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HINTEGRA revision arthroplasty for failed total ankle prostheses. | LitMetric

HINTEGRA revision arthroplasty for failed total ankle prostheses.

J Bone Joint Surg Am

Clinic of Orthopaedic Surgery, Kantonsspital Baselland Liestal, Rheinstrasse 26, CH-4410 Liestal, Switzerland.

Published: July 2013

AI Article Synopsis

  • Total ankle replacements that fail are commonly treated with arthrodesis, but revision arthroplasty using the HINTEGRA prosthesis is being explored as an alternative.
  • In a study of 117 cases, most reasons for failure involved issues with the metallic components, bone, soft tissues, or infections, and most of the talar and tibial components were revised.
  • The results showed that 85% of patients experienced improved AOFAS scores after an average of 6.2 years, with a nine-year survival rate for the revision surgeries at 83%, though single-coated hydroxyapatite components had a higher rate of loosening compared to double-coated ones.

Article Abstract

Background: When a total ankle replacement fails, arthrodesis has been advocated as the treatment of choice. With the availability of a wide spectrum of implants, revision arthroplasty may become a viable alternative.

Methods: We reviewed a consecutive series of 117 cases (116 patients [fifty-six female and sixty male]; mean age, 55.0 ± 12.0 years) in which a total ankle arthroplasty failed after a mean of 4.3 years and was revised with use of the HINTEGRA three-component total ankle prosthesis. The reason for revision involved the metallic components in sixty ankles (51%), the bone in twenty-eight (24%), the soft tissues in twenty (17%), and infection in nine (8%). The talar component was revised in 104 ankles (89%) and the tibial component, in 106 (91%).

Results: Early complications included a fracture of the malleoli in two ankles and a dislocation of the polyethylene insert in one. Seventeen (15%) of the revision arthroplasties required further revision surgery, in most cases for loosening of one or two of the prosthetic components. The mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score for the remaining 100 ankles (85%) improved from 44 ± 18 preoperatively to 72 ± 19 (p < 0.01) at the time of the latest follow-up (mean, 6.2 years). The estimated survival of the revision arthroplasties at nine years, with loosening of components as the end point, was 83%. The prevalence of component loosening was higher (p < 0.005) with the use of single-coated hydroxyapatite components (six of twenty-three ankles, 26%) than with double-coated components (five of ninety-four ankles, 5%). The correlation between the extent of bone loss at the resection surface and the prevalence of component failure was weak and not significant.

Conclusions: The medium-term results of revision arthroplasty after a failed total ankle arthroplasty were similar to those after primary arthroplasty. The key to success was firm anchorage of the components to primary bone stock. A single hydroxyapatite component coating should no longer be used for revision total ankle arthroplasty.

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Source
http://dx.doi.org/10.2106/JBJS.L.00538DOI Listing

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