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Transcript of HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky,...
![Page 1: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/1.jpg)
HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses
by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg
JBJS Essent Surg TechVolume 3(2):e12
April 10, 2013
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 2: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/2.jpg)
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 3: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/3.jpg)
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 4: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/4.jpg)
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 5: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/5.jpg)
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 6: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/6.jpg)
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 7: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/7.jpg)
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 8: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/8.jpg)
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 9: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/9.jpg)
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 10: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/10.jpg)
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 11: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/11.jpg)
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 12: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/12.jpg)
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 13: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/13.jpg)
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.
![Page 14: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/14.jpg)
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.
![Page 15: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/15.jpg)
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.
![Page 16: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/16.jpg)
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.
![Page 17: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/17.jpg)
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.
![Page 18: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/18.jpg)
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.
![Page 19: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/19.jpg)
Preoperative SPECT showing hot spots in the medial and lateral gutters.
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 20: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/20.jpg)
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.
![Page 21: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/21.jpg)
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.
![Page 22: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/22.jpg)
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.
![Page 23: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/23.jpg)
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.
![Page 24: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/24.jpg)
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.
![Page 25: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/25.jpg)
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.
![Page 26: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/26.jpg)
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.
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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.
![Page 28: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/28.jpg)
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.
![Page 29: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/29.jpg)
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.
![Page 30: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/30.jpg)
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.
![Page 31: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/31.jpg)
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.
![Page 32: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/32.jpg)
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.
![Page 33: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/33.jpg)
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.
![Page 34: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/34.jpg)
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.
![Page 35: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/35.jpg)
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.
![Page 36: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/36.jpg)
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.
![Page 37: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/37.jpg)
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.
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 38: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/38.jpg)
Intraoperative image demonstrating the osteotomy and mobilization of the calcaneal tuberosity.
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 39: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/39.jpg)
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.
Beat Hintermann et al. JBJS Essent Surg Tech 2013;3:e12
©2013 by The Journal of Bone and Joint Surgery, Inc.
![Page 40: HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses by Beat Hintermann, Lukas Zwicky, Markus Knupp, Heath B. Henninger, and Alexej Barg JBJS.](https://reader036.fdocuments.in/reader036/viewer/2022070414/5697c0041a28abf838cc48ae/html5/thumbnails/40.jpg)
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.