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HINTEGRA Revision Arthroplasty for Failed Total Ankle ProsthesesSurgical Technique
Beat Hintermann, MD1; Lukas Zwicky, MSc1; Markus Knupp, MD1; Heath B. Henninger, PhD2; Alexej Barg, MD3
1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland Liestal, Rheinstrasse 26, CH-4410 Liestal, Switzerland
2 Harold K. Dunn Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108
3 Department of Orthopaedic Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland. E-mail address for A. Barg: alexejbarg@mail.ru
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Based on an original article: J Bone Joint Surg Am. 2013 Jul 3;95(12):tk-tk.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Jun 26;3(2):e12 1-14. doi: 10.2106/JBJS.ST.M.00021
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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.


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 prosthesis12.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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