Computer Hexapod-assisted Orthopaedic Surgery for the Correction of Multiplanar Deformities throughout the Lower Limb

Jonathan Ming Ren French; Joshua Filer; Kathryn Hogan; James William Alexander Fletcher; Stephen Mitchell

doi:10.5005/jp-journals-10080-1608

Computer Hexapod-assisted Orthopaedic Surgery for the Correction of Multiplanar Deformities throughout the Lower Limb

Strategies Trauma Limb Reconstr. 2024 Jan-Apr;19(1):9-14. doi: 10.5005/jp-journals-10080-1608.

Authors

Jonathan Ming Ren French¹, Joshua Filer², Kathryn Hogan², James William Alexander Fletcher³, Stephen Mitchell²

Affiliations

¹ Limb Reconstruction Unit, Trauma and Orthopaedics, Bristol Royal Infirmary; Musculoskeletal Research Unit, University of Bristol, Bristol, England, United Kingdom.
² Limb Reconstruction Unit, Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, England, United Kingdom.
³ Limb Reconstruction Unit, Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, England; Department for Health, University of Bath, Bath, United Kingdom.

Abstract

Introduction: Computerised hexapod-assisted orthopaedic surgery (CHAOS) is a method by which complex multiplanar, multilevel deformity can be corrected with a high degree of accuracy utilising minimally invasive techniques within a single operative event. This study's aim was to report the reliability, accuracy and magnitude of correction achieved, alongside patient-reported outcomes and risk factors for complications when using the CHAOS technique throughout the lower limb.

Materials and methods: Retrospective review of medical records and radiographs for consecutive patients who underwent CHAOS for lower limb deformity correction at a tertiary centre between 2012 and 2020.

Results: There were 70 cases in 56 patients, with the site of surgery being the femur in 48 cases, proximal tibia in 17 and distal tibia in 5 cases. Multiplanar correction was performed in 43 cases, and multilevel osteotomy was undertaken in 23 cases. Fixation was undertaken with intramedullary nailing (IMN) in 49 cases and locked plates in 21.The maximum corrections were 40° rotation, 20° coronal angulation, 51° sagittal angulation and 62-mm mechanical axis deviation (MAD). Deformity correction was mechanically satisfactory in all patients bar one who was undercorrected requiring revision. The mean patient global impression of change (PGIC) score was 6.2 out of 7.Overall complication rate was 12/70 (17%). Complications from femoral surgery included two nonunions, one case of undercorrection, one case of stiffness, one muscle hernia and one pulmonary embolism. Complications from tibial surgery were one compartment syndrome, one pseudoaneurysm of the anterior tibial artery requiring stenting, one transient neurapraxia of the common peroneal nerve, one locking plate fatigue failure, one seroma and one superficial wound infection.

Conclusion: Computerised hexapod-assisted orthopaedic surgery can be used for accurate correction of complex multilevel and multiplanar deformities of both the femur and tibia. The risk profile appears to differ between femoral and tibial surgeries, and also to that of traditional circular frame correction. Patients remain highly satisfied with both the functional and symptomatic outcomes.

How to cite this article: French JMR, Filer J, Hogan K, et al. Computer Hexapod-assisted Orthopaedic Surgery for the Correction of Multiplanar Deformities throughout the Lower Limb. Strategies Trauma Limb Reconstr 2024;19(1):9-14.

Keywords: Chaos; Deformity correction; Hexapod frame.