HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky,...

HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses

by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg

JBJS Essent Surg TechVolume 3(2):e12

April 10, 2013

Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12

Anterior view of the feet showing swelling and valgus deformity of affected left ankle.

Posterior view of the feet showing swelling and valgus deformity of affected left ankle.

Preoperative anteroposterior weight-bearing radiograph showing an unbalanced ankle with medial translation of the talus.

Preoperative lateral weight-bearing radiograph of the foot and ankle showing loosening of the tibial component.

Preoperative anteroposterior weight-bearing radiograph of the foot showing slight external rotation of the talar component.

Preoperative weight-bearing radiograph (alignment view) showing lateral offset of the calcaneus.

Preoperative SPECT showing hot spots in the medial and lateral gutters.

Decision algorithm for revision arthroplasty (talar component) for a patient with a failed total ankle replacement (TAR).

Decision algorithm for revision arthroplasty (tibial component) for a patient with a failed total ankle replacement (TAR).

Removal of a talar component with use of an impactor in a right ankle.

Creation of a window to remove the stemmed tibial component in a right ankle.

Debridement of bone surfaces in a right ankle.

Minimal resection on the tibial side with use of the tibial resection device in a right ankle.

Allograft bone block inserted into the central defect in a right ankle.

Impaction of the allograft with a lamina spreader in a right ankle.

Creation of a flush resection surface in a right ankle.

Trimming of talar bone stock to accommodate a standard talar component in a right ankle.

Photograph and preoperative radiographs showing a massive bone defect on the talar side after removal of a subsided talar component in a left ankle.

Freehand parallel cut to the tibial resection surface while holding the foot precisely in a neutral position in a left ankle.

Revision resection block mounted to the created flat osseous surface in a left ankle (with fluoroscopic verification).

Impaction of allograft into a central defect with use of a lamina spreader in a left ankle.

Fixation of the allograft with use of headless screws in a left ankle.

Insertion of a talar component with demineralized bone matrix on its undersurface with use of the pegs as guiding tools in a left ankle (with fluoroscopic verification).

Final position after insertion of the tibial component and polyethylene insert showing a balanced ankle and an appropriate position of the implants in a left ankle (with fluoroscopic verification).

Top: Preoperative weight-bearing radiographs show a destabilized ankle in the sagittal plane after subsidence and anterior tilt of the tibial component, and a talar component positioned too

far anteriorly.

Intraoperative image demonstrating the osteotomy and mobilization of the calcaneal tuberosity.

Top: Preoperative weight-bearing radiographs show substantial loosening of a total ankle prosthesis with subsidence of the talar component and varus malalignment of the hindfoot.

A cement spacer containing gentamicin has been inserted into the osseous defect after resection of a failed total ankle prosthesis because infection was suspected in a left ankle.

HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky,...

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