Comparison of extramedullary versus intramedullary referencing for tibial component alignment in total ankle arthroplasty.

Adams, Samuel B

Demetracopoulos, Constantine A

Viens, Nicholas A

DeOrio, James K

Easley, Mark E

Queen, Robin M

Nunley, James A

United States

2014-06-20T02:37:45Z

2013-12

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.

http://www.ncbi.nlm.nih.gov/pubmed/24043353

1071100713505534

1944-7876

https://hdl.handle.net/10161/8908

eng

SAGE Publications

Foot Ankle Int

10.1177/1071100713505534

component alignment

extramedullary referencing

intramedullary referencing

tibial component

total ankle arthroplasty

Arthroplasty, Replacement, Ankle

Bone Malalignment

Humans

Joint Prosthesis

Prosthesis Fitting

Retrospective Studies

Tibia

Comparison of extramedullary versus intramedullary referencing for tibial component alignment in total ankle arthroplasty.

Journal article

Adams, Samuel B|0000-0003-1020-1167

DeOrio, James K|0000-0001-5181-9049|0000-0003-1231-8203

Easley, Mark E|0000-0003-2995-3908

Nunley, James A|0000-0002-3825-7536

http://www.ncbi.nlm.nih.gov/pubmed/24043353

1624

1628

12

Clinical Science Departments

Duke

Faculty

Orthopaedics

School of Medicine

Published

34