Total Ankle Arthroplasty: Brazilian Experience With the Hintegra Prosthesis

Abstract

Ankle arthrosis is becoming more and more common. The search for solutions that preserve joint function has led to a new generation of prosthesis with three components and more degrees of freedom. This paper presents the results achieved for ten patients treated with the HINTEGRA Prosthesis (Integra, New Deal), through collaborative action between the Foot and Ankle Groups of the Orthopedics and Traumatology divisions of Escola Paulista de Medicina, Unifesp, and the School of Medicine of the University of São Paulo (USP). The ten patients (six women and four men, aged between 29 and 66 years), underwent a surgical procedure consisting of Hintermann's technique, between January and June 2005. They were evaluated at prearranged intervals, and the data were subjected to statistical analysis. The surgery led to a significant improvement in ankle mobility. Radiological evaluation showed no signs of loosening or failure in the prosthetic components in any of the patients studied. Although the complication rate in our sample was high, it was equivalent to the rates found by other authors, and directly represents the learning curve associate with this kind of procedure. Four years after the procedure, it was found that the patients pain levels had significantly decreased, and that their functional patterns had significantly improved, with AOFAS and Hintermann scores indicating results that were excellent for 20%, good for 70% and poor for 10%. Treatment of ankle arthritis by means of total arthroplasty using the HINTEGRA prosthesis was capable of providing good results over an average observation period of four years.

Study of the radiographic parameters of normal ankles

“…We selected 12 studies assessing radiographic patterns of normal ankles, and identified a total of 15 possible radiographic measurements (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) .…”

“…The treatment of ankle arthrosis includes conservative measures (drug and orthotic treatment), orthobiologic resources (5) and surgical procedures (joint debridement, arthrodiastases, supramalleolar osteotomies, en bloc autologous cartilage transplantation, total arthroplasty and ankle arthrodesis) (6)(7)(8)(9)(10)(11)(12) . Surgical treatment prognosis depends, among other factors, on the degree of joint damage, patient characteristics, and tibiotalar joint realignment (6) .…”

Short Term Results of the Cadence Total Ankle Prosthesis: A Dutch Non-Designer Case Series

“…The total ROM and clin- makes it hard to compare complication rates. Complications are categorized as intraoperative and postoperative [1,3,11,13,20,25], as minor and major [18,19,26], as high grade, medium grade, and low grade [2,10,23], or are not classified at all [2,9,12,14,16]. A further issue is heterogeneity in which events are counted as complications, for example HO is sometimes mentioned as complication and sometimes as radiological outcome.…”

Cartilage lesions and ankle osteoarthrosis: review of the literature and treatment algorithm

“…The third-generation prostheses, which comprise three elements (tibial, talar and intermediate components), have been the most successful of these so far. 77 , 78 , 79 …”

“…During the postoperative period, the complications relate to dehiscence of the surgical incision and infection. 78 , 81 Over the long term, the greatest complication is aseptic loosening of the tibial or talar components, followed by stress fracturing, capsule retraction and retraction of the periarticular soft tissues. 82 …”