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A Comparison of Radiographic Alignment Using Patient-Specific and Standard Instrumentation in Total Ankle

Nicholas Veale1, Kristian Efremov2, Colin Wood1

  • 1Boston Bone and Joint Institute, Waltham, MA, USA.

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|April 24, 2026
PubMed
Summary

Patient-specific instrumentation (PSI) in total ankle arthroplasty (TAA) improved tibial alignment and reduced lucencies compared to standard instrumentation (SI). However, short-term clinical outcomes were similar, necessitating further research on long-term benefits.

Keywords:
ankle arthroplasty techniquesorthopaedic implant positioningpatient-specific instrumentationpreoperative planningradiographic analysis

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Radiology

Background:

  • Total ankle arthroplasty (TAA) rates are rising, with implant malalignment a key complication predictor.
  • Intraoperative alignment assessment in TAA is challenging.
  • Patient-specific instrumentation (PSI) aims to enhance implant positioning accuracy.

Purpose of the Study:

  • To compare radiographic alignment and postoperative function between TAA using PSI with an Infinity implant and standard instrumentation (SI) with a Salto Talaris implant.
  • To evaluate the efficacy of PSI in improving implant positioning and patient outcomes in TAA.
  • To identify potential differences in complications and revision rates between the two instrumentation methods.

Main Methods:

  • Retrospective review of 114 TAA cases using PSI versus 80 TAA cases using SI.
  • Comparison of demographics, radiographic alignment, range of motion (ROM), complications, and AOFAS scores at minimum 1-year follow-up.
  • Radiographic assessment included tibial component coronal and sagittal alignment.

Main Results:

  • PSI group showed significantly better tibial component alignment (coronal and sagittal) and fewer lucencies than the SI group.
  • Operative time was significantly longer for PSI (119 min) compared to SI (96 min).
  • AOFAS alignment scores were higher in the PSI group, but total AOFAS scores and revision/debridement rates were similar between groups.

Conclusions:

  • PSI in TAA offers modest improvements in tibial alignment and reduced early lucencies compared to SI.
  • No significant short-term differences in clinical outcomes, ROM, or AOFAS scores were observed between the two groups.
  • Further long-term studies are required to determine the clinical impact and implant survivorship of PSI versus SI in TAA.