Department of Orthopaedics, University of Chile, Santiago, Chile.
Pacific Orthopaedic Associates, Alhambra, CA, USA.
Foot Ankle Int. 2021 Jul;42(7):851-858. doi: 10.1177/1071100721996379. Epub 2021 Mar 22.
Several benefits are published supporting patient-specific instrumentation (PSI) in total ankle arthroplasty (TAA). This study seeks to determine if TAA with PSI yields different radiographic outcomes vs standard instrumentation (SI).
Sixty-seven primary TAA patients having surgery using PSI or SI between 2013 and 2015 were retrospectively reviewed using weightbearing radiographs at 6-12 weeks postsurgery. Radiographic parameters analyzed were the medial distal tibia angle (MDTA), talar-tilt angle (TTA), anatomic sagittal distal tibia angle (aSDTA), lateral talar station (LTS), and talar component inclination angle (TCI). A comparison of the 2 groups for each radiologic parameter's distribution was performed using a nonparametric median test and Fisher exact test. Furthermore, TAAs with all radiographic measurements within acceptable limits were classified as "perfectly aligned." The rate of "perfectly aligned" TAAs between groups was compared using a Fisher exact test with a significance of .05.
Of the 67 TAAs, 51 were done with PSI and 16 with SI. There were no differences between groups in MDTA ( = .174), TTA ( = .145), aSDTA ( = .98), LTS ( = .922), or TCI angle ( = .98). When the rate of "perfectly aligned TAA" between the 2 groups were compared, there was no significant difference ( = .35).
No significant radiographic alignment differences were found between PSI and SI implants. This study showed that both techniques achieve reproducible TAA radiographic coronal and sagittal alignment for the tibial component when performed by experienced surgeons. The talar component's sagittal alignment is similar whether or not PSI was used but is noticeably different from normal anatomic alignment by design.
Level III, retrospective cohort study using prospectively collected data.
有多项研究报道支持在全踝关节置换术（TAA）中使用患者特异性假体（PSI）。本研究旨在确定 TAA 采用 PSI 是否会产生与标准假体（SI）不同的影像学结果。
回顾性分析了 2013 年至 2015 年间使用 PSI 或 SI 进行手术的 67 例初次 TAA 患者的术后 6-12 周负重位 X 线片。分析的影像学参数包括内侧距骨下胫骨角（MDTA）、距骨倾斜角（TTA）、解剖矢状位胫骨远端角（aSDTA）、外侧距骨平台（LTS）和距骨假体倾斜角（TCI）。采用非参数中位数检验和 Fisher 确切检验比较两组患者各影像学参数的分布情况。此外，将所有影像学测量值均在可接受范围内的 TAA 归类为“完全对齐”。采用 Fisher 确切检验比较两组间“完全对齐”TAA 的比例，并设定.05 为检验水准。
67 例 TAA 中，51 例行 PSI，16 例行 SI。两组间 MDTA（ =.174）、TTA（ =.145）、aSDTA（ =.98）、LTS（ =.922）或 TCI 角度（ =.98）无统计学差异。比较两组间“完全对齐 TAA”的比例，无统计学差异（ =.35）。
PSI 和 SI 植入物之间未发现明显的影像学对线差异。本研究表明，在经验丰富的外科医生操作下，两种技术均可实现重复性的 TAA 胫骨部件冠状位和矢状位对线。无论是否使用 PSI，距骨部件的矢状位对线均相似，但与正常解剖对位明显不同，这是设计使然。
III 级，前瞻性收集数据的回顾性队列研究。
