Medium-term results of the HINTEGRA total ankle arthroplasty

Abstract

Objective: The aim of this study was to determine patient satisfaction, survivorship, and revision rate of the HINTEGRA total ankle arthroplasty (TAA). Our secondary objective was to assess hindfoot function. Methods: All patients who underwent a HINTEGRA TAA between 2007 and 2014 were evaluated. We included a total of 69 patients (69 ankles), who were subjected to clinical and radiological examination and completed a visual analogue scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, and the self-reported foot and ankle score (SEFAS). Hindfoot function was assessed using the AOFAS hindfoot score. Mean follow-up was 62 (57–101) months. Results: The mean VAS score was 2 (0–3) and the SEFAS was 37 (26–48) at the most recent follow-up, while the AOFAS ankle score improved from 57 (52–62) to 87 (82–93). The AOFAS hindfoot score improved from 82 to 92 postoperatively. Eight patients had periprosthetic osteolysis and 5 underwent bone grafting of cysts. We detected polyethylene and hydroxyapatite particles in specimens obtained from the cysts. Eight patients had their procedures converted to an ankle arthrodesis. Conclusion: In select patients, TAA improved quality of life. Our medium-term follow-up of the HINTEGRA TAA observed a survivorship of 89% at 5 years with an improvement in the AOFAS score and a mean SEFAS score of 37. We recommend that large periprosthetic cysts, which may be caused by the hydroxyapatite coating and polyethylene particles, be bone grafted prophylactically. We found hindfoot function to be preserved. Level of Evidence IV; Therapeutic Studies; Case Series.

CT Scan Assessment and Functional Outcome of Periprosthetic Bone Grafting After Total Ankle Arthroplasty at Medium-term Follow-up

“…There was no malalignment identified that could have led to cyst formation. 5,21,24,31,36,46,60 Cysts were most often located in the central talus, in zone 6 and 12.…”

“…Cyst location was recorded using Gruen-like zones, from the radiographs. 5,21,24,31,36,46,60 There were no pre-TAA CT scans available for these patients. Seven of the 8 patients had posttraumatic osteoarthritis, whereas 1 had primary osteoarthritis as indication for their TAA.…”

“…The midterm survival rate of total ankle arthroplasty (TAA) has increased to 89%-91% with third-generation implants such as the Hintegra, but complications do occur. 2,5,16,21,29,31,32,39,40,41,48,59…”

“…Periprosthetic cysts have been correlated with TAA failure when more than one-third of the bone implant interface is compromised or cortical lysis occurs, commonly reported with mobile-bearing prosthesis, nonanatomic designs, hydroxyapatite coating, and malalignment. 1,6,31,45 Koivu et al 35 reported that osteolysis was the reason for 75% of revision cases and 43% of failure cases in their review of 130 Ankle Evolutive System (AES; Biomet, Valence, France) replacements. Yang et al 59 reported in their series that periprosthetic cyst grafting was the most common indication for reoperation, with 19 of 210 (9%) Hintegra TAA requiring bone grafting.…”

“…The midterm survival rate of total ankle arthroplasty (TAA) has increased to 89%-91% with third-generation implants such as the Hintegra, but complications do occur. 2,5,16,21,29,31,32,39,40,41,48,59 Periprosthetic cysts are reported to occur in up to 95% of TAA at the medium and long term, with an uncertain significance. 5,8,15,25,30,34-38,43,55, 60 Kohonen et al 33 reported that 34.6% of ankles had at least 1 periprosthetic cyst larger than 10 mm on radiographs at a mean follow-up of 43 months.…”