Fabian Krause Inselspital, University of Berne 1
> 9/14 > 76 years, female > Posttraumatic end-stage ankle arthrosis > Ankle ROM D/F 10-0-20 2
> 2/15 3
> 1/17 > Ongoing anterior ankle pain, ankle ROM restricted, > Night pain gone > Ankle ROM D/F 10-0-25 4
> 11/15 > 66 years, male, diabetes > Bilateral flatfoot, TTA 18 valgus > Ankle ROM 10-0-15 5
> 1/16 6
> 1/17 > No pain, hiking for 3 hours > Ankle ROM D/F 15-0-30 7
> Paradigm Shift Lateral transfibular approach Curved implant Minimal resection Coronal rails Implant stability at all interfaces 8
Trabecular Metal Material Prolong Poly Ti Tivanium Alloy CoCr Trabecular Metal Material 9
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> Porous cellular construct Tantalum > 0.98 coefficient of friction > Long-term biologic ingrowth => vascularization and bone remodeling > >10-year successful clinical history 11
> Semi-conforming articular surface Varus Valgus loading Axial rotation A/P translation 12
> Restores normal articular anatomy, stability and motion > Frame for accuracy and alignment > Surgical procedure is reliable > Deformities can be corrected 13
> Restores normal articular anatomy, stability and motion > Frame for accuracy and alignment > Surgical procedure is reliable > Deformities can be corrected 14
> Restores normal articular anatomy, stability and motion > Frame for accuracy and alignment > Surgical procedure is reliable > Deformities can be corrected 15
> Restores normal articular anatomy, stability and motion > Frame for accuracy and alignment > Surgical procedure is reliable > Deformities can be corrected 16
> Restores normal articular anatomy, stability and motion > Frame for accuracy and alignment > Surgical procedure is reliable > Deformities can be corrected 17
> 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
> Increased surface area at boneimplant interface compared to flat cuts > Minimal resection > High Density Bone 19
> Lateral transfibular approach: correct deformities > Use old incisions: ankle fractures or reconstructions > May reduce risk of wound healing complications 20
> Transfibular approach: Extended posterior release for retractor protection of posteromedial neurovascular bundle => Unfeasible by anterior approach => Superior postop dorsiflexion 21
> Lew Schon: > 90 cases: all fibulas healed even with lengthening or realignment 22
> Syndesmosis issue 23
> 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
> 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
> 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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> CH: ZIMMER Results Total and Ankle lessons Arthroplasty learnt 52
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> 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
Thank you! fabian.krause@insel.ch