HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses

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Presentation transcript:

HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS Essent Surg Tech Volume 3(2):e12 April 10, 2013 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Anterior view of the feet showing swelling and valgus deformity of affected left ankle. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Posterior view of the feet showing swelling and valgus deformity of affected left ankle. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Preoperative anteroposterior weight-bearing radiograph showing an unbalanced ankle with medial translation of the talus. Preoperative anteroposterior weight-bearing radiograph showing an unbalanced ankle with medial translation of the talus. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Preoperative lateral weight-bearing radiograph of the foot and ankle showing loosening of the tibial component. Preoperative lateral weight-bearing radiograph of the foot and ankle showing loosening of the tibial component. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Preoperative anteroposterior weight-bearing radiograph of the foot showing slight external rotation of the talar component. Preoperative anteroposterior weight-bearing radiograph of the foot showing slight external rotation of the talar component. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Preoperative weight-bearing radiograph (alignment view) showing lateral offset of the calcaneus. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Preoperative SPECT showing hot spots in the medial and lateral gutters. Preoperative SPECT showing hot spots in the medial and lateral gutters. (This is not the same patient as shown in Figs. 1-A through 2-D). Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Decision algorithm for revision arthroplasty (talar component) for a patient with a failed total ankle replacement (TAR). Decision algorithm for revision arthroplasty (talar component) for a patient with a failed total ankle replacement (TAR). Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Decision algorithm for revision arthroplasty (tibial 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). Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Removal of a talar component with use of an impactor in a right ankle. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Creation of a window to remove the stemmed tibial component in a right ankle. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Debridement of bone surfaces in a right ankle. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Minimal resection on the tibial side with use of the tibial resection device in a right ankle. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Allograft bone block inserted into the central defect in a right ankle. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Impaction of the allograft with a lamina spreader in a right ankle. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Creation of a flush resection surface in a right ankle. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Trimming of talar bone stock to accommodate a standard talar component in a right ankle. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Photograph and preoperative radiographs showing a massive bone defect on the talar side after removal of a subsided talar component in a left 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. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Freehand parallel cut to the tibial resection surface while holding the foot precisely in a neutral position 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. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Revision resection block mounted to the created flat osseous surface in a left ankle (with fluoroscopic verification). Revision resection block mounted to the created flat osseous surface in a left ankle (with fluoroscopic verification). Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Impaction of allograft into a central defect with use of a lamina spreader in a left ankle. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Fixation of the allograft with use of headless screws in a left ankle. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

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). 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). Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

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). 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). Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

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. 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. Bottom: Postoperative weight-bearing radiographs show a well-stabilized ankle after anterior opening-wedge osteotomy of the distal part of the tibia and appropriate positioning of the components. Solid line = weight-bearing axis of the tibia. Center of the circle = center of mass of the talus. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

Intraoperative image demonstrating the osteotomy and mobilization of the calcaneal tuberosity. Intraoperative image demonstrating the osteotomy and mobilization of the calcaneal tuberosity. This is a lateral approach to a left ankle. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

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. 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. An allograft with screw fixation has been used on the talar side. Bottom: Postoperative weight-bearing radiographs show a well-stabilized ankle after a lateral sliding osteotomy of the calcaneus and appropriate positioning of the prosthetic components. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.

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. 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. Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12 ©2013 by The Journal of Bone and Joint Surgery, Inc.