Abstract
Preoperative computerized tomography (CT) scan-based, engineer-provided alignment
plans and patient-specific pinning blocks for total ankle replacement (TAR) are available
for use in the United States. However, nonbiased studies that justify the additional
expense associated with this technology through support of the marketed benefits of
less procedural complexity, less intraoperative radiation and reduced surgical time,
are lacking. Therefore, to verify the manufacturer's proposed benefits, we sought
to investigate our experience with this preoperative CT scan-based, engineer-provided
plan and patient-specific pinning blocks during primary TAR. In review of our 50 TAR
patients, we found that “perfect” radiographic alignment was not consistently achieved
and the accuracy of component prediction was modest. Furthermore, the preoperative
plans and patient-specific pinning blocks did not simplify the complexity of our operations
since the operative time, intraoperative image intensification time and radiation
dose per case all exceeded published historical TAR controls. Interestingly, we identified
a significant difference in placement accuracy between the arced and flat-top talar
component types that were implanted with the arced being more frequently malaligned.
We did not find associations between preoperative deformity severity and accuracy
of postoperative alignment. These findings suggest that it is imperative to have surgeons
continue to rely on their own surgical planning and experience to achieve optimum
radiographic alignment rather than depending on engineer-based recommendations or
“surface matched” pinning blocks. Ultimately, we were unable to support the purported
benefits of this CT scan-based, engineer-provided alignment plan and patient-specific
pinning blocks for this manufacturer's primary TAR systems.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: June 30, 2022
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2022 by the American College of Foot and Ankle Surgeons. All rights reserved.
