Weight-Bearing CT and Functional 3D Imaging in Orthopedic Surgery: A Historical Perspective and Future Pathways

Lower extremity orthopedic disorders, particularly degenerative diseases and related deformities, are a leading cause of pain and disability worldwide, significantly impacting patients’ quality of life. Historically, radiography has been the primary imaging method for the evaluation and diagnosis of most of these disorders. At the same time, second-level imaging techniques (MRI, CT) have contributed to improving the diagnosis and study of lower limb disorders. Because many lower extremity conditions are dynamic and load-dependent, assessment under physiological weight-bearing is often essential to capture clinically meaningful alignment, joint congruency, and instability. Over the past decade, weight-bearing CT (WBCT) has accelerated this shift by enabling 3D evaluation in standing conditions, improving preoperative planning, postoperative assessment, and objective outcome follow-up. In parallel, a broader ecosystem of functional, standing 3D imaging approaches is emerging, including low-dose standing imaging, biplanar imaging with 3D reconstruction, other weight-bearing/standing 3D modalities, and AI-enabled quantitative analytics creating new opportunities to study deformity, biomechanics, and treatment effects in real-world conditions.This Research Topic will provide a comprehensive, forward-looking overview of WBCT as the core technology for functional, load-dependent assessment in orthopedic surgery, while also welcoming high-quality work on related standing/weight-bearing 3D imaging approaches that complement or extend WBCT in clinical care. The goal is to summarize current applications, identify implementation pathways, and discuss the potential impact on clinical and surgical practice, training, and patient follow-up.We welcome articles that address, but are not limited to, the following topics:• Application of WBCT in the preoperative setting and planning of lower-limb disorders (hip, knee, ankle, and foot).• Standing/weight-bearing 3D imaging approaches beyond WBCT (e.g., low-dose standing 3D imaging, biplanar imaging with 3D reconstruction, and other functional 3D modalities) and comparative studies versus WBCT and/or radiographs.• 3D measurements and reconstruction methods from WBCT/standing imaging to improve surgical planning, precision, and safety.• Intraoperative imaging workflows and their integration with navigation, patient-specific instrumentation, or virtual/augmented reality.• Cost-effectiveness, radiation dose, feasibility, and workflow implementation.• Education, surgeon training, and outcome assessment enabled by functional/weight-bearing 3D imaging.• Image processing and spatial analysis for WBCT/standing 3D imaging (e.g., distance mapping) and clinically oriented quantitative assessment.• Future developments in functional imaging and load-dependent biomechanical assessment, with a clear clinical link to WBCT or related standing 3D imaging.We invite contributions from the orthopedic community with the goal of inspiring advances in patient care. Together, we aim to explore the future trajectory of these technologies and translate progress into tangible clinical benefits.Dr. Indino reports receiving personal fees for lectures and as a course speaker from Arthrex, and personal fees for consulting services from Zimmer Biomet. Dr. Usuelli reports relationships with Zimmer Biomet, Paragon 28, Arthrex, Geistlich, and Lima. The other Topic Editors declare no conflict of interest. Topic editors: Cristian Indino, Federico Giuseppe Usuelli, Ben Efrima, Agustín Barbero, CAMILLA MACCARIO Source: https://www.frontiersin.org/research-topics/80727/weight-bearing-ct-and-functional-3d-imaging-in-orthopedic-surgery-a-historical-perspective-and-future-pathways