Hintermann Total Ankle Arthroplasty

Historical Overview, Current Concepts and Future Perspectives
1. Auflage 2005
ISBN: 978-3-211-27254-1
Verlag: Springer Vienna
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 195 Seiten

Increasing success of arthroplasty of joints like the hip and knee along with concerns about the long-term outcomes of ankle arthrodesis has renewed interest in ankle arthroplasty. The new implants have been designed with attention to reproducing normal ankle anatomy, joint kinematics, ligament stability, and mechanical alignment. This publication will be the first comprehensive atlas on this topic and offers a unique physiological and mechanical characteristics of the ankle joint and of the selected total ankle system. Furthermore it will greatly enhance one's knowledge of this dynamic field and stimulate the scientific approach to management of end-stage arthritis of the ankle. It reflects the author's accumulated experience of the last decade with extended laboratory work on biomechanics of the ankle joint complex and more than 350 total ankle procedures. The atlas is well illustrated with many impressive figures, drawings and coloured pictures.

Autoren/Hrsg.

Hintermann, Beat

Inhaltsverzeichnis

1;Foreword;7
2;Acknowledgements;9
3;Preface;11
4;Contents;13
5;Chapter 1 Introduction;19
5.1;1.1 Why Total Ankle Arthroplasty?;19
5.2;1.2 Poor Success Rate with Early Attempts;20
5.3;1.3 Where Are We Today?;20
5.4;References;21
6;Chapter 2 Characteristics of the Diseased Ankle;23
6.1;2.1 Epidemiology;23
6.2;2.2 Characteristics of Ankle Arthritis;23
6.2.1;2.2.1 Primary Osteoarthrosis;26
6.2.2;2.2.2 Post-Traumatic Osteoarthrosis;26
6.2.3;2.2.3 Systemic Arthritis;27
6.3;2.3 Conclusions;27
6.4;References;27
7;Chapter 3 Ankle Arthrodesis;29
7.1;3.1 Historical Background;29
7.2;3.2 Biomechanical Considerations;30
7.2.1;3.2.1 Isolated Ankle Arthrodesis;31
7.2.2;3.2.2 Extensive Hindfoot Fusions;31
7.3;3.3 Techniques and Results;31
7.3.1;3.3.1 Ankle Arthrodesis without Internal Fixation;32
7.3.2;3.3.2 Ankle Arthrodesis with Internal Fixation;32
7.3.3;3.3.3 Functional Outcome after Ankle Arthrodesis;35
7.3.4;3.3.4 Degenerative Changes after Ankle Arthrodesis;36
7.3.5;3.3.5 Ankle Arthrodesis versus Total Ankle Arthroplasty;37
7.4;3.4 Conclusions;39
7.5;References;39
8;Chapter 4 Anatomic and Biomechanical Characteristics of the Ankle Joint and Total Ankle Arthroplasty;43
8.1;4.1 Anatomic Considerations;43
8.1.1;4.1.1 Bony Configuration;43
8.1.2;4.1.2 Ligamentous Configuration;45
8.2;4.2 Ankle Joint Motion;47
8.2.1;4.2.1 Axis of Rotation;47
8.2.2;4.2.2 Range of Ankle Motion;48
8.2.3;4.2.3 Restraints of Ankle Motion;48
8.3;4.3 Bone Support at the Ankle;49
8.4;4.4 Contact Area and Forces at the Ankle;52
8.4.1;4.4.1 Contact Area;52
8.4.2;4.4.2 Axial Load and Stress Forces of the Ankle;52
8.5;4.5 Fixation of Total Ankle Prostheses;53
8.6;4.6 Limitations of Polyethylene;55
8.7;4.7 Component Design;55
8.8;4.8 Conclusions;57
8.9;References;58
9;Chapter 5 History of Total Ankle Arthroplasty;61
9.1;5.1 Classification of Total Ankle Arthroplasties;61
9.2;5.2 First-Generation Total Ankle Arthroplasty – Cemented Type;63
9.2.1;5.2.1 Pioneers in Total Ankle Arthroplasty;63
9.2.2;5.2.2 Short-Term Results;65
9.2.3;5.2.3 Mid- to Long-Term Results;65
9.2.4;5.2.4 Specific Problems with Early Use of Total Ankle Implants;66
9.3;5.3 Second-Generation Total Ankle Arthroplasty – Uncemented Type;67
9.3.1;5.3.1 Basic Biomechanical Considerations in New Prosthetic Designs;67
9.3.2;5.3.2 Two-Component Designs;68
9.3.3;5.3.3 Three-Component Designs;69
9.3.4;5.3.4 First Results;69
9.3.5;5.3.5 Critical Issues in Second-Generation Total Ankle Replacement;70
9.4;5.4 Conclusions;71
9.5;References;71
10;Chapter 6 Current Designs of Total Ankle Prostheses;77
10.1;6.1 AES® Ankle;77
10.1.1;6.1.1 Background and Design;77
10.1.2;6.1.2 Results;78
10.1.3;6.1.3 Concerns;78
10.2;6.2 AGILITY Ankle;79
10.2.1;6.2.1 Background and Design;79
10.2.2;6.2.2 Results;80
10.2.3;6.2.3 Concerns;81
10.3;6.3 Buechel-Pappas Ankle;82
10.3.1;6.3.1 Background and Design;82
10.3.2;6.3.2 Results;83
10.3.3;6.3.3 Concerns;84
10.4;6.4 ESKA Ankle;86
10.4.1;6.4.1 Background and Design;86
10.4.2;6.4.2 Results;86
10.4.3;6.4.3 Concerns;88
10.5;6.5 HINTEGRA® Ankle;88
10.5.1;6.5.1 Background and Design;88
10.5.2;6.5.2 Results;90
10.5.3;6.5.3 Concerns;90
10.6;6.6 Ramses Ankle;93
10.6.1;6.6.1 Background and Design;93
10.6.2;6.6.2 Results;95
10.6.3;6.6.3 Concerns;95
10.7;6.7 SALTO® Ankle;96
10.7.1;6.7.1 Background and Design;96
10.7.2;6.7.2 Results;96
10.7.3;6.7.3 Concerns;96
10.8;6.8 S.T.A.R. Ankle;98
10.8.1;6.8.1 Background and Design;98
10.8.2;6.8.2 Results;99
10.8.3;6.8.3 Concerns;100
10.9;6.9 TNK Ankle;102
10.9.1;6.9.1 Background and Design;102
10.9.2;6.9.2 Results;102
10.9.3;6.9.3 Concerns;105
10.10;6.10 Conclusions;105
10.11;References;106
11;Chapter 7 Preoperative Considerations for Total Ankle Arthroplasty;109
11.1;7.1 Indications;109
11.2;7.2 Contraindications;110
11.3;7.3 Considerations Specific to Total Ankle Replacement Surgery;111
11.3.1;7.3.1 Rheumatoid Arthritis and Inflammatory Arthropathy;111
11.3.2;7.3.2 Infection;111
11.3.3;7.3.3 Osteopenia and Osteoporosis;113
11.3.4;7.3.4 Weight Restrictions;113
11.3.5;7.3.5 Adjacent Joint Arthritis;115
11.3.6;7.3.6 Lower Limb, Ankle, or Hindfoot Malalignment;116
11.3.7;7.3.7 Hindfoot-Ankle Instability;116
11.3.8;7.3.8 Heel Cord Contracture;119
11.3.9;7.3.9 Soft-Tissue Considerations;119
11.3.10;7.3.10 Age Considerations;119
11.3.11;7.3.11 Activity Limitations;120
11.3.12;7.3.12 Smoking;121
11.4;7.4 Conclusions;121
11.5;References;121
12;Chapter 8 Surgical Techniques;123
12.1;8.1 Preoperative Planning;123
12.2;8.2 Surgical Approach to the Ankle;123
12.2.1;8.2.1 Anterior Approach to the Ankle;123
12.2.2;8.2.2 Lateral Approach to the Ankle;126
12.2.3;8.2.3 Complications;126
12.3;8.3 Surgical Preparation of the Ankle;126
12.4;8.4 Insertion of the Implants;131
12.5;8.5 Wound Closure;134
12.6;8.6 Additional Surgeries;135
12.6.1;8.6.1 Lateral Ligament Reconstruction;135
12.6.2;8.6.2 Peroneal Tendon Transfer;137
12.6.3;8.6.3 Dorsiflexion Osteotomy of the First Metatarsal;137
12.6.4;8.6.4 Valgisation Osteotomy of the Calcaneus;138
12.6.5;8.6.5 Medial Ligament Reconstruction;138
12.6.6;8.6.6 Medial Sliding Osteotomy of the Calcaneus;138
12.6.7;8.6.7 Hindfoot Fusion;138
12.6.8;8.6.8 Heel Cord Lengthening;139
12.7;8.7 Conclusions;139
12.8;References;144
13;Chapter 9 Postoperative Care and Follow-up;145
13.1;9.1 Postoperative Care;145
13.2;9.2 Rehabilitation Program;146
13.3;9.3 Follow-up Examination;146
13.3.1;9.3.1 Clinical Assessment;146
13.3.2;9.3.2 Radiographic Measurements;147
13.4;9.4 Conclusions;151
13.5;References;151
14;Chapter 10 What is Feasible in Total Ankle Arthroplasty?;153
14.1;10.1 Reconstruction of the Malaligned Ankle;153
14.1.1;10.1.1 Varus Malalignment;153
14.1.2;10.1.2 Valgus Malalignment;157
14.1.3;10.1.3 Sagittal Plane Malalignment;159
14.2;10.2 Reconstruction of the Post-Traumatic Hindfoot and Ankle;159
14.2.1;10.2.1 Fibular Malunion;160
14.2.2;10.2.2 Tibiofibular Instability (Syndesmotic Incompetence);162
14.2.3;10.2.3 Calcaneal Malunion;163
14.3;10.3 Specific Articular Pathologies and Disorders;168
14.3.1;10.3.1 Systemic Inflammatory Arthritis;168
14.3.2;10.3.2 Clubfoot Deformity;170
14.3.3;10.3.3 Post-Polio Foot Deformity;170
14.3.4;10.3.4 Avascular Necrosis;170
14.3.5;10.3.5 Septic Arthritis;173
14.4;10.4 Disarthrodesis;176
14.5;10.5 Revision Arthroplasty (for Failed Primary Arthroplasty);177
14.6;10.6 Conclusions;180
15;Chapter 11 Complications of Total Ankle Arthroplasty;181
15.1;11.1 Characteristics of Ankle Osteoarthritis;181
15.1.1;11.1.1 Primary Osteoarthrosis of the Ankle;181
15.1.2;11.1.2 Post-Traumatic Osteoarthrosis of the Ankle;181
15.1.3;11.1.3 Rheumatoid Arthritis of the Ankle;181
15.2;11.2 Patient Selection;183
15.2.1;11.2.1 Age of the Patient;183
15.2.2;11.2.2 Weight of the Patient;183
15.3;11.3 Preoperative Conditions and Planning;183
15.3.1;11.3.1 Soft-Tissue Conditions;183
15.3.2;11.3.2 Malalignment and Malunion;183
15.3.3;11.3.3 Preoperative Foot Deformity;185
15.4;11.4 Implant- and Implantation-Related Complications;186
15.4.1;11.4.1 Problems with First-Generation Total Ankle Prostheses;186
15.4.2;11.4.2 Problems with Second-Generation Total Ankle Prostheses;186
15.5;11.5 Early Postoperative Complications;193
15.5.1;11.5.1 Wound Healing Problems;193
15.5.2;11.5.2 Swelling;194
15.5.3;11.5.3 Infection;194
15.5.4;11.5.4 Deep Venous Thrombosis;194
15.5.5;11.5.5 Syndesmotic Nonunion / Instability;194
15.5.6;11.5.6 Fractures of Malleoli;194
15.6;11.6 Late Postoperative Complications;194
15.6.1;11.6.1 Loss of Motion;194
15.6.2;11.6.2 Aseptic Loosening;196
15.6.3;11.6.3 Subsidence;198
15.6.4;11.6.4 Polyethylene Wear;199
15.7;11.7 Salvage of Failed Total Ankle Arthroplasty;199
15.8;11.8 Conclusions;199
15.8.1;11.8.1 Requirements for Successful Total Ankle Arthroplasty;201
15.8.2;11.8.2 Surgeon Experience, Skill, and Training;201
15.9;References;201
16;Chapter 12 Future Directions;203
16.1;12.1 Current Concerns to be Addressed;203
16.1.1;12.1.1 Prospective Studies;203
16.1.2;12.1.2 Prosthetic Design;203
16.1.3;12.1.3 Preoperative Planning and Implantation Technique;203
16.1.4;12.1.4 Polyethylene Wear;204
16.1.5;12.1.5 Stability of Bone-Implant Interface;204
16.2;12.2 Further Success will Increase Patient Demand;204
16.3;12.3 Further Research;204
16.4;12.4 Conclusions;205
17;Subject Index;207

Leseproben

Chapter 8 SURGICAL TECHNIQUES (p. 105)

Although many surgical approaches have been described in the literature, most current total ankle prostheses are implanted using the standard anterior ankle approach. Because of the fragility of the soft tissues around the ankle, however, and scars from previous injuries or surgeries, the approach sometimes demands a modified technique in order to prevent wound healing problems. Various techniques are used to implant current ankle prostheses. In most cases, however, a jig is used to align a tibial resection block with respect to the longitudinal axis of the tibia. Talar resection is made, to some extent, as a free-hand surgery. In some cases (with the AGILITYTM ankle, for example), an external fixator/ distractor is used to realign the ankle and tension the ligaments.

8.1 Preoperative Planning

Recognizing critical preoperative risk factors and doing careful preoperative planning are important factors for limiting complications and obtaining satisfactory results. Meticulous clinical and radiological assessment is required. Clinically, the surgeon should examine and document the softtissue conditions, hindfoot alignment, ankle stability, foot deformities, foot vascularization, and sensibility. Lateral and anteroposterior weightbearing radiographs of the foot and ankle are mandatory, and may help to identify possible osteoarthritis in adjacent joints, as well as varus and valgus deformities of the hindfoot and longitudinal arch. The use of MRI may also help to determine the condition of the subchondral bone, particularly with respect to potential osteonecrosis.

8.2 Surgical Approach to the Ankle

Most of the current total ankle prostheses (the Buechel-PappasTM ankle [15], the HINTEGRA® ankle [8], the TNK ankle [19], the Ramses ankle [16], the SALTO® ankle [2], and the S.T.A.R. ankle [14]) are implanted using the standard anterior ankle approach, which uses a single incision between the anterior tibial and extensor hallucis longus tendons. The AGILITYTM ankle uses the same anterior incision, as well as a lateral incision over the distal fibula to mobilize and bridge the tibiofibular syndesmosis [17]. The ESKA ankle, by contrast, is implanted using a single lateral (transfibular) approach [18].

8.2.1 Anterior Approach to the Ankle

The patient is positioned supine, with the heel of the foot on the edge of the table. A support beneath the ipsilateral hip, and/or tilting the table serves to get the foot in an upright position so that the ankle is seen from the front side of the leg (Fig. 8.1). A longitudinal skin incision is made over the center of the ankle (Fig. 8.2), taking care to identify and retract the medial branch of the superficial peroneal nerve (Fig. 8.3). The approach is made longitudinally between the extensor hallucis longus and anterior tibial tendons, through the tendon sheet of the extensor hallucis longus [5, 21] or of the anterior tibial tendon [8, 10]. Once the distal tibia is exposed just beneath the anterior tibial tendon ("safety area"), the soft tissues are pushed sideways using a raspatory subperiosteally. Then, the neurovascular bundle is retracted laterally, and two Hohmann retractors are inserted (Fig. 8.4). The ankle capsule is incised vertically over the midpoint of the ankle. Note that it may be necessary to excise the central part of this capsule to gain good exposure.