HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses: Surgical Technique.

INTRODUCTION

In our experience, revision ankle arthroplasty with a three-component total ankle prosthesis following a failed total ankle replacement has provided encouraging midterm results with substantial pain relief while preserving the range of motion of the replaced ankle.

STEP 1 PREOPERATIVE ASSESSMENT AND PLANNING: Determine the treatment using a decision algorithm.

STEP 2 PATIENT POSITIONING: Use spinal or general anesthesia, administer intravenous antibiotics, position the patient supine, and apply a tourniquet.

STEP 3 SURGICAL APPROACH TO THE FAILED PROSTHESIS: Use an anterior approach to expose the failed ankle prosthesis.

STEP 4 REMOVAL OF THE PROSTHESIS: Remove the polyethylene insert, the talar component, and the tibial component, making sure to not compromise any remaining bone stock.

STEP 5 REVISION ANKLE ARTHROPLASTY: Prepare the tibial and talar bone stock to obtain solid osseous surfaces, and use the appropriate prosthetic components.

STEP 6 ADDITIONAL SURGICALPROCEDURES IF NECESSARY: If necessary, perform arthrodesis of adjacent joints, correcting osteotomies of the distal parts of the tibia and fibula, calcaneal osteotomy, and/or ligamentoplasty.

STEP 7 CLOSURE OF ALL INCISIONS: Close all incisions.

STEP 8 POSTOPERATIVE CARE: A short leg splint is worn for two days, followed by partial weight-bearing; the ankle is protected in a splint at night and with a walking boot during the day for six to eight weeks.

RESULTS

Between 2000 and 2010, 117 ankles in 116 patients (fifty-six female and sixty male; mean age, 55.0 ± 12.0 years) who presented with a failed total ankle arthroplasty after a mean of 4.3 ± 3.9 years were treated by revision arthroplasty with use of the HINTEGRA three-component total ankle prosthesis.

WHAT TO WATCH FOR

IndicationsContraindicationsPitfalls & Challenges.