Advertisement

Computed Tomography Derived Patient-specific Instrumentation Total Ankle Arthroplasty Survivorship Outcomes

Published:September 06, 2022DOI:https://doi.org/10.1053/j.jfas.2022.08.012

      Abstract

      Computed tomography (CT) derived patient-specific total ankle arthroplasty (TAA) systems have been utilized for improved accuracy and reproducible implant alignment. The purpose of the present study was to report the overall implant survivorship as well as radiographic analysis of patients who underwent primary TAA utilizing CT-derived patient-specific instrumentation. A retrospective review of medical charts and radiographs were performed on patients who had undergone primary TAA at a single institution in the Midwest region from March 2013 to October 2020. Radiographic analysis included preoperative, initial postoperative, and final follow-up coronal and sagittal tibiotalar alignment as well as periprosthetic radiolucency. A total of 96 patients with a mean follow-up of 3 years (range, 0.3-7.3 years) were included. Implant survivorship was found to be 92% at median follow-up of 3 years. A total of 8 cases (8.3%) required revision/reoperation, with 6 (6.3%) of these reoperations directly related for failure of one of the metallic implant components. There was significant improvement in both coronal and sagittal tibiotalar alignment from preoperative to initial postoperative follow-up (p < .001). At latest postoperative follow-up, there were 88% of TAAs that remained in a neutral alignment following surgery. A total of 10 cases were found to have radiolucency at latest follow-up. In conclusion, the use of CT derived patient-specific TAA showed high implant survivorship with significant improvement of sagittal and coronal tibiotalar alignment. With better implant alignment and position, it potentially reduces the risk of early implant failure or implant loosening in long-term follow-up.

      Keywords

      Level of Clinical Evidence

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Glazebrook M
        • Daniels T
        • Younger A
        • Foote CJ
        • Penner M
        • Wing K
        • Lau J
        • Leighton R
        • Dunbar M
        Comparison of health-related quality of life between patients with end-stage ankle and hip arthrosis.
        J Bone Joint Surg Am. 2008; 90 (PMID:18310699): 499-505
        • Saltzman CL
        • Zimmerman MB
        • O'Rourke M
        • Brown TD
        • Buckwalter JA
        • Johnston R
        Impact of comorbidities on the measurement of health in patients with ankle osteoarthritis.
        J Bone Joint Surg Am. 2006; 88 (PMID:17079392): 2366-2372
        • Raikin SM
        • Rasouli MR
        • Espandar R
        • Maltenfort MG
        Trends in treatment of advanced ankle arthropathy by total ankle replacement or ankle fusion.
        Foot Ankle Int. 2014; 35 (PMID:24357680): 216-224
        • Terrell RD
        • Montgomery SR
        • Pannell WC
        • Sandlin MI
        • Inoue H
        • Wang JC
        • SooHoo NF
        Comparison of practice patterns in total ankle replacement and ankle fusion in the United States.
        Foot Ankle Int. 2013; 34 (PMID:23774468): 1486-1492
        • Shih CL
        • Chen SJ
        • Huang PJ
        Clinical outcomes of total ankle arthroplasty versus ankle arthrodesis for the treatment of end-stage ankle arthritis in the last decade: a systematic review and meta-analysis.
        J Foot Ankle Surg. 2020; 59 (PMID:32709528): 1032-1039
        • Koo K
        • Liddle AD
        • Pastides PS
        • Rosenfeld PF
        The salto total ankle arthroplasty - clinical and radiological outcomes at five years.
        Foot Ankle Surg. 2019; 25 (PMID:30321952): 523-528
        • Penner M
        • Davis WH
        • Wing K
        • Bemenderfer T
        • Waly F
        • Anderson RB
        The infinity total ankle system: early clinical results with 2- to 4-year follow-up.
        Foot Ankle Spec. 2019; 12 (PMID:29865886): 159-166
        • Frigg A
        • Germann U
        • Huber M
        • Horisberger M
        Survival of the Scandinavian total ankle replacement (STAR): results of ten to nineteen years follow-up.
        Int Orthop. 2017; 41 (PMID:28744802): 2075-2082
        • Giannini S
        • Romagnoli M
        • Barbadoro P
        • Marcheggiani Muccioli GM
        • Cadossi M
        • Grassi A
        • Zaffagnini S
        Results at a minimum follow-up of 5 years of a ligaments-compatible total ankle replacement design.
        Foot Ankle Surg. 2017; 23 (PMID:28578794): 116-121
        • Koivu H
        • Kohonen I
        • Mattila K
        • Loyttyniemi E
        • Tiusanen H
        Long-term results of Scandinavian total ankle replacement.
        Foot Ankle Int. 2017; 38 (PMID:28535724): 723-731
        • Stewart MG
        • Green CL
        • Adams SB
        • DeOrio JK
        • Easley ME
        • Nunley JA
        Midterm results of the salto talaris total ankle arthroplasty.
        Foot Ankle Int. 2017; 38 (PMID:28750551): 1215-1221
        • Gross CE
        • Lampley A
        • Green CL
        • DeOrio JK
        • Easley M
        • Adams S
        • Nunley JA
        The effect of obesity on functional outcomes and complications in total ankle arthroplasty.
        Foot Ankle Int. 2016; 37 (PMID:26377200): 137-141
        • Adams SB
        • Demetracopoulos CA
        • Queen RM
        • Easley ME
        • DeOrio JK
        • Nunley JA
        Early to mid-term results of fixed-bearing total ankle arthroplasty with a modular intramedullary tibial component.
        J Bone Joint Surg Am. 2014; 96 (PMID:25471913): 1983-1989
        • Barg A
        • Zwicky L
        • Knupp M
        • Henninger HB
        • Hintermann B
        HINTEGRA total ankle replacement: survivorship analysis in 684 patients.
        J Bone Joint Surg Am. 2013; 95 (PMID:23824385): 1175-1183
        • Schenk K
        • Lieske S
        • John M
        • Franke K
        • Mouly S
        • Lizee E
        • Neumann W
        Prospective study of a cementless, mobile-bearing, third generation total ankle prosthesis.
        Foot Ankle Int. 2011; 32 (PMID:22049861): 755-763
        • Gougoulias NE
        • Khanna A
        • Maffulli N
        History and evolution in total ankle arthroplasty.
        Br Med Bull. 2009; 89 (PMID:19008282): 111-151
        • Wood PL
        • Prem H
        • Sutton C
        Total ankle replacement: medium-term results in 200 Scandinavian total ankle replacements.
        J Bone Joint Surg Br. 2008; 90 (PMID:18450626): 605-609
        • Singer S
        • Klejman S
        • Pinsker E
        • Houck J
        • Daniels T
        Ankle arthroplasty and ankle arthrodesis: gait analysis compared with normal controls.
        J Bone Joint Surg Am. 2013; 95 (e191PMID:24352777): 1-10
        • Dekker TJ
        • Walton D
        • Vinson EN
        • Hamid KS
        • Federer AE
        • Easley ME
        • DeOrio JK
        • Nunley JA
        • Adams SB
        Hindfoot arthritis progression and arthrodesis risk after total ankle replacement.
        Foot Ankle Int. 2017; 38 (PMID:28810805): 1183-1187
        • 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 (PMID:25941196): 1163-1169
        • 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 (PMID:27920333): 412-418
        • 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 (PMID:24719401): 665-676
        • Queen RM
        • Adams SB
        • 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 (PMID:24196462): 1927-1934
        • Doets HC
        • Brand R
        • Nelissen RG
        Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs.
        J Bone Joint Surg Am. 2006; 88 (PMID:16757761): 1272-1284
        • Haskell A
        • Mann RA
        Ankle arthroplasty with preoperative coronal plane deformity: short-term results.
        Clin Orthop Relat Res. 2004; 424 (PMID:15241149): 98-103https://doi.org/10.1097/01.blo.0000132248.64290.52
        • Hamid KS
        • Matson AP
        • Nwachukwu BU
        • Scott DJ
        • Mather RC
        • DeOrio JK
        Determining the cost-savings threshold and alignment accuracy of patient-specific instrumentation in total ankle replacements.
        Foot Ankle Int. 2017; 38 (PMID:27649973): 49-57
        • Vander Griend RA
        • Younger ASE
        • Buedts K
        • Chiodo CP
        • Coetzee JC
        • Ledoux WR
        • Pinzur MS
        • Prasad K
        • Queen RM
        • Saltzman CL
        • Thordarson DB
        Total ankle arthroplasty: minimum follow-up policy for reporting results and guidelines for reporting problems and complications resulting in reoperations.
        Foot Ankle Int. 2017; 38 (PMID:28682140): 703-704
        • Schweitzer KM
        • Adams SB
        • Viens NA
        • Queen RM
        • Easley ME
        • Deorio JK
        • Nunley JA
        Early prospective clinical results of a modern fixed-bearing total ankle arthroplasty.
        J Bone Joint Surg Am. 2013; 95 (PMID:23780538): 1002-1011
        • Rushing CJ
        • Kibbler K
        • Hyer CF
        • Berlet GC
        The infinity total ankle prosthesis: outcomes at short-term follow-up.
        Foot Ankle Spec. 2022; 15 (PMID:32772552)1938640020946199
        • Cody EA
        • Taylor MA
        • Nunley JA
        • Parekh SG
        • DeOrio JK
        Increased early revision rate with the infinity total ankle prosthesis.
        Foot Ankle Int. 2019; 40 (PMID:30175612): 9-17
        • Valderrabano V
        • Hintermann B
        • Dick W
        Scandinavian total ankle replacement: a 3.7-year average follow-up of 65 patients.
        Clin Orthop Relat Res. 2004; 424 (PMID:15241143): 47-56
        • Lee KJ
        • Wang SH
        • Lee GW
        • Lee KB
        Accuracy assessment of measuring component position after total ankle arthroplasty using a conventional method.
        J Orthop Surg Res. 2017; 12 (PMID:28756766): 115
        • Hobson SA
        • Karantana A
        • Dhar S
        Total ankle replacement in patients with significant preoperative deformity of the hindfoot.
        J Bone Joint Surg Br. 2009; 91 (PMID:19336808): 481-486
        • Lee GW
        • Wang SH
        • Lee KB
        Comparison of intermediate to long-term outcomes of total ankle arthroplasty in ankles with preoperative varus, valgus, and neutral alignment.
        J Bone Joint Surg Am. 2018; 100 (PMID:29762278): 835-842
        • Lefrancois T
        • Younger A
        • Wing K
        • Penner MJ
        • Dryden P
        • Wong H
        • Daniels T
        • Glazebrook M
        A prospective study of four total ankle arthroplasty implants by non-designer investigators.
        J Bone Joint Surg Am. 2017; 99 (PMID:28196036): 342-348
        • Pellegrini MJ
        • Schiff AP
        • Adams SB
        • Queen RM
        • DeOrio JK
        • Nunley JA
        • Easley ME
        Conversion of tibiotalar arthrodesis to total ankle arthroplasty.
        J Bone Joint Surg Am. 2015; 97 (PMID:26677234): 2004-2013
        • Schipper ON
        • Jiang JJ
        • Chen L
        • Koh J
        • Toolan BC
        Effect of diabetes mellitus on perioperative complications and hospital outcomes after ankle arthrodesis and total ankle arthroplasty.
        Foot Ankle Int. 2015; 36 (PMID:25413307): 258-267
        • Saito GH
        • Sanders AE
        • de Cesar
        • Netto C
        • O'Malley MJ
        • Ellis SJ
        • Demetracopoulos CA
        Short-term complications, reoperations, and radiographic outcomes of a new fixed-bearing total ankle arthroplasty.
        Foot Ankle Int. 2018; 39 (PMID:29589784): 787-794
        • Rushing CJ
        • McKenna BJ
        • Zulauf EA
        • Hyer CF
        • Berlet GC
        Intermediate-term outcomes of a third-generation, 2-component total ankle prosthesis.
        Foot Ankle Int. 2021; 42 (PMID:33508961): 935-943