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Total Ankle Arthroplasty - part 5

Báo cáo trên một dòng của 116 bệnh nhân liên tiếp (122 chân) tại một theo dõi trung bình 18,9 của tháng (từ 1 đến 3 năm). Trước phẫu thuật chẩn đoán viêm xương khớp sau chấn thương WS trong 91 trường hợp (75%), viêm xương khớp tiểu học ở 16 trường hợp (13%), và viêm khớp hệ thống trong 15 trường hợp (12%). Tám mắt cá chân (6,6%) | 72 Chapter 6 Current Designs properly positioned dislocation of the bearing is unlikely. 6.5.2 Results Hintermann et al 12 reported on a consecutive series of 116 patients 122 ankles at a mean followup of 18.9 months range 1 to 3 years . Preoperative diagnosis was post-traumatic osteoarthrosis in 91 cases 75 primary osteoarthrosis in 16 cases 13 and systemic arthritis in 15 cases 12 . Eight ankles 6.6 had to be revised. Four were revised because of loosening of at least one component one because of dislocation of the meniscus and three for other reasons. All revisions were successful. Eighty-four percent of patients were satisfied and the clinical result was rated as good or excellent in 82 of the cases Figs. 6.16 and 6.17 . The AOFAS Hindfoot Score 14 improved from 40 points pre-operatively to 85 points at follow-up. Eighty-three ankles 68 were completely pain free. The average range of motion was clinically 39 range 15 to 55 and under fluoroscopy that is true ankle motion 37 range 7 to 62 . Radiographically the tibial component was stable in all ankles and no tilting of the component had occurred since the surgery. Migration of the talar component was however observed in two ankles. 6.5.3 Concerns A major concern with the first design was the positioning of the talar component which tended to slide too posteriorly while press fitting see Fig. 11.9 Chap. 11 Complications of Total Ankle Arthroplasty . With the addition of two talar pegs the newer design may resist such translational forces during press fitting. A potential concern in uncemented resurfacing prostheses is the use of screws that may create stress shielding. The HINTEGRA ankle however uses oval holes on the tibial side so that some settling of the component during osseointegration is possible. On the talar side the two screws are Fig. 6.12. HINTEGRA ankle. The HINTEGRA Total Ankle Prosthesis is a nonconstrained three-component system. This new version uses pegs see text . From Newdeal SA in Lyon France