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Effect of Preoperative Coronal Plane Alignment on Actual Versus Predicted Alignment Using Patient Specific
Andrew Regal1, Tisileli S Tuifua2, Brandon M Scharer3
1Podiatric Medicine and Surgery Residency, Ascension Wisconsin Hospital, Milwaukee, WI.
Summary
Patient-specific instrumentation for total ankle replacement generally offers high accuracy. However, preoperative varus deformity can reduce the precision of this technique, impacting alignment outcomes.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Radiographic Analysis
Background:
- Accurate alignment is crucial for total ankle replacement (TAR) success and implant longevity.
- Patient-specific instrumentation (PSI) is increasingly adopted for TAR implantation.
- The impact of preoperative deformity on PSI accuracy in TAR remains unevaluated in current literature.
Purpose of the Study:
- To assess the accuracy and reproducibility of PSI in total ankle replacement.
- To evaluate the influence of preoperative deformity on PSI accuracy.
Main Methods:
- Retrospective radiographic analysis of 97 consecutive total ankle replacement patients.
- Comparison of preoperative and postoperative films against CT-based surgical plans.
- Subgroup analysis focusing on the effect of preoperative coronal plane deformities (varus vs. valgus).
Main Results:
- Overall postoperative coronal and sagittal plane alignment was within 2° of predicted in 87.6% and 88.7% of patients, respectively.
- Tibial and talar implant sizes were accurately predicted in 81.4% and 75.3% of cases.
- Patients with preoperative varus deformity showed a significantly higher difference between predicted and actual postoperative alignment (1.1° vs. 0.3°, p = .02) compared to those with valgus deformity.
Conclusions:
- Patient-specific instrumentation demonstrates high overall accuracy in total ankle replacement.
- Preoperative varus deformity is associated with reduced accuracy in achieving planned alignment with PSI.
- Surgeons should consider preoperative deformity when utilizing PSI for total ankle replacement.
