WEIGHTBEARING CT AND LOWER LIMB PERSONALIZED ORTHOPAEDIC TREATMENTS

Musculoskeletal deformities, especially in the lower extremities, are frequent pathological conditions involving multiplanar morphological anomalies and changes. Accurate morphologic evaluations are of utmost importance in the case of arthroplasties, which are aimed at restoring the original anatomy through customized approaches, i.e., joint prosthesis designs and/or custom implants. Relevant radiological investigations are more descriptive and representative when performed under loaded conditions. This is possible through standard imaging procedures, but these are limited by the fact that these provide only two-dimensional images. Nowadays these investigations are now possible in 3D and in real loading conditions using novel weight-bearing computed-tomography (WBCT) systems, thanks to the recent application of cone-beam technology in orthopedics. These provide 3D scans of the extremities in standing positions, for more realistic and minimally invasive analyses with respect to standard CT scans in supine or traditional radiographs. The purpose of this study is to report our experience of using WBCT in an orthopedic center, especially in the cases of personalized treatment designs. To this end, a number of clinical trials have been defined to enroll patients, whose imagining data are used for patient-specific joint modeling, prosthesis designing, pre/post operative monitoring and basic functional-biomechanical interpretation. In particular, the personalized design of total knee and ankle prostheses, patient-specific definition of knee and calcaneal osteotomies, patello-femoral alignment after medial retinacular ligament reconstruction, bone architecture and calcifications 3D reconstructions in the diabetic foot, and assessment of overall foot realignment after surgical correction of severe flatfoot have taken advantage of these new medical imaging systems. All these applications are supported by innovative data manipulation and processing, including novel and original measurements, and in combination with other survey methodologies, e.g., state-of-the-art gait analysis and magnetic resonance imaging.