Ankle replacement-Wright Infinity ankle replacement surgical technique
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Total Ankle replacements have been implanted for the treatment of arthritic conditions of the ankle for a few decades now. The design and biomechanics of these early implants was at best rudimentary and were manufactured on the premise that the ankle is a monoaxial joint capable of movement only in the sagittal plane. It did not allow for translational or rotational movements of the ankle that is now known to occur in human ankles. These were simple two component assemblies that articulated against each other and failed either due to lack of osseointegration or excessive wear
Subsequent generations of implants used more modern ideology to create metal components for the tibia and talus with intervening ultra high molecular weight polyethylene acting either as a spacer when fixed or as a meniscus engaging in mobile bearing functions. These proved to be much more successful both in terms of function and of survivorship. The Wright Infinity ankle replacement is one of the latest evolutions of ankle replacement.
The use of the Prophecy cutting jigs are a unique feature of the Wright Infinity Ankle Replacement. This requires a CT scan of the lower limb in question (using a specific protocol ) to enable 3D technology to create these unique jigs. The software uses specific anatomic high points on the tibia and talus including prominences osteophytes and peaks and troughs to create a Wright Infinity jig that will sit on the respective bones fitting into these high points (the so called ‘sweet spot’ where the jig fits perfectly without a toggle). The software also creates an accurate model of the distal tibia and the talus which are sterilisable so that the jig can be fitted onto these anatomically perfect models to assess and practice the orientation of these jigs when fitted on to the actual patients ankle bones on table. Thus at least two copies of these bone models are available sterilised to use for practice on table
Author: Kartik Hariharan FRCS
Institution: Aneuran Bevan University Health Board ,Wales ,UK.