Introduction

Osteoarthritis in the foot and ankle affects approximately 30,000 patients annually in the UK. Evidence has shown that excess weight exacerbates foot pain, with significant increases in joint forces. However, despite the current trend for Clinical Commissioning Groups to ration surgery for obese patients, studies have not yet determined the effect of weight loss in obese patients with foot and ankle arthritis.

Introduction

High Tibial Osteotomy has become an increasingly popular management option for patients with painful medial compartment osteoarthritis. The Fujisawa method used to calculate the angle of correction is well-documented but there have been no studies to look at the reliability and accuracy of web-based systems to calculate this angle.

Minimally Invasive foot surgery remains controversial

Potential benefits include a reduced incidence of wound complications, faster return to employment and normal footwear. There are no studies published regarding the results of minimally invasive dorsal cheilectomy.

Introduction

The management of young patients with painful medial compartment osteoarthritis remains controversial. Opening wedge medial high-tibial osteotomy using a locking plate has shown good results in selected patients. This cohort of patients has high physical demands and previous studies have warned against operating on patients with increased body mass index (BMI).

Introduction

Minimally Invasive foot surgery remains controversial. Potential benefits include a reduced incidence of wound complications, faster return to employment and normal footwear. There are no studies published regarding the results of minimally invasive dorsal cheilectomy.

Introduction: The use of mini C-arm systems has become established in hand surgery. Potential advantages of the mini C-arm include decreased radiation exposure by reducing screening time, increased distance from the beam, tighter beam collimation and surgeon control of the C-arm. Little has been written in the literature regarding their use in foot and ankle surgery.

Aims: To compare the radiation dose and screening times delivered by the mini C-arm with standard fluoroscopy in elective foot and ankle surgical procedures. A secondary objective was to quantify the cost of both techniques.

Patients and methods: We prospectively studied 137 patients who underwent fluoroscopic screening during various elective foot and ankle procedures. Of these 72 were screened using standard fluoroscopy and the remaining 55 using the mini C-arm. During each procedure screening time and radiation dose were prospectively recorded. The Dose Area Product (DAP) meters on both machines for the determination of radiation exposure and scatter to the operating theatre and staff were used. A cost benefit analysis for radiographer attendance and theatre delay was calculated.

Results: The mean DAP for standard fluoroscopy was 7.43 CGycm2 (sd 9.41) whereas with the mini C-arm it was 3.46 CGycm2 (sd 3.51). There was a statistically significant reduction in the DAP (P = 0.0013). Mean screening time was 13 seconds (SD 14.7) with standard fluoroscopy and 14.5 seconds (SD 18.1) with the mini C-arm. No statistically significant difference was found between screening times. (p = 0.987). The potential total saving of the mini c-arm for 137 procedures was £4086

Conclusion: We recommend the use of the mini C-arm in foot and ankle surgery as it reduces radiation exposure and cost when compared to standard fluoroscopy. We acknowledge that there is a learning curve for surgeons to minimise screening time.