> ZIMMER Total Ankle Arthroplasty. Fabian Krause Inselspital, University of Berne

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1 Fabian Krause Inselspital, University of Berne 1

2 > 9/14 > 76 years, female > Posttraumatic end-stage ankle arthrosis > Ankle ROM D/F

3 > 2/15 3

4 > 1/17 > Ongoing anterior ankle pain, ankle ROM restricted, > Night pain gone > Ankle ROM D/F

5 > 11/15 > 66 years, male, diabetes > Bilateral flatfoot, TTA 18 valgus > Ankle ROM

6 > 1/16 6

7 > 1/17 > No pain, hiking for 3 hours > Ankle ROM D/F

8 > Paradigm Shift Lateral transfibular approach Curved implant Minimal resection Coronal rails Implant stability at all interfaces 8

9 Trabecular Metal Material Prolong Poly Ti Tivanium Alloy CoCr Trabecular Metal Material 9

10 10

11 > Porous cellular construct Tantalum > 0.98 coefficient of friction > Long-term biologic ingrowth => vascularization and bone remodeling > >10-year successful clinical history 11

12 > Semi-conforming articular surface Varus Valgus loading Axial rotation A/P translation 12

13 > Restores normal articular anatomy, stability and motion > Frame for accuracy and alignment > Surgical procedure is reliable > Deformities can be corrected 13

14 > Restores normal articular anatomy, stability and motion > Frame for accuracy and alignment > Surgical procedure is reliable > Deformities can be corrected 14

15 > Restores normal articular anatomy, stability and motion > Frame for accuracy and alignment > Surgical procedure is reliable > Deformities can be corrected 15

16 > Restores normal articular anatomy, stability and motion > Frame for accuracy and alignment > Surgical procedure is reliable > Deformities can be corrected 16

17 > Restores normal articular anatomy, stability and motion > Frame for accuracy and alignment > Surgical procedure is reliable > Deformities can be corrected 17

18 > Transfibular approach: Direct visualization: anatomic center of rotation + autocentration capacity of curved implant => superior sagittal alignment, less talus subluxation => equal load distribution => less wear and loosening 18

19 > Increased surface area at boneimplant interface compared to flat cuts > Minimal resection > High Density Bone 19

20 > Lateral transfibular approach: correct deformities > Use old incisions: ankle fractures or reconstructions > May reduce risk of wound healing complications 20

21 > Transfibular approach: Extended posterior release for retractor protection of posteromedial neurovascular bundle => Unfeasible by anterior approach => Superior postop dorsiflexion 21

22 > Lew Schon: > 90 cases: all fibulas healed even with lengthening or realignment 22

23 > Syndesmosis issue 23

24 > Results 1 56 pts., mean follow-up 19 months osseous union of the fibular osteotomy after 4 months in mean radiolucencies in up to 33% in 1 of 6 tibial zones, 12% in 1 of 6 talar zones, mostly asymptomatic painful loosening of the tibial component in 2 pts. 1 Barg A. et a.. Foot Ankle Orthop. (2016) 1 24

25 > Results 1 67 pts., minimum follow-up 12 months AOFAS 33 => 85, VAS pain 8 => 2 1 Usuelly F. et al.. SICOT J. 2016;2:38. 25

26 > Own results As of 1/15 27 pts. in CH (Berne, Thun, Winterthur, Biel, Monthey) osseous union of the fibular osteotomy in all cases Complications: intraop. medial malleolar fracture (2), tibial component subsidence (1), anterior impingement (1), superficial infection (1), early deep infection (1), medial gutter impingement (1), fibula hardware removal (1) 26

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52 > CH: ZIMMER Results Total and Ankle lessons Arthroplasty learnt 52

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55 > Lessons learnt Syndesmosis and fibula healing not an issue Reliable procedure and appropriate alignment with awkward frame Easier to correct deformities Superior ROM (posterior release) Long-term results? Revision implants!!! 55

56 Thank you!

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