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An Analysis of 50 Consecutive Total Ankle Replacements Undergoing Preoperative Computerized Tomography Scan-Based,
Garrett Biela1, Jason Piraino2, Thomas S Roukis3
1Post-Graduate Year 2 Resident, Department of Orthopaedic Surgery & Rehabilitation, Foot & Ankle Service Line, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
Summary
Preoperative planning using CT scans and patient-specific blocks for total ankle replacement (TAR) did not improve accuracy or efficiency. This technology did not reduce complexity, radiation, or surgical time in primary TAR cases.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Preoperative computerized tomography (CT) scan-based, engineer-provided alignment plans and patient-specific pinning blocks are available for total ankle replacement (TAR).
- Marketed benefits include less procedural complexity, reduced intraoperative radiation, and shorter surgical times.
- Independent studies validating these claims are lacking.
Purpose of the Study:
- To investigate the efficacy of preoperative CT scan-based planning and patient-specific pinning blocks in primary total ankle replacement.
- To verify the manufacturer's proposed benefits regarding procedural complexity, radiation exposure, and surgical duration.
Main Methods:
- Retrospective review of 50 primary total ankle replacement (TAR) patients.
- Analysis of preoperative CT scan-based alignment plans and patient-specific pinning block utilization.
- Comparison of operative time, intraoperative image intensification time, and radiation dose against historical TAR controls.
Main Results:
- "Perfect" radiographic alignment was not consistently achieved, with modest component prediction accuracy.
- Operative time, intraoperative radiation, and image intensification time exceeded historical TAR controls.
- Arced talar components showed significantly higher malalignment rates compared to flat-top components.
- No association was found between preoperative deformity severity and postoperative alignment accuracy.
Conclusions:
- Preoperative CT-based planning and patient-specific blocks did not simplify procedures or improve outcomes in primary TAR.
- Surgeons should rely on their own planning and experience for optimal radiographic alignment.
- The purported benefits of this technology for primary TAR were not supported by this study.
