Therapeutic, Level IV: Case series.

n ABSTRACTFrom 1989 until the end of 1993, 73 Ramses Total Ankle Arthroplasty (Ramses TAA) procedures were performed by the surgeons of the Talus Group. It was the beginning of our experience with this implant. We evaluated the long-term clinical results in 69 cases, after 10 years to 14 years postoperatively. Out of 57 cases the result was good for 40 cases, fair for 14 cases, and poor for 3 cases. Arthroplasties were considered to be a failure with removal of the implant and arthrodesis done in 7 cases: 4 for pain without loosening and 3 for clinical and radiographic loosening. Twenty-three complications occurred on these 12 cases: 3 malposition, 3 with significant instability, 1 progressive misplacement in varus, 4 medial malleolar fractures, 6 submalleolar syndromes, and 6 with evidence of clinical loosening. We had to do a second operation in 12 cases: 2 revisions with a larger mobile disk, 7 arthrodeses for failure, 3 revisions to another ankle arthroplasty without cement. The cumulative rate of survival after Ramses TAA was not influenced by age, sex, or weight. On the other hand, previous operative treatment, and especially the range of dorsiflexion postoperatively, significantly affected the rate of survival. The long-term results of Ramses TAA appear more promising. On the basis of these findings, this implant appears promising. It is essential that there be an appropriate liberation of malleoli. The Achilles lengthening appears to be important to achieve adequate postoperative dorsiflexion. The surgical technique is uncomplicated. The Ramses prosthesis is a semiconstrained prosthesis allowing, with congruence, flexion-extension, AP translation, and valgus and varus.

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