Reliability analysis of WBCT-derived 3D models for comparing preoperative and postoperative alignment in total ankle arthroplasty.

IF 1.9 3区医学 Q2 ORTHOPEDICS Foot and Ankle Surgery Pub Date : 2024-10-02 DOI:10.1016/j.fas.2024.09.007

Federico G Usuelli, Agustin Barbero, Amit Benady, Yair Green Halimi, Nissim Kahimov, Cristian Indino, Camila Maccario, Ben Efrima

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Abstract

Background: Traditional imaging techniques for total ankle arthroplasty (TAA) evaluation are limited by rotational bias and bone superimposition, highlighting the necessity for more precise assessment methods. The advent of weight-bearing computed tomography (WBCT) generated 3D enhance the visualization of foot and ankle alignment, offering unmatched detail. This study aims to assess the accuracy of preoperative and postoperative measurements in TAA across all three planes using WBCT-generated 3D models. We hypothesize that these models can be reliably used to compare preoperative and postoperative alignment.

Methods: For 81 patients undergoing TAA, preoperative and postoperative WBCT models were created. Measurements included five coronal angles: Alpha, Tibiotalar Surface Angle (TSA), Talar Tilt Angle (TT), Salzmann's 20 degrees Angle (SA), and Talocalcaneal Angle (TCA); three sagittal angles: Beta, Gamma, and Tibiotalar Ratio (TTR); and one axial angle: The Posterior Talar Rotational Angle (PTARA). Two raters evaluated these before and after surgery in two separate sessions. The study then compared preoperative to postoperative measurements, calculating inter-rater and intra-rater reliability.

Results: Significant changes were observed in three coronal angles (TSA, TT, and SA) and two sagittal angles (Beta and Gamma), with P-values of 0.2, 0.007, 0.019, <0.001, and <0.001, respectively. No significant changes were noted in Alpha, TCA, TTR, and PTARA, with P-values of 0.2, 0.9, 0.2, and 0.6, respectively. Intra-rater and inter-rater reliability scores ranged from 0.885 to 0.97, indicating good to excellent interclass correlation across all planes, both pre-and postoperatively.

Conclusion: WBCT-generated 3D modeling and image analysis software have enabled a detailed comparison between preoperative alignment and postoperative TAA positioning across coronal, sagittal, and axial planes, revealing significant adjustments in coronal and sagittal alignments. The high reliability and reproducibility of these measurements affirm their value in preoperative planning in improving the accuracy of surgical interventions.

Level of evidence: Level III of evidence.

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用于比较全踝关节置换术术前和术后对位的 WBCT 衍生三维模型的可靠性分析。

背景：传统的全踝关节置换术（TAA）评估成像技术受到旋转偏差和骨叠加的限制，因此需要更精确的评估方法。负重计算机断层扫描（WBCT）产生的三维图像增强了足踝对位的可视化，提供了无与伦比的细节。本研究旨在使用 WBCT 生成的三维模型评估 TAA 在所有三个平面上的术前和术后测量的准确性。我们假设这些模型可以可靠地用于比较术前和术后的对齐情况：方法：我们为 81 名接受 TAA 手术的患者创建了术前和术后 WBCT 模型。测量包括五个冠状角：阿尔法角（Alpha）、胫骨表面角（TSA）、距骨倾斜角（TT）、萨尔茨曼 20 度角（SA）和距骨角（TCA）；三个矢状角：贝塔角（Beta）、伽马角（Gamma）和距骨角（TCA）：贝塔角（Beta）、伽马角（Gamma）和胫距比（TTR）；以及一个轴角：胫骨后旋转角度（PTARA）。两名评分员在手术前后分两次对这些数据进行评估。然后，该研究比较了术前和术后的测量结果，计算了评分者之间和评分者内部的可靠性：结果：观察到三个冠状角（TSA、TT 和 SA）和两个矢状角（Beta 和 Gamma）发生了显著变化，P 值分别为 0.2、0.007、0.019：通过 WBCT 生成的三维建模和图像分析软件，可以在冠状面、矢状面和轴面上对术前对位和术后 TAA 定位进行详细比较，发现冠状面和矢状面的对位有明显调整。这些测量结果的高可靠性和可重复性肯定了它们在术前规划中的价值，从而提高了手术干预的准确性：证据等级：三级

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来源期刊

Foot and Ankle Surgery ORTHOPEDICS-

CiteScore

4.60

自引率

16.00%

发文量

202

期刊介绍： Foot and Ankle Surgery is essential reading for everyone interested in the foot and ankle and its disorders. The approach is broad and includes all aspects of the subject from basic science to clinical management. Problems of both children and adults are included, as is trauma and chronic disease. Foot and Ankle Surgery is the official journal of European Foot and Ankle Society. The aims of this journal are to promote the art and science of ankle and foot surgery, to publish peer-reviewed research articles, to provide regular reviews by acknowledged experts on common problems, and to provide a forum for discussion with letters to the Editors. Reviews of books are also published. Papers are invited for possible publication in Foot and Ankle Surgery on the understanding that the material has not been published elsewhere or accepted for publication in another journal and does not infringe prior copyright.