Mazzotti Antonio, Zielli Simone Ottavio, Arceri Alberto, Artioli Elena, Langone Laura, Sgubbi Federico, Geraci Giuseppe, Faldini Cesare
IRCCS Istituto Ortopedico Rizzoli 1st Orthopaedics and Traumatologic Clinic Bologna Italy.
Department of Biomedical and Neuromotor Sciences (DIBINEM) Alma Mater Studiorum University of Bologna Bologna Italy.
J Exp Orthop. 2024 Jul 26;11(3):e12026. doi: 10.1002/jeo2.12026. eCollection 2024 Jul.
This retrospective radiological analysis aimed to assess the accuracy of implant positioning in patients with ankle arthritis undergoing custom-made total ankle arthroplasty (TAA) with patient-specific instrumentation (PSI) compared with preoperative planning.
Patients who underwent custom-made TAA with PSI from January 2018 to March 2023 were retrospectively evaluated, focusing on the tibial anterior surface (TAS) angle, tibial lateral surface (TLS) angle and tibiotalar ratio (TTR). Additionally, data regarding the time from the preoperative computed tomography (CT) scan to surgery, associated procedures and complications were recorded.
No associated procedures were performed, and only one intraoperative complication, an iatrogenic lateral malleolar fracture, was recorded. In the coronal plane, custom-made TAA with PSI consistently achieved precise positioning of prosthetic components, even in cases with significant preoperative deformities or bone deficits. However, a statistically significant deviation from the planned values was observed in the sagittal plane ( = 0.007). A notable correlation was identified between the time elapsed from the preoperative CT scan to surgery and the deviation from the planned to the actual postoperative TAS angle ( < 0.001).
This study underscores the efficacy of PSI systems in achieving precise positioning in the coronal plane, in accordance with preoperative planning. In contrast, sagittal plane positioning did not demonstrate the same level of accuracy, as evidenced by a statistically significant difference between the planned and postoperative TLS values. Nevertheless, all measurements remained within the recommended range according to the existing literature.
Level IV.
本回顾性放射学分析旨在评估与术前规划相比，接受定制全踝关节置换术（TAA）并使用患者特异性器械（PSI）的踝关节炎患者植入物定位的准确性。
回顾性评估2018年1月至2023年3月接受定制TAA并使用PSI的患者，重点关注胫骨前表面（TAS）角、胫骨外侧表面（TLS）角和胫距比（TTR）。此外，记录从术前计算机断层扫描（CT）扫描到手术的时间、相关手术和并发症的数据。
未进行相关手术，仅记录了1例术中并发症，即医源性外踝骨折。在冠状面，即使在术前存在明显畸形或骨缺损的情况下，使用PSI的定制TAA也始终能实现假体组件的精确定位。然而，在矢状面观察到与计划值有统计学显著偏差（=0.007）。术前CT扫描到手术的时间与术后实际TAS角与计划值的偏差之间存在显著相关性（<0.001）。
本研究强调了PSI系统在根据术前规划在冠状面实现精确定位方面的有效性。相比之下，矢状面定位并未显示出相同水平的准确性，计划值与术后TLS值之间存在统计学显著差异即可证明。尽管如此，根据现有文献，所有测量值仍在推荐范围内。
四级。
