Patient-specific instrumentation in total ankle arthroplasty

Antonio Mazzotti, Alberto Arceri, Simone Zielli, Simone Bonelli, Valentina Viglione, Cesare Faldini, Antonio Mazzotti, Alberto Arceri, Simone Zielli, Simone Bonelli, Valentina Viglione, Cesare Faldini

Abstract

The recent increase in the adoption of total ankle arthroplasty (TAA) reflects the improvements in implant designs and surgical techniques, including the use of preoperative navigation system and patient-specific instrumentation (PSI), such as custom-made cutting guides. Cutting guides are customized with respect to each patient's anatomy based on preoperative ankle computed tomography scans, and they drive the saw intra-operatively to improve the accuracy of bone resection and implant positioning. Despite some promising results, the main queries in the literature are whether PSI improves the reliability of achieving neutral ankle alignment and more accurate implant sizing, whether it is actually superior over standard techniques, and whether it is cost effective. Moreover, the advantages of PSI in clinical outcomes are still theoretical because the current literature does not allow to confirm its superiority. The purpose of this review article is therefore to assess the current literature on PSI in TAA with regard to current implants with PSI, templating and preoperative planning strategies, alignment and sizing, clinical outcomes, cost analysis, and comparison with standard techniques.

Keywords: Ankle computer navigation system; INBONE II; Infinity; Patient-specific instrumentation; Preoperative navigation; Prophecy; Total ankle arthroplasty; Total ankle replacement.

Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no competing interests.

©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.

References

    1. Saito GH, Sanders AE, O'Malley MJ, Deland JT, Ellis SJ, Demetracopoulos CA. Accuracy of patient-specific instrumentation in total ankle arthroplasty: A comparative study. Foot Ankle Surg. 2019;25:383–389.
    1. Cenni F, Leardini A, Cheli A, Catani F, Belvedere C, Romagnoli M, Giannini S. Position of the prosthesis components in total ankle replacement and the effect on motion at the replaced joint. Int Orthop. 2012;36:571–578.
    1. Reb CW, Berlet GC. Experience with Navigation in Total Ankle Arthroplasty. Is It Worth the Cost? Foot Ankle Clin. 2017;22:455–463.
    1. Cody EA, Scott DJ, Easley ME. Total Ankle Arthroplasty: A Critical Analysis Review. JBJS Rev. 2018;6:e8.
    1. Rushing CJ, Kibbler K, Hyer CF, Berlet GC. The INFINITY Total Ankle Prosthesis: Outcomes at Short-Term Follow-up. Foot Ankle Spec. 2020:1938640020946199.
    1. King A, Bali N, Kassam AA, Hughes A, Talbot N, Sharpe I. Early outcomes and radiographic alignment of the Infinity total ankle replacement with a minimum of two year follow-up data. Foot Ankle Surg. 2019;25:826–833.
    1. Scott RT, Witt BL, Hyer CF. Design comparison of the INBONE I versus INBONE II total ankle system. Foot Ankle Spec. 2013;6:137–140.
    1. Faldini C, Mazzotti A, Belvedere C, Durastanti G, Panciera A, Geraci G, Leardini A. A new ligament-compatible patient-specific 3D-printed implant and instrumentation for total ankle arthroplasty: from biomechanical studies to clinical cases. J Orthop Traumatol. 2020;21:16.
    1. Giannini S, Romagnoli M, O'Connor JJ, Catani F, Nogarin L, Magnan B, Malerba F, Massari L, Guelfi M, Milano L, Volpe A, Rebeccato A, Leardini A. Early clinical results of the BOX ankle replacement are satisfactory: a multicenter feasibility study of 158 ankles. J Foot Ankle Surg. 2011;50:641–647.
    1. Berlet GC, Penner MJ, Lancianese S, Stemniski PM, Obert RM. Total Ankle Arthroplasty Accuracy and Reproducibility Using Preoperative CT Scan-Derived, Patient-Specific Guides. Foot Ankle Int. 2014;35:665–676.
    1. Hsu AR, Davis WH, Cohen BE, Jones CP, Ellington JK, Anderson RB. Radiographic Outcomes of Preoperative CT Scan-Derived Patient-Specific Total Ankle Arthroplasty. Foot Ankle Int. 2015;36:1163–1169.
    1. Hanselman AE, Powell BD, Santrock RD. Total ankle arthroplasty with severe preoperative varus deformity. Orthopedics. 2015;38:e343–e346.
    1. Daigre J, Berlet G, Van Dyke B, Peterson KS, Santrock R. Accuracy and Reproducibility Using Patient-Specific Instrumentation in Total Ankle Arthroplasty. Foot Ankle Int. 2017;38:412–418.
    1. Najefi AA, Malhotra K, Goldberg A. Mechanical and anatomical axis of the lower limb in total ankle arthroplasty. Foot (Edinb) 2020;44:101666.
    1. Barg A, Elsner A, Anderson AE, Hintermann B. The effect of three-component total ankle replacement malalignment on clinical outcome: pain relief and functional outcome in 317 consecutive patients. J Bone Joint Surg Am. 2011;93:1969–1978.
    1. Sikorski JM. Alignment in total knee replacement. J Bone Joint Surg Br. 2008;90:1121–1127.
    1. Waly FJ, Yeo NE, Penner MJ. Computed Navigation Guidance for Ankle Replacement in the Setting of Ankle Deformity. Clin Podiatr Med Surg. 2018;35:85–94.
    1. Franz AC, Krähenbühl N, Ruiz R, Susdorf R, Horn-Lang T, Barg A, Hintermann B. Hindfoot balancing in total ankle replacement: the role of supramalleolar osteotomies. Int Orthop. 2020;44:1859–1867.
    1. Barg A, Knupp M, Henninger HB, Zwicky L, Hintermann B. Total ankle replacement using HINTEGRA, an unconstrained, three-component system: surgical technique and pitfalls. Foot Ankle Clin. 2012;17:607–635.
    1. Adams SB Jr, Spritzer CE, Hofstaetter SG, Jakoi AM, Pietrobon R, Nunley JA 2nd, Easley ME. Computer-assisted tibia preparation for total ankle arthroplasty: a cadaveric study. Int J Med Robot. 2007;3:336–340.
    1. Tochigi Y, Rudert MJ, Brown TD, McIff TE, Saltzman CL. The effect of accuracy of implantation on range of movement of the Scandinavian Total Ankle Replacement. J Bone Joint Surg Br. 2005;87:736–740.
    1. Kakkar R, Siddique MS. Stresses in the ankle joint and total ankle replacement design. Foot Ankle Surg. 2011;17:58–63.
    1. Bonner TJ, Eardley WG, Patterson P, Gregg PJ. The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg Br. 2011;93:1217–1222.
    1. Hsu AR, Haddad SL. Early clinical and radiographic outcomes of intramedullary-fixation total ankle arthroplasty. J Bone Joint Surg Am. 2015;97:194–200.
    1. Queen RM, Adams SB Jr, Viens NA, Friend JK, Easley ME, Deorio JK, Nunley JA. Differences in outcomes following total ankle replacement in patients with neutral alignment compared with tibiotalar joint malalignment. J Bone Joint Surg Am. 2013;95:1927–1934.
    1. Simonson DC, Roukis TS. Incidence of Complications During the Surgeon Learning Curve Period for Primary Total Ankle Replacement: A Systematic Review. Clin Podiatr Med Surg. 2015;32:473–482.
    1. Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, Amendola A. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J. 2005;25:44–46.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe