It is important to perform accurate bone cutting for the tibia and talus and to adjust soft-tissue balance when performing total ankle arthroplasty in rheumatoid arthritis cases with complex deformities to avoid prosthesis edge loading. We studied 38 cases with rheumatoid arthritis. A custom-made surgical guide was used for 24 cases since January 2007 to produce accurate osteotomies; the remaining cases used a conventional osteotomy guide. The tibial/talar component angular surface angles and tilting angle between components were measured with x-rays during standing. The error angle of the tibial bone cut was 1.9±1.5 degrees in the conventional group compared with 1.0±0.8 degrees in the custom-made group (P=0.02). The tilting angle between components was 0.3±0.4 degrees in the custom-made group compared with 1.1±1.4 degrees in the conventional group (P=0.01). The custom-made surgical guide based on preoperative 3-dimensional evaluation helped produce accurate and stable bone cutting. These benefits were enhanced by using malleolar sliding osteotomy to control the soft-tissue balance, with subsequent tilt between components being nearly parallel in the standing postoperative radiograph.
Departments of *Orthopaedics
∥Rheumatology, National Hospital Organization, Osaka Minami Medical Center
†Department of Orthopaedics, Bell Land General Hospital
Departments of §Orthopaedic Material Science
‡Orthopaedics, Osaka University Graduate School of Medicine
¶Department of Orthopaedics, Osaka Rosai Hospital, Osaka, Japan
T.M. has received funding in support of this research from JST (Japan Science and Technology Agency).
The authors declare that they have nothing to disclose.
Address correspondence and reprint requests to Jun Hashimoto, MD, PhD, Department of Immune Disease, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano City, Osaka 586-8521, Japan. E-mail: firstname.lastname@example.org.