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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

doi: 10.1097/BTO.0b013e318294cdbb
Special Technical Articles

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:

© 2014 by Lippincott Williams & Wilkins