Hintermann B, Valderrabano V, Knupp M, Horisberger M
Orthopädische Universitätsklinik, Universitätsspital Basel, Spitalstrasse 21, 4031, Basel, Schweiz.
Orthopade. 2006 May;35(5):533-45. doi: 10.1007/s00132-006-0941-y.
The HINTEGRA ankle was developed as an attempt to specifically address the needs of minimal bone resection, extended bone support, proper ligament balancing, and minimal contact stresses within and around the prosthesis. The purpose of this article was to present the design and rationale of this prosthesis, and to analyze the clinical and radiological short- to mid-term results particularly with respect to the revisions and learning curve. Of the 278 total ankle replacements (between 2000 and 2004) with the HINTEGRA ankle, 271 ankles [patients: 261, males: 133, females: 128, age: 58.4 years (range: 25-90 years)] were clinically and radiographically assessed after 36.1 months (range: 12-64 months). The preoperative diagnosis was post-traumatic osteoarthrosis in 206 cases (76.0%), systemic arthritis in 34 cases (12.5%), and a primary osteoarthrosis in 31 cases (11.5%). Beside 4 perioperative and 19 early postoperative complications, a late complication occurred in 40 cases (14.8%). Of these, 22 complications (8.2%) were not related to implants, and 18 complications (6.6%) were related to implants. In all, 39 cases (14.4%) were revised; of these, 5 cases (1.8%) were revised to ankle arthrodesis. All other 34 revision arthroplasties were successful and did not evidence any differences in the outcome to the non-revised ankles. The AOFAS hindfoot score improved from 40.3 (range: 14-61) to 85.0 (range: 44-100) points at last follow-up. Radiographically, the tibial component was stable in all remaining 266 ankles, and no tilting of the component occurred since surgery. The talar component was positioned too posteriorly in 12 ankles (4.4%). The concept of minimal bone resection and wide bony support was shown to be successful on the tibial and talar sides. Most complications occurred in the early cases of this series, and the learning curve was found to be short and steep. Despite the high amount of post-traumatic cases with limited soft tissue quality, the obtained function, pain relief, and patient satisfaction were promising and, compared with other devices, the results mostly were superior. This may support the belief that anatomically shaped surfaces, as is the case in the HINTEGRA ankle, may advance success in total ankle replacement.
HINTEGRA踝关节的研发旨在专门满足最小骨切除、延长骨支撑、适当韧带平衡以及假体内部和周围最小接触应力的需求。本文的目的是介绍该假体的设计和原理，并分析临床和放射学的短期至中期结果，特别是关于翻修情况和学习曲线。在2000年至2004年间进行的278例使用HINTEGRA踝关节的全踝关节置换术中，271例踝关节（患者261例，男性133例，女性128例，年龄58.4岁，范围25 - 90岁）在36.1个月（范围12 - 64个月）后进行了临床和影像学评估。术前诊断为创伤后骨关节炎206例（76.0%），全身性关节炎34例（12.5%），原发性骨关节炎31例（11.5%）。除4例围手术期和19例术后早期并发症外，40例（14.8%）出现晚期并发症。其中，22例并发症（8.2%）与植入物无关，18例并发症（6.6%）与植入物有关。总共39例（14.4%）进行了翻修；其中，5例（1.8%）翻修为踝关节融合术。其他34例翻修关节成形术均成功，与未翻修的踝关节相比，结果无明显差异。末次随访时，美国足踝外科协会（AOFAS）后足评分从40.3分（范围14 - 61分）提高到85.0分（范围44 - 100分）。影像学检查显示，在其余266例踝关节中，胫骨组件均稳定，自手术以来组件未发生倾斜。距骨组件在12例踝关节（4.4%）中位置过于靠后。最小骨切除和广泛骨支撑的理念在胫骨和距骨侧均被证明是成功的。大多数并发症发生在该系列的早期病例中，学习曲线短且陡。尽管创伤后病例中软组织质量有限的情况较多，但所获得的功能、疼痛缓解和患者满意度令人满意，与其他装置相比，结果大多更优。这可能支持这样一种观点，即HINTEGRA踝关节那样的解剖形状表面可能会提高全踝关节置换的成功率。
