Techniques in Orthopaedics:
Special Technical Articles
Use of a Custom-made Surgical Guide in Total Ankle Arthroplasty in Rheumatoid Arthritis Cases
Hirao, Makoto MD, PhD*; Oka, Kunihiro MD, PhD†; Ikemoto, Sumika BE‡; Nakao, Ryoji BE§; Tsuboi, Hideki MD, PhD∥; Nampei, Akihide MD, PhD¶; Akita, Shosuke MD, PhD*; Shi, Kenrin MD, PhD‡; Ebina, Kosuke MD, PhD‡; Murase, Tsuyoshi MD, PhD‡; Sugamoto, Kazuomi MD, PhD§; Yoshikawa, Hideki MD, PhD‡; Hashimoto, Jun MD, PhD∥
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.
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