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Total Ankle Replacement-Three-Component Prosthesis

Valderrabano, Victor MD; Pagenstert, Geert MD; Hintermann, Beat MD

Techniques in Foot & Ankle Surgery: March 2005 - Volume 4 - Issue 1 - p 42-54
doi: 10.1097/01.btf.0000152575.86782.8a

The purposes of this study were to list possible indications and contraindications for total ankle replacement, describe the standard ventral surgical approach for total ankle replacement, present a new 3-component and anatomic total ankle prosthesis (HINTEGRA®, Newdeal SA, Lyon, France), and show its clinical and radiologic outcome. Recognition of critical preoperative risk factors and careful preoperative planning are important factors for limiting complications and obtaining satisfactory results for total ankle arthroplasty. Meticulous clinical and radiologic assessment is required. The accurate knowledge of the indications and relative and absolute contraindications is of great importance. Although many surgical approaches have been described in the literature, depending on the type of implanted total ankle replacement, most of the current total ankle arthroplasties are performed using the standard ventral ankle joint approach, a single incision between the anterior tibial and extensor hallucis longus tendons. 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 study was to determine the short-term results in a consecutive series of 128 patients (134 ankles). Preoperative diagnosis was posttraumatic osteoarthrosis in 100 cases (75%), primary osteoarthrosis in 19 cases (13%), and systemic arthritis in 15 cases (12%). Eleven ankles (8.2%) had to be revised. After an average of 18.3 months (range 1-3 years), the patients were satisfied after 82% of the replaced ankles, and the clinical result was rated to be good-excellent in 79% of the cases. The American Orthopaedic Foot & Ankle Society hindfoot score improved from 39 points preoperatively to 86 points at follow-up. Ninety-six ankles (72%) were completely pain free. The average range of motion was clinically 37° (range 10-55°) and under fluoroscopy (true ankle motion) 34° (range 5-62°).

Clinic of Orthopaedic Surgery, University of Basel, Kantonsspital, Basel, Switzerland

Address correspondence and reprint requests to Beat Hintermann, MD, and Victor Valderrabano, MD, Orthopaedic Department, University Hospital of Basel, Basel 4031, Switzerland. E-mail:;

© 2005 Lippincott Williams & Wilkins, Inc.