Escudero Mario I, Symes Michael, Bemenderfer Thomas Bradford, Barahona Maximiliano, Anderson Robert, Davis Hodges, Wing Kevin J, Penner Murray J
Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada (MIE, MS, KJW, MJP).
Orthocarolina Foot and Ankle Institute, Charlotte, North Carolina (TBB, RA, HD).
Foot Ankle Spec. 2020 Feb;13(1):32-42. doi: 10.1177/1938640019828069. Epub 2019 Feb 13.
Patient-specific instrumentation (PSI) has been developed for total ankle arthroplasty (TAA), with proven benefits. One concern regarding PSI is the need for more soft tissue dissection in order to accurately position the PSI guides, which has the theoretical disadvantage of increased osteolysis. The purpose of our study is to compare the incidence and magnitude of osteolysis for the INFINITY Total Ankle System between PSI and standard referencing (SR) techniques. Sixty-seven patients who underwent primary TAA using Prophecy (PSI) or SR technique between 2013 and 2015 were reviewed in a retrospective observational study. Osteolysis was assessed on radiographs at 2 years. The incidence was calculated by binomial distribution. The number of zones compromised and the magnitude of osteolysis was calculated using the median as a summary statistic and interquartile range as dispersion statistic. Fisher exact test was used to compare both groups, then a regression model was estimated to calculate the odds ratio for osteolysis. Of the 67 TAAs, 51 were in the PSI group and 16 in the SR group. In the PSI group the incidence, number of compromised zones (CZ), and magnitude was 41% (25%-59%), 1 [1-2], and 2 [2-3], respectively. In the SR group these were 36% (13%-65%), 3 [2-3], and 3 [2-4], respectively. No significant differences were found ( = .46, = .12, = .33). A slightly higher risk of osteolysis was found in the PSI group (odds ratio = 1.33 [0.36-4.83]) ( = .46). The majority of lesions were in 1 zone with size of 2 to 5 mm (63% for all cohort, 64% PSI, 60% SR). Two cases underwent revision for aseptic loosening, 1 in the SR group and 1 in the PSI group. According to our data, there is no significant difference between PSI and SR in terms of risk, incidence, size and magnitude of osteolysis in the INFINITY Total Ankle System at 2 years. Therapeutic, Level III, Retrospective cohort study.
已开发出针对全踝关节置换术（TAA）的患者特异性器械（PSI），且已证实其具有诸多益处。关于PSI的一个担忧是，为了精确放置PSI导向器需要进行更多的软组织剥离，这在理论上存在增加骨溶解的缺点。我们研究的目的是比较INFINITY全踝关节系统中PSI技术与标准参考（SR）技术的骨溶解发生率及严重程度。在一项回顾性观察研究中，对2013年至2015年间使用Prophecy（PSI）或SR技术接受初次TAA的67例患者进行了评估。在术后2年通过X线片评估骨溶解情况。通过二项分布计算发生率。使用中位数作为汇总统计量、四分位间距作为离散统计量来计算受累区域数量及骨溶解严重程度。采用Fisher精确检验比较两组，然后估计回归模型以计算骨溶解的比值比。在这67例TAA中，51例在PSI组，16例在SR组。PSI组的发生率、受累区域数量（CZ）及严重程度分别为41%（25%-59%）、1[1-2]和2[2-3]。SR组的这些指标分别为36%（13%-65%）、3[2-3]和3[2-4]。未发现显著差异（P = 0.46，P = 0.12，P = 0.33）。在PSI组发现骨溶解风险略高（比值比 = 1.33[0.36-4.83]）（P = 0.46）。大多数病变位于1个区域，大小为2至5毫米（所有队列中为63%，PSI组为64%，SR组为60%）。2例因无菌性松动接受翻修手术，1例在SR组，1例在PSI组。根据我们的数据，在INFINITY全踝关节系统中，术后2年时，PSI与SR在骨溶解风险、发生率、大小及严重程度方面无显著差异。治疗性，III级，回顾性队列研究。
