Evaluation of clinical efficacy of total ankle arthroplasty in end-stage ankle arthritis based on 3D-printed navigation-guided osteotomy and patient-specific cutting guides with standard implants.

Abstract

To evaluate total ankle arthroplasty (TAA) using 3D-printed navigation-assisted osteotomy with patient-specific cutting guides and standard implants, compared with conventional TAA. This retrospective analysis included 82 individuals diagnosed with end-stage ankle arthritis who received total ankle arthroplasty (TAA) between January 2020 and June 2023.Based on surgical technique, patients were divided into a patient-specific instrumentation (PSI) group (n = 33) and a control group (n = 49). The PSI group received preoperative 3D CT-based planning for personalized osteotomy guides patient-specific and implants, while the control group underwent standard procedures. Perioperative parameters, functional recovery (dorsiflexion, plantarflexion, MOXFQ, FAAM), radiographic alignment (α angle, β angle, ADTA), and complication rates were compared. The PSI group showed significant advantages over the control group in operative time (1.01 ± 0.09 h vs. 1.47 ± 0.15 h)(P < 0.01). At 12 months postoperatively, the PSI group demonstrated significantly greater improvements in ankle dorsiflexion and plantarflexion range of motion, MOXFQ, and FAAM scores (all P < 0.01). Radiographic assessments indicated that the PSI group achieved superior correction and consistency in α angle, β angle, and ADTA compared to the control group (P < 0.01). The overall complication rate was significantly lower in the PSI group (2/33 vs 6/49, P < 0.05), with no cases of prosthesis subsidence or revision reported. This approach improves surgical accuracy and efficiency, accelerates recovery, and reduces complications, supporting its use for precise management of end-stage ankle arthritis.