Enhancing Total Ankle Arthroplasty Planning: The Role of Artificial Intelligence and 3D Imaging in Hindfoot Realignment

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Weight-bearing computed tomography (WBCT) and artificial intelligence (AI) are increasingly used in orthopedic surgical planning, particularly for complex cases like total ankle arthroplasty (TAR) with hindfoot malalignment. This study evaluates the efficacy of AI-assisted planning using WBCT for hindfoot realignment during TAR in valgus ankle osteoarthritis. Methods: This retrospective study included 62 patients with valgus ankle osteoarthritis undergoing TAR. Pre-operative and post-operative WBCT scans were analyzed using AI-driven software (DISIOR) for semi-automated measurements and virtual surgical planning. Manual measurements were compared to AI-generated data. The study assessed AI's ability to determine the necessity of additional hindfoot procedures (medial displacement calcaneal osteotomy (MDCO) or subtalar arthrodesis) and quantify required corrections. Results: AI-assisted planning significantly aided in identifying the need for additional hindfoot procedures, especially in cases with talar tilt >10°. AI modified surgical plans in 6.5% of cases, all with talar tilt >10%, indicating improved detection of residual deformity. However, the accuracy of AI in quantifying precise corrections was limited, particularly in the presence of metal artifacts. Manual and AI measurements showed strong correlations pre-operatively, but post-operative correlations diminished Conclusion: AI-assisted planning using WBCT improves the determination of the need for additional procedures during TAR for valgus ankle osteoarthritis, particularly in severe deformities. While AI enhances surgical decision-making, its quantification accuracy requires further refinement. Future research should focus on improving AI algorithms to enhance measurement accuracy and refine virtual planning for optimal patient outcomes. Represents the correction of talar tilt using DISIOR. (A) The pre-operative Talar tilt marked by the yellow line with valgus malalignment. Note the red dotted line representing the longitudinal tibial axis far away from the calcaneus (B) Virtual planning of talar tilt correction after the rotation of the talus and calcaneus together. Note the parallel yellow line and the correction of the Hindfoot moment arm. A slight valgus is expected due to the monopodial stance that exacerbates the pressure of the subtalar joint.