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.