). Conclusion: The present study showed that intraoperative HAV fluoroscopy in the simulated weightbearing position is a potentially useful method to predict postoperative hindfoot alignment in the weightbearing position. Patients with a lower body mass index had smaller HAA deviations between intraoperative and postoperative measurements of hindfoot alignment. Level of Evidence: Level IV, retrospective case series.

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