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Comparison of two operative techniques for total ankle arthroplasty: intramedullary referencing vs CT scan-
derived patient-specific guides
Shawn Werner, MD
Michael Brage, MD
Disclosure
Comparison of two operative techniques for total ankle arthroplasty: intramedullary referencing vs CT scan-derived patient-specific guides
Shawn Werner, MD: no disclosures
Michael Brage, MD: consultant for Wright Medical INC, Extremity Medical, Stryker, and Osteomed
Our disclosures are in the final AOFAS Mobile App.
Comparison of two operative techniques for total ankle arthroplasty
Preop navigation and patient-specific instrumentation has many theoretical benefits in total ankle arthroplasty
I. Decreased surgical time
II. Improved implant alignment
III. Decreased surgical complexity
IV. Decreased fluoroscopy exposure
No study has compared the two techniques
Intramedullary
Patient-specifc
Methods One surgeon utilizing two operative techniques
Intra-medullary referencing INBONE II, Wright Medical Technology Memphis TN
CT scan derived patient specific guide PROPHECY, Wright Medical Technology Memphis TN
74 TAAs performed between 2011-2013 65 INBONE II
8 without any additional procedures at time of TAA 25 without additional bone procedures
9 PROPHECY 4 without additional procedures at time of TAA 8 without additional bone procedures
Comparison of two operative techniques for total ankle arthroplasty
Results
Demographics
Average age 62.7
38 M, 35 F
Reason for TAA
Osteoarthritis: 34
Post-traumatic arthritis: 33
Rheumatoid Arthritis: 4
Failed Fusion: 3
Comparison of two operative techniques for total ankle arthroplasty
Osteoarthritis
Rheumatoid
Post-traumatic
Comparison of ALL PROPHECY vs INBONE II did not show statistically significant difference between: Surgical or Tourniquet time
Comparison of ALL PROPHECY vs INBONE II showed statistical significance for fluoroscopy exposure Decreased fluoroscopy shots (30 vs 38, p-value 0.01) However, there were more additional procedures in the INBONE II
vs PROPHECY group
Comparison of cases without additional bone procedures, requiring fluoroscopy, showed no statistical difference between the two groups INBONE 32.8 shots; PROPHECY 29.1 shots. P-value 0.21
Comparison of two operative techniques for total ankle arthroplasty
0
5
10
15
20
25
30
Midfoot or subtalarfusion
Tendon procedure Osteotomy Hardware removal fusion takedown exostosis excision
Additional Procedures performed at time of TAA
INBONE II PROPHECY
Comparison of two operative techniques for total ankle arthroplasty
0
20
40
60
80
100
120
140
160
AVG Surgical T (mins) AVG Tourniquet T (mins)
Procedure Time for TAA
INBONE II PROPHECY INBONE II* PROPHECY*
Comparison of two operative techniques for total ankle arthroplasty
*denotes case without additional procedures (INBONE 8, PROPHECY 4)
0
5
10
15
20
25
30
35
40
45
AVG # Fluoroscopy shots
Fluoroscopy Exposure
INBONE PROPHECY INBONE* PROPHECY *
Comparison of two operative techniques for total ankle arthroplasty
*denotes case without additional bone procedures requiring fluoroscopy(INBONE 25 vs PROPHECY 8)
CONCLUSIONS
Intra-medullary referencing and CT scan-derived patient specific guides have similar surgical times and fluoroscopy exposure
More research is warranted
Larger population size
Component alignment comparison
Track surgical time and fluoroscopy data as surgeon experience increases with patient-specific guide
Comparison of two operative techniques for total ankle arthroplasty
References• 1. Adams SB, Demetracopoulos CA, Viens NA, et al. Comparison of extramedullary versus intramedullary
referencing for tibial component alignment in total ankle arthroplasty. Foot Ankle Int. 2013;34(12):1624-1628.• 2. Queen RM, Adams SB, Viens NA, et al. Differences in outcomes following total ankle replacement in
patients with neutral alignment compared with tibiotalar joint malalignment. J Bone Joint Surg Am. 2013;95(21):1927-1934.
• 3. Datir A, Xing M, Kakarala A, Terk MR, Labib SA. Radiographic evaluation of INBONE total ankle arthroplasty: a retrospective analysis of 30 cases. Skeletal Radiol. 2013;42(12):1693-1701.
• 4. Hsu AR, Haddad SL. Early clinical and radiographic outcomes of intramedullary-fixation total ankle arthroplasty. J Bone Joint Surg Am. 2015;97(3):194-200.
• 5. 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(10):1163-1169.
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• 7. 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(7):665-676.
• 8. Preyssas P, Toullec É, Henry M, Neron JB, Mabit C, Brilhault J. Total ankle arthroplasty - three-component total ankle arthroplasty in western France: a radiographic study. Orthop Traumatol Surg Res. 2012;98(4 Suppl):S31-40.
• 9. Guyer AJ, Richardson G. Current concepts review: total ankle arthroplasty. Foot Ankle Int. 2008;29(2):256-264.