University of Twente Student Theses
Towards the application of virtual planning and patient specific guides in complex foot surgery.
Bergwerff, E. (2021) Towards the application of virtual planning and patient specific guides in complex foot surgery.
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| Abstract: | Complex foot deformity is a multiplanar deformity of the foot, for which surgical correction is necessary. Preoperative planning of complex foot surgery at Medisch Spectrum Twente (MST) is currently based on reference angles describing healthy foot anatomy in combination with a 3D printed model of the foot, obtained from CT data. The digital 3D model may further be used to virtually plan corrective surgery and design patient specific guides (PSGs). The aim of this study was to determine how virtual planning and PSGs can be applied in complex foot surgery at MST. We have developed workflows for acquisition of an accurate foot model, virtual planning of complex foot surgery and PSG design. An accurate foot model is an anatomically correct foot model, which enables the use of non-weightbearing reference angles during virtual planning. The effect of manual redressing of the foot was studied in two cases of rigid foot deformity to determine how the foot should be positioned during CT acquisition. The results show that the natural supine alignment differs from the maximum achievable neutral alignment. Therefore, CT data should be acquired with the foot set in the neutral alignment. The effect of virtual planning was studied by comparing two cases: one treated with, and one treated without virtual planning. The within-subject change in foot anatomy was compared between these cases based on measured reference angles. Additionally, the measured reference angles in the preoperative foot, postoperative foot and planned result were all compared to normal values. The results indicate an improved postoperative foot alignment when applying virtual planning in comparison to the current treatment. Initial PSG designs were developed and tested in vitro in consultation with one orthopaedic surgeon. The final design consisted of a proximal cutting/repositioning guide in combination with a distal repositioning guide. The design for the cutting/repositioning guide was promising, but adaptations to the repositioning guide are needed before application during surgery is possible. In summary, we found that CT data should be acquired from a neutrally positioned foot to enable the use of normal values for reference angles during virtual planning. The cases studied in this thesis demonstrate that the application of virtual planning in complex foot surgery can already result in a more optimal postoperative foot alignment compared to the current treatment. The application of PSGs may improve the result of complex foot surgery even further, but the current PSG design must be improved and validated before it can be applied in complex foot surgery. |
| Item Type: | Essay (Master) |
| Clients: | Medisch Spectrum Twente |
| Faculty: | TNW: Science and Technology |
| Subject: | 44 medicine, 50 technical science in general |
| Programme: | Technical Medicine MSc (60033) |
| Link to this item: | https://purl.utwente.nl/essays/89212 |
| Export this item as: | BibTeX EndNote HTML Citation Reference Manager |
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