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HINTEGRA Total Ankle Replacement: Survivorship Analysis in 684 Patients
Alexej Barg, MD1; Lukas Zwicky, MSc2; Markus Knupp, MD2; Heath B. Henninger, PhD3; Beat Hintermann, MD2
1 Orthopaedic Department, University Hospital of Basel, University of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland. E-mail address: alexejbarg@mail.ru
2 Clinic of Orthopaedic Surgery, Kantonsspital Baselland Liestal, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
3 Harold K. Dunn Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108
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Investigation performed at Kantonsspital Baselland Liestal, Liestal, Switzerland

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jul 03;95(13):1175-1183. doi: 10.2106/JBJS.L.01234
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Total ankle replacement is increasingly recommended for patients with end-stage ankle osteoarthritis. We analyzed the survivorship of 722 arthroplasties performed with one type of three-component total ankle prosthesis.


Seven hundred and seventy-nine primary total ankle arthroplasties (741 patients) were performed between May 2000 and July 2010 with use of the HINTEGRA three-component prosthesis. A logistic multiple regression model was used to identify independent risk factors for prosthesis failure in 684 patients (722 ankles). The mean time to final follow-up (and standard deviation) was 6.3 ± 2.9 years.


Seven hundred and twenty-two ankles (684 patients) were available for survivorship analysis at the latest follow-up. The overall survival rates were 94% and 84% after five and ten years, respectively. Sixty-one ankles had a revision arthroplasty (twenty-seven both components, thirteen the tibial component only, and fourteen the talar component only) or were converted to a fusion (seven ankles).There were no polyethylene failures. There were no amputations. The generation category of the prosthesis, the cause of ankle osteoarthritis, and the age of the patient were identified as independent risk factors for prosthesis failure.


The midterm survivorship of the HINTEGRA implant was comparable with that of other third-generation total ankle replacements.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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