Impact of Joint Line Level in Total Ankle Arthroplasty: Standard Techniques vs Patient-Specific Instruments.

Foot & Ankle Orthopaedics Pub Date : 2024-12-16 eCollection Date: 2024-10-01 DOI:10.1177/24730114241303474
Alberto Arceri, Antonio Mazzotti, Federico Sgubbi, Simone O Zielli, Elena Artioli, Laura Langone, Pejman Abdi, Cesare Faldini
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引用次数: 0

Abstract

Background: Total ankle arthroplasty (TAA) is an effective treatment for severe end-stage ankle osteoarthritis (AO). Despite satisfactory results, range of motion (ROM) is still suboptimal compared to healthy ankles. This issue may stem from different conditions, and the difficulty in accurately restoring the height of the joint line may be one of them. Recent studies in TAA have demonstrated that an elevated joint line is associated with reduced postoperative ROM and poorer functional scores. To improve the accuracy of bone resection and implant positioning, the use of patient-specific instruments (PSIs) has been proposed. The aim of this study is to compare joint line height, ROM, and functional clinical outcomes between standard TAA and TAA using PSI.

Methods: A retrospective analysis was conducted on a consecutive cohort of patients who underwent standard TAA and TAA with PSI between January 2020 and December 2022. Radiographic assessments, including measurement of joint line height ratio (JLHR) and ROM, were performed. The clinical outcome was assessed using the Forgotten Joint Score.

Result: Fifty-one patients underwent standard TAA, whereas 13 received TAA with PSI. The mean JLHR preoperatively was 1.51 ± 0.24 and postoperatively was 1.56 ± 0.23 in the standard TAA group (P = .056). Conversely, the mean JLHR of PSI TAA group passed from 1.52 ± 0.19 to 1.41 ± 0.21 after TAA (P < .05). Although the postoperative joint line level in the PSI TAA group was lower compared with both the preoperative levels and the postoperative standard TAA group (P < .05), no significant differences were observed in ROM or clinical outcome scores at the mean 1-year follow-up.

Conclusion: This study suggests that PSI may improve the accuracy of reestablishing this implant's alignment closer to the native joint line. However, contrary to the study's initial hypothesis, PSI was not associated with any difference in ROM or clinical outcomes compared with standard TAA technique. Additional factors including the prosthetic implant design, presence of heterotopic calcifications, soft tissue contracture, surgical technique, post-TAA tibial slope, and preoperative ROM may have a greater impact than joint line level.

Level of evidence: Level III, retrospective cohort study.

全踝关节置换术中关节线水平的影响:标准技术与患者专用器械。
背景:全踝关节置换术(TAA)是治疗严重终末期踝关节骨关节炎(AO)的有效方法。尽管结果令人满意,但与健康的脚踝相比,活动范围(ROM)仍然不是最佳的。这个问题可能源于不同的情况,难以准确恢复关节线的高度可能是其中之一。最近的TAA研究表明,关节线升高与术后ROM减少和功能评分较差有关。为了提高骨切除和种植体定位的准确性,已经提出使用患者专用器械(PSIs)。本研究的目的是比较标准TAA和使用PSI的TAA之间的关节线高度、ROM和功能临床结果。方法:对2020年1月至2022年12月期间接受标准TAA和TAA合并PSI的连续队列患者进行回顾性分析。影像学评估,包括测量关节线高比(JLHR)和ROM。使用遗忘关节评分评估临床结果。结果:51例患者行标准TAA, 13例患者行伴PSI TAA。标准TAA组JLHR术前平均值为1.51±0.24,术后平均值为1.56±0.23 (P = 0.056)。相反,PSI TAA组的平均JLHR从1.52±0.19增加到1.41±0.21 (P P)结论:PSI可以提高种植体重建的准确性,使其更接近原关节线。然而,与研究最初的假设相反,与标准TAA技术相比,PSI与ROM或临床结果没有任何差异。其他因素包括假体植入设计、异位钙化、软组织挛缩、手术技术、taa后胫骨斜度和术前ROM可能比关节线水平有更大的影响。证据等级:III级,回顾性队列研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Foot & Ankle Orthopaedics
Foot & Ankle Orthopaedics Medicine-Orthopedics and Sports Medicine
CiteScore
1.20
自引率
0.00%
发文量
1152
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