Supramalleolar Osteotomy for Tibial Component Malposition in Total Ankle Replacement

2017 ◽  
Vol 38 (9) ◽  
pp. 952-956 ◽  
Author(s):  
Manja Deforth ◽  
Nicola Krähenbühl ◽  
Lukas Zwicky ◽  
Markus Knupp ◽  
Beat Hintermann
Keyword(s):  
Tibial Component ◽  
Corrective Osteotomy ◽  
Distal Tibia ◽  
Case Series ◽  
Outcome Data ◽  
Total Ankle Replacement ◽  
Level Of Evidence ◽  
Supramalleolar Osteotomy ◽  
Ankle Replacement ◽  
Surface Angle

Background: Persistent pain despite a total ankle replacement is not uncommon. A main source of pain may be an insufficiently balanced ankle. An alternative to the revision of the existing arthroplasty is the use of a corrective osteotomy of the distal tibia, above the stable implant. This strictly extraarticular procedure preserves the integrity of the replaced joint. The aim of this study was to review a series of patients in whom a corrective supramalleolar osteotomy was performed to realign a varus misaligned tibial component in total ankle replacement. We hypothesized that the supramalleolar osteotomy would correct the malpositioned tibial component, resulting in pain relief and improvement of function. Methods: Twenty-two patients (9 male, 13 female; mean age, 62.6 years; range, 44.7-80) were treated with a supramalleolar osteotomy to correct a painful ankle with a varus malpositioned tibial component. Prospectively recorded radiologic and clinical outcome data as well as complications and reoperations were analyzed. Results: The tibial anterior surface angle significantly changed from 85.2 ± 2.5 degrees preoperatively to 91.4 ± 2.9 degrees postoperatively ( P < .0001), the American Orthopaedic Foot & Ankle Society hindfoot score significantly increased from 46 ± 14 to 66 ± 16 points ( P < .0001) and the patient’s pain score measured with the visual analog scale significantly decreased from 5.8 ± 1.9 to 3.3 ± 2.4 ( P < .001). No statistical difference was found in the tibial lateral surface angle and the range of motion of the ankle when comparing the preoperative to the postoperative measurements. The osteotomy healed in all but 3 patients on first attempt. Fifteen patients (68%) were (very) satisfied, 4 moderately satisfied, and 3 patients were not satisfied with the result. Conclusion: The supramalleolar osteotomy was found to be a reliable treatment option for correcting the varus misaligned tibial component in a painful replaced ankle. However, nonunion (14%) should be mentioned as a possible complication of this surgery. Nonetheless, as a strictly extraarticular procedure, it did not compromise function of the previously replaced ankle, and it was shown to relieve pain without having to have revised a well-fixed ankle arthroplasty. Level of evidence: Level IV, case series.

scholarly journals Supramalleolar Osteotomy for Tibial Component Malposition in Total Ankle Replacement

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Manja Deforth ◽  
Nicola Krähenbühl ◽  
Lukas Zwicky ◽  
Markus Knupp ◽  
Beat Hintermann
Keyword(s):  
Range Of Motion ◽  
Ankle Joint ◽  
Tibial Component ◽  
Corrective Osteotomy ◽  
Distal Tibia ◽  
Total Ankle Replacement ◽  
Postoperative Result ◽  
Supramalleolar Osteotomy ◽  
Ankle Replacement ◽  
Surface Angle

Category: Ankle Introduction/Purpose: A key for success in total ankle replacement is a balanced ankle joint. If the tibial component is misaligned, the ligamentous structures, the malleoli and the tendons may be overused, which, may lead to pain and impairment during gait. A misaligned tibial component can be revised using a corrective bone resection and re-insertion of a new component or using a corrective osteotomy of the distal tibia above the stable implant. The aim of this study was to review a series of patients, in whom a corrective supramalleolar osteotomy was performed to realign a misaligned tibial component in total ankle replacement. Methods: Twenty-two patients (nine male; 13 female; mean age, 62.6 years; range, 44.7 – 80.0) were treated with a supramalleolar osteotomy to correct a painful dysbalanced ankle, following a varus implanted tibial component. Following radiological and clinical outcomes were recorded preoperatively and at the follow-up examination within the first 24 months: the tibial anterior surface angle (TAS), the tibial lateral surface angle (TLS), patient’s pain measured with the Visual Analogue Scale (VAS), the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score, range of motion (ROM) of the ankle and patient’s satisfaction. Furthermore, postoperative complications were reviewed. Results: The TAS changed on average from 85.2 ± 2.5 degrees preoperatively to 91.4 ± 2.9 degrees postoperatively (p < 0.0001), the AOFAS score increased from 46 ± 14 to 66 ± 16 points (p < .0001) and the VAS pain score decreased from 5.8 ± 1.9 to 3.3 ± 2.4 (p < .001). No statistical difference was found in the TLS and the range of motion. The osteotomy healed in 19 patients (86%), re-osteosynthesis was successful in the remaining three patients. In one of these three patients, a chronic infection of the ankle joint led to a below-knee amputation. Fifteen patients (68%) were (very) satisfied, four (18%) moderately satisfied and three (14 %) patients were not satisfied with the obtained postoperative result. Conclusion: The supramalleolar osteotomy was found to be an efficient alternative to correct the misaligned tibial component in total ankle replacement. Pain could be successfully addressed in the majority of the patients. The treatment of a malpositioned, well anchored tibial component with a supramalleolar osteotomy, instead of exchanging the tibial component, allows preservation of the bone stock. However, non-union should be mentioned as a possible complication of this surgery. Nonetheless, this method might be a feasible treatment option, especially for younger patients.

scholarly journals Complications, Reoperations, and Postoperative Outcomes of Simultaneous Supramalleolar Osteotomy and Total Ankle Replacement in Misaligned Osteoarthritic Ankles in Comparison to Total Ankle Replacement Alone

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0005
Author(s):  
Anne-Constance Franz ◽  
Manja Deforth ◽  
Lukas Zwicky ◽  
Christine Schweizer ◽  
Beat Hintermann
Keyword(s):  
Clinical Outcome ◽  
Polyethylene Wear ◽  
Distal Tibia ◽  
Cyst Formation ◽  
Total Ankle Replacement ◽  
Control Group ◽  
Tibial Resection ◽  
Supramalleolar Osteotomy ◽  
Ankle Replacement ◽  
Surface Angle

Category: Ankle Arthritis Introduction/Purpose: A key for success in total ankle replacement (TAR) is a balanced ankle joint with a physiological loading of the implant, minimizing the wear of the polyethylene insert. Theoretically, in ankles with distal tibial deformities, this can be achieved with a correcting tibial resection cut. As an alternative, supramalleolar osteotomy (SMOT) can be used for balancing the ankle during TAR surgery. To date, however, no data exist whether a SMOT in addition to TAR results in better outcome over time, and which are the additional risks with such extensive surgery. The aim of the study was therefore 1) to determine the risk of a simultaneously performed SMOT in comparison to TAR only, and 2) to compare the postoperative clinical outcomes. Methods: Between 2002 and 2014, 23 patients (male, 12; female, 11; mean age 60 [22-72] years) underwent simultaneously a SMOT and a TAR for treatment of a severe misaligned osteoarthritic ankle (tibial anterior surface angle [TAS] <84° [n=9] or >96° [n=1], or tibial lateral surface angle [TLS] <70° [n=13]) (SMOT&TAR group). Statistical matching was applied to extract a subgroup out of 510 TAR patients from our prospectively collected database with the same baseline characteristics, including similar preoperative alignments (control group). The matched 23 TAR patients (male, 16; female, 7; mean age 58 [35 - 79] years) were compared regarding additional procedures, complications and reoperations. Pre- and postoperative alignment measured on radiographs and clinical outcome (range of motion [ROM], pain on the visual analogue scale [VAS] and AOFAS hindfoot score) were compared. Results: While more additional osteotomies were done in the SMOT&TAR group (calcaneus, 5:1; fibula, 7:1), more ligament reconstructions and tendon transfers were done in control group (ligament reconstruction, 0:6; tendon transfer, 0:6). There was no difference, neither in the complication rate nor in the reoperation rate between both groups. However, there was a tendency of instability, subsequent polyethylene wear and cyst formation in the TAR group. The postoperative TAS was closer to neutral in the SMOT&TAR (pre- to postoperatively: 82.9° to 90.4° vs. 82.6° to 87.8°). While ROM was lower in the SMOT&TAR (30°) than in the TAR group (39°) (p=0.01), there was no difference in the clinical outcome (VAS pain 1.2 vs. 1.5 [p=0.58], AOFAS score 82 vs. 82 [p=0.99]). Conclusion: A SMOT performed simultaneously with TAR for the treatment of a severely deformed ankle resulted in a more neutral and better balanced ankle, and it was not associated with a greater risk of complications or reoperations. The only disadvantage was a slightly smaller ROM. Thus, SMOT should be considered in TAR with greater hindfoot deformities at the distal tibia as it is more powerful to address deforming forces. As shown, SMOT and TAR can be done simultaneously without taking greater risks.

Living With Both a Total Ankle Replacement and an Ankle Fusion: A Qualitative Study From the Patients’ Perspective

2021 ◽  
pp. 107110072110044
Author(s):  
Catherine Conlin ◽  
Ryan M. Khan ◽  
Ian Wilson ◽  
Timothy R. Daniels ◽  
Mansur Halai ◽  
...  
Keyword(s):  
Hospital Setting ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Qualitative Description ◽  
Level Of Evidence ◽  
Foot Placement ◽  
Advantages And Disadvantages ◽  
Ankle Fusion ◽  
Ankle Replacement ◽  
Patient Reported

Background: Total ankle replacement (TAR) and ankle fusion are effective treatments for end-stage ankle arthritis. Comparative studies elucidate differences in treatment outcomes; however, the literature lacks evidence demonstrating what outcomes are important to patients. The purpose of this study was to investigate patients’ experiences of living with both a TAR and ankle fusion. Methods: This research study used qualitative description. Individuals were selected from a cohort of patients with TAR and/or ankle fusion (n = 1254). Eligible patients were English speaking with a TAR and contralateral ankle fusion, and a minimum of 1 year since their most recent ankle reconstruction. Surgeries were performed by a single experienced surgeon, and semistructured interviews were conducted by a single researcher in a private hospital setting or by telephone. Ankle Osteoarthritis Scale (AOS) scores, radiographs, and ancillary surgical procedures were collected to characterize patients. Themes were derived through qualitative data analysis. Results: Ten adults (8 men, 2 women), ages 59 to 90 years, were included. Average AOS pain and disability scores were similar for both surgeries for most patients. Participants discussed perceptions of each reconstructed ankle. Ankle fusions were considered stable and strong, but also stiff and compromising balance. TARs were considered flexible and more like a “normal ankle,” though patients expressed concerns about their TAR “turning” on uneven ground. Individuals applied this knowledge to facilitate movement, particularly during a first step and transitioning between positions. They described the need for careful foot placement and attention to the environment to avoid potential challenges. Conclusion: This study provides insight into the experiences of individuals living with a TAR and ankle fusion. In this unusual but limited group of patients, we found that each ankle reconstruction was generally perceived to have different characteristics, advantages, and disadvantages. Most participants articulated a preference for their TAR. These findings can help clinicians better counsel patients on expectations after TAR and ankle fusion, and improve patient-reported outcome measures by better capturing meaningful outcomes for patients. Level of Evidence: Level IV, case series.

scholarly journals Total Ankle Replacement Conversion to Tibiotalocalcaneal Arthrodesis With Bulk Femoral Head Allograft and Pseudoelastic Intramedullary Nail Providing Sustained Joint Compression

2018 ◽  
Vol 3 (4) ◽  
pp. 247301141880448
Author(s):  
Mark Jay Conklin ◽  
Kathryn Elizabeth Smith ◽  
Jeremy Webster Blair ◽  
Kenneth Michael Dupont
Keyword(s):  
Femoral Head ◽  
Intramedullary Nail ◽  
Case Series ◽  
Preliminary Evidence ◽  
Total Ankle Replacement ◽  
Level Of Evidence ◽  
Computed Tomographic ◽  
Tibiotalocalcaneal Arthrodesis ◽  
First Case ◽  
Ankle Replacement

Tibiotalocalcaneal (TTC) arthrodesis is commonly performed to salvage a failed total ankle replacement. These salvage procedures are complicated by significant bone loss from the ankle replacement and are associated with low patient satisfaction. Here, we describe 2 cases of patients who presented with a failed total ankle replacement and underwent arthrodesis using a bulk femoral head allograft and a novel pseudoelastic intramedullary nail. The intramedullary nail contains an internal pseudoelastic element that adapts to bone resorption and settling allowing for compression to be maintained at the arthrodesis sites throughout healing. In the first case, a 65-year-old woman with a failed total ankle replacement underwent TTC arthrodesis. The second case involved an obese 53-year-old woman who had previously undergone 2 total ankle replacement procedures that resulted in unsuccessful outcomes. In both cases, union was demonstrated on computed tomographic scan by 6 months. At 2 years postsurgery, both patients were satisfied with the procedure. These cases provide preliminary evidence that tibiotalocalcaneal arthrodesis with a pseudoelastic IM nail and structural allograft is an appropriate treatment for failed total ankle replacements. Level of Evidence: Level IV, therapeutic, case series.

scholarly journals Sports and Recreational Activities following Total Ankle Replacement

Joints ◽  
2017 ◽  
Vol 05 (01) ◽  
pp. 012-016 ◽  
Author(s):  
Federico Usuelli ◽  
Andrea Pantalone ◽  
Camilla Maccario ◽  
Matteo Guelfi ◽  
Vincenzo Salini
Keyword(s):  
Los Angeles ◽  
Pain Score ◽  
Short Form ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Activity Level ◽  
Level Of Evidence ◽  
Recreational Activities ◽  
Ankle Replacement ◽  
And Function

Purpose In literature, there is a controversy regarding whether patients who have undergone total ankle replacement (TAR) can participate in sports and recreational activities. The purpose of this study was to report change in sports activity level after TAR. Methods A retrospective study was performed, enrolling 76 patients with symptomatic end-stage ankle arthritis who underwent TAR from May 2011 to October 2014. Patients were mainly males (44/76; 58%) and 56 years old on average (range: 22.3–79.6 years) at the time of surgery. They were treated with mobile-bearing prosthesis implanted with an anterior approach. Patients were evaluated preoperatively and 12 months postoperatively. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, the visual analog scale (VAS) pain score, and the 12-Item Short Form Health Survey (SF-12) – physical component summary (PCS) and mental component summary (MCS). Activity level was assessed with the University of California at Los Angeles (UCLA) activity scale. Results At 12 months postoperatively, statistically significant increase was reported for AOFAS scores (from 32.8 ± 12.7 preoperatively to 72.6 ± 13.3; p < 0.001), SF-12 PCS (from 34.3 ± 5.1 preoperatively to 45.4 ± 6.4; p < 0.001), and SF-12 MCS (from 39.8 ± 7.5 preoperatively to 51.4 ± 6.1; p < 0.001). A statistically significant decrease was detected in VAS pain score (from 8.7 ± 1.6 preoperatively to 2.2 ± 1.6; p < 0.001). The UCLA activity levels increased significantly from 2.4 ± 0.8 to 6.3 ± 2.3 (p < 0.001). Conclusion Pain and function significantly improved in patients affected by ankle osteoarthritis, who underwent TAR, at 1-year follow-up. In addition, activity level showed a significant increase respect to preoperative condition. Level of Evidence Level IV, retrospective case series.

Comparison of Tibial and Talar Bone Density in Patients Undergoing Total Ankle Replacement vs Non–Ankle Arthritis Matched Controls

2019 ◽  
Vol 40 (12) ◽  
pp. 1408-1415
Author(s):  
Thos Harnroongroj ◽  
Lauren G. Volpert ◽  
Scott J. Ellis ◽  
Carolyn M. Sofka ◽  
Jonathan T. Deland ◽  
...  
Keyword(s):  
Bone Density ◽  
Ankle Joint ◽  
Articular Surface ◽  
Distal Tibia ◽  
Total Ankle Replacement ◽  
Control Group ◽  
Ankle Arthritis ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Significant Difference

Background: Bone quality in the distal tibia and talus is an important factor contributing to initial component stability in total ankle replacement (TAR). However, the effect of ankle arthritis on bone density in the tibia and talus remains unclear. The objective of this study was to compare bone density of tibia and talus in arthritic and nonarthritic ankles as a function of distance from ankle joint. Methods: We retrospectively reviewed 93 end-stage ankle arthritis patients who had preoperative nonweightbearing ankle computed tomography (CT) and identified a cohort of 83 nonarthritic ankle patients as a demographic-matched control group. A region of interest tool was used to calculate Hounsfield unit (HU) values in the cancellous region of the tibia and talus. Measurements were obtained on axial cut CTs from 6 to 12 mm above the tibial plafond, and 1 to 4 mm below the talar dome. HU measurements between groups and the decrease of HU at the relative level in each group were compared. Results: Arthritic ankles demonstrated significantly greater mean bone density than nonarthritic ankles at between 6 and 10 mm above the joint in the tibia ( P < .05). No significant difference in bone density between 10 and 12 mm from the joint in the tibia nor at any level of the talus was found between groups. In both groups, bone density decreased significantly at each successive level away from the ankle joint. Conclusion: Ankle arthritis patients demonstrated greater or equal bone density in both the tibia and talus compared to demographic-matched controls. In both groups, bone density decreased with increasing distance away from the articular surface. In TAR, tibial bone resection between 6 and 8 mm may provide improved initial implant stability. Level of Evidence: Level III, comparative study.

Secondary Subtalar Joint Osteoarthritis Following Total Ankle Replacement

2019 ◽  
Vol 40 (10) ◽  
pp. 1122-1128 ◽  
Author(s):  
Marc Sokolowski ◽  
Nicola Krähenbühl ◽  
Chen Wang ◽  
Lukas Zwicky ◽  
Christine Schweizer ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Case Series ◽  
Fusion Rate ◽  
Total Ankle Replacement ◽  
Time Interval ◽  
Level Of Evidence ◽  
Joint Fusion ◽  
Ankle Replacement ◽  
Cystic Changes

Background:An advantage of total ankle replacement (TAR) compared to ankle fusion is that by maintaining motion, the occurrence of hypermobility of adjacent joints may be prevented. This could affect the development of symptomatic subtalar joint osteoarthritis (OA). The aim of the study was to determine the incidence of subtalar joint fusion and the progression of subtalar joint OA following TAR.Methods:Secondary subtalar joint fusion rate was determined from a cohort of 941 patients receiving primary TAR between 2000 and 2016. The indication for fusion, the time interval from primary TAR to fusion, and the union rate were evaluated. To assess the progression of subtalar joint OA, degenerative changes of the subtalar joint were classified in 671 patients using the Kellgren-Lawrence score (KLS) prior to TAR and at latest follow-up.Results:In 4% (37) of the patients, a secondary subtalar joint fusion was necessary. The indication for fusion was symptomatic OA in 51% (19), hindfoot instability in 27% (10), osteonecrosis of the talus in 19% (7), and cystic changes of the talus in 3% (1) of the patients. Time from primary TAR to subtalar joint fusion due to progressive OA was 5.0 (range, 0.3-10) years and for other reasons 1.6 (range, 0.2-11.6) years ( P = .3). In 68% (456) of the patients, no progression of subtalar joint OA was observed.Conclusion:The incidence of secondary subtalar joint fusion was low. The most common reason for subtalar joint fusion following TAR was symptomatic OA.Level of Evidence:Level IV, case series.

Syndesmotic Overload in 3-Component Total Ankle Replacement

2019 ◽  
Vol 41 (3) ◽  
pp. 275-285 ◽  
Author(s):  
Roxa Ruiz ◽  
Roman Susdorf ◽  
Nicola Krähenbühl ◽  
Alexej Barg ◽  
Beat Hintermann
Keyword(s):  
Revision Surgery ◽  
Case Series ◽  
Mobile Bearing ◽  
Cyst Formation ◽  
Total Ankle Replacement ◽  
Effective Treatment Option ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Ankle Replacement

Background: Mobile-bearing total ankle replacement (TAR) potentially enables motion at the tibial implant–polyethylene insert (PI) interface. Such additional freedom of movement may overload periarticular ligaments and subsequently result in coronal translation of the talus. The aim of this study was to assess whether syndesmotic overload affects clinical and radiographic outcomes following mobile-bearing TAR and whether tibiofibular fusion is an effective treatment option. Methods: Thirty-one patients who underwent revision surgery for syndesmotic overload after mobile-bearing TAR were retrospectively analyzed. Clinical and radiographic outcomes were assessed before and after index TAR, preoperatively to revision surgery, and at the last follow-up after revision surgery. Computed tomography scans were also analyzed. Results: Ankles with lateral talar translation prior to revision surgery were about 10 times more likely to have valgus tibial implant position ( P = .003). A wide tibiofibular distance at the level of the syndesmosis after index TAR was associated with an increased hindfoot moment arm at revision surgery ( P = .025). Decrease of PI height at revision surgery and a PI fracture were evident in 10 (32%) and 4 (13%) cases, respectively. Talar cyst formation at revision surgery was evident in 12 (39%) cases. Tibiofibular fusion was effective in restoring function of the replaced ankle and providing pain relief. Conclusion: Syndesmotic overload impaired clinical and radiographic outcomes after mobile-bearing TAR. Proper implant positioning and additional realignment procedures may prevent overload of periarticular soft tissue structures after mobile-bearing TAR. Level of Evidence: Level IV, retrospective case series.

Scandinavian Total Ankle Replacement: 15-Year Follow-up

2018 ◽  
Vol 39 (2) ◽  
pp. 135-142 ◽  
Author(s):  
Ariel Palanca ◽  
Roger A. Mann ◽  
Jeffrey A. Mann ◽  
Andrew Haskell
Keyword(s):  
Case Series ◽  
Mobile Bearing ◽  
The United States ◽  
Clinical Findings ◽  
Total Ankle Replacement ◽  
Fourth Generation ◽  
Level Of Evidence ◽  
Prosthetic Alignment ◽  
Ankle Replacement

Background: Over the past decade, total ankle arthroplasty (TAA) has become a mainstay in the treatment of end-stage ankle arthritis. Currently in its fourth generation, the Scandanavian Total Ankle Replacement (STAR) is the only 3-piece mobile bearing ankle prosthesis available in the United States. Our current study reports implant survivorship at 15 years and patient outcomes for a subset of these survivors available for study. Methods: Eighty-four TAAs were performed between 1998 and 2000. Metal component survivorship at 15 years was calculated with a Kaplan-Meier curve. Twenty-four (29%) of 84 patients were available for participation with a minimum 15-year follow-up. Any radiographic changes were documented. All additional procedures and complications were recorded. Clinical findings, self-reported performance and pain evaluations, and AOFAS ankle/hindfoot scores were noted. Results: Metal implant survival was 73% at 15 years. Of the 24 patients available for clinical evaluation, 18 of 24 patients (70.7%) had no change in prosthetic alignment from the immediate postoperative radiograph. Only 1 subtalar fusion was required for symptomatic adjacent joint arthritis. Three patients sustained a broken polyethylene component. AOFAS scores improved from an average of 39.6 points preoperatively, to an average of 71.6. More than half (52.4%) of patients with retained implants required an additional surgical procedure; 3 required 2 additional procedures. The average time to subsequent procedure was 10.2 years. Conclusion: Our small cohort demonstrated STAR ankles with retention at 9 years were highly likely to survive to 15 years, and patients continued to have significant improvement in pain relief and minimal decrease in function. At 15 years from TAA, metal survivorship was 73%. As with all ankle replacements, supplementary procedures were common. Level of Evidence: Level IV, case series.

Perioperative Complications of HINTEGRA Total Ankle Replacement: Our Initial 50 Cases

2008 ◽  
Vol 29 (10) ◽  
pp. 978-984 ◽  
Author(s):  
Keun-Bae Lee ◽  
Sang-Gwon Cho ◽  
Chang-Ich Hur ◽  
Taek-Rim Yoon
Keyword(s):  
Tibial Component ◽  
Perioperative Complications ◽  
Skin Grafting ◽  
Total Ankle Replacement ◽  
Wound Complications ◽  
Soft Tissue Coverage ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Group A ◽  
Group B

Background: The purpose of the present study was to report the perioperative complications that occurred among our initial 50 consecutive cases of HINTEGRA total ankle replacement. Materials and Methods: This was a retrospective study of 50 cases composed of 30 men and 18 women of average age 57 years. Perioperative complications were used to compare the first 25 cases (Group A) with the subsequent 25 (Group B). Results: Perioperative complications occurred in 15 cases (60%) in Group A but in only five (20%) in Group B. No major wound complications requiring a soft-tissue coverage procedure were encountered. Minor wound complications occurred in three cases in each group which resolved with skin grafting or topical dressing changes. One deep infection occurred in Group A, which required implant removal and antibiotic impregnated spacer prior to revision TAR. Four patients sustained intraoperative malleolus fractures in Group A, but only one in Group B. Coronal malposition of the tibial component occurred in three cases in Group A and in two in Group B. Increased sagittal slope of the tibial component occurred in two cases in Group B and sagittal malposition of the talar component occurred in two cases in Group A. There were seven instances of anterior translation of the talar component with respect to the tibial component; four in Group A and three in Group B. Conclusion: These results suggest that TAR has a steep learning curve. Moreover, knowledge of the perioperative complications of TAR may reduce the incidence of complications. Level of Evidence: III, Therapeutic Study

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