Comparison of extramedullary versus intramedullary referencing for tibial component alignment in total ankle arthroplasty.
Abstract
BACKGROUND: The majority of total ankle arthroplasty (TAA) systems use extramedullary
alignment guides for tibial component placement. However, at least 1 system offers
intramedullary referencing. In total knee arthroplasty, studies suggest that tibial
component placement is more accurate with intramedullary referencing. The purpose
of this study was to compare the accuracy of extramedullary referencing with intramedullary
referencing for tibial component placement in total ankle arthroplasty. METHODS: The
coronal and sagittal tibial component alignment was evaluated on the postoperative
weight-bearing anteroposterior (AP) and lateral radiographs of 236 consecutive fixed-bearing
TAAs. Radiographs were measured blindly by 2 investigators. The postoperative alignment
of the prosthesis was compared with the surgeon's intended alignment in both planes.
The accuracy of tibial component alignment was compared between the extramedullary
and intramedullary referencing techniques using unpaired t tests. Interrater and intrarater
reliabilities were assessed with intraclass correlation coefficients (ICCs). RESULTS:
Eighty-three tibial components placed with an extramedullary referencing technique
were compared with 153 implants placed with an intramedullary referencing technique.
The accuracy of the extramedullary referencing was within a mean of 1.5 ± 1.4 degrees
and 4.1 ± 2.9 degrees in the coronal and sagittal planes, respectively. The accuracy
of intramedullary referencing was within a mean of 1.4 ± 1.1 degrees and 2.5 ± 1.8
degrees in the coronal and sagittal planes, respectively. There was a significant
difference (P < .001) between the 2 techniques with respect to the sagittal plane
alignment. Interrater ICCs for coronal and sagittal alignment were high (0.81 and
0.94, respectively). Intrarater ICCs for coronal and sagittal alignment were high
for both investigators. CONCLUSIONS: Initial sagittal plane tibial component alignment
was notably more accurate when intramedullary referencing was used. Further studies
are needed to determine the effect of this difference on clinical outcomes and long-term
survivability of the implants. LEVEL OF EVIDENCE: Level III, retrospective comparative
study.
Type
Journal articleSubject
component alignmentextramedullary referencing
intramedullary referencing
tibial component
total ankle arthroplasty
Arthroplasty, Replacement, Ankle
Bone Malalignment
Humans
Joint Prosthesis
Prosthesis Fitting
Retrospective Studies
Tibia
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https://hdl.handle.net/10161/8908Published Version (Please cite this version)
10.1177/1071100713505534Publication Info
Adams, Samuel B; Demetracopoulos, Constantine A; Viens, Nicholas A; DeOrio, James
K; Easley, Mark E; Queen, Robin M; & Nunley, James A (2013). Comparison of extramedullary versus intramedullary referencing for tibial component
alignment in total ankle arthroplasty. Foot Ankle Int, 34(12). pp. 1624-1628. 10.1177/1071100713505534. Retrieved from https://hdl.handle.net/10161/8908.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Samuel Bruce Adams Jr.
Associate Professor of Orthopaedic Surgery
James Keith DeOrio
Professor of Orthopaedic Surgery
Mark Erik Easley
Associate Professor of Orthopaedic Surgery
James Albert Nunley II
Goldner Jones Distinguished Professor of Orthopaedic Surgery
My current research interests are both clinical and basic science. Currently, in
the Orthopaedic Research Laboratory, we are investigating the biomechanical properties
of the deltoid ligament in the ankle. This is a clinically relevant problem and we
will hopefully identify ways to improve the correction of the adult relaxed flat foot.
We are also performing a preliminary investigation into the blood supply of the distal
tibia to look for a vascularized bone transfer. We have
Robin Marie Queen
Assistant Professor of Orthopaedic Surgery
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
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