Beat Hintermann1, Lukas Zwicky1, Markus Knupp1, Heath B Henninger2, Alexej Barg3. 1. Clinic of Orthopaedic Surgery, Kantonsspital Baselland Liestal, Rheinstrasse 26, CH-4410 Liestal, Switzerland. 2. Harold K. Dunn Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. 3. Department of Orthopaedic Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland. E-mail address for A. Barg: alexejbarg@mail.ru.
Abstract
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 prosthesis12. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
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 prosthesis12. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
Authors: Andrej Trampuz; Kerryl E Piper; Melissa J Jacobson; Arlen D Hanssen; Krishnan K Unni; Douglas R Osmon; Jayawant N Mandrekar; Franklin R Cockerill; James M Steckelberg; James F Greenleaf; Robin Patel Journal: N Engl J Med Date: 2007-08-16 Impact factor: 91.245
Authors: Markus Knupp; Geert I Pagenstert; Alexej Barg; Lilianna Bolliger; Mark E Easley; Beat Hintermann Journal: J Orthop Res Date: 2009-11 Impact factor: 3.494