The Hintegra total ankle replacement: survivorship, failure modes and patient reported outcomes in seventy consecutive cases with a minimum five year follow-up

Purpose

The Hintegra total ankle replacement (TAR) has been widely used worldwide for ankle arthroplasty since its introduction in 2000. The implant survivorship, patient reported outcomes, rate of periprosthetic cyst formation and reoperation rates are variably reported. The purpose of this study is to determine the functional outcomes and survivorship of the Hintegra TAR, in consecutive cases by multiple surgeons in a single UK institution, with a minimum of five year follow-up.

Methods

A retrospective review of prospectively collected data for 70 consecutive Hintegra TAR cases performed between 2010 and 2014. Data collected included patient demographics, complications, reoperations, revisions and patient reported outcome measures (PROMS: AOS, MOX-FQ, pain VAS and EQ-5D 3L).

Results

Seventy patients underwent Hintegra TAR (54 male/16 female) with an average age of 69 (range 48–84 years). Mean follow up was 76 months (range 60–104), 10 patients died during the follow-up. Implant survivorship was 81.7% at most recent follow-up. The commonest radiographic finding was periprosthetic cysts (n = 28, 40%): size range (7–40 mm). Nine patients required re-operation: six periprosthetic cyst debridement and grafting at a mean of 61 months (range 27–91), one lateral gutter debridement, one periprosthetic fracture and one debridement for deep infection. PROMS data was available for the majority of patients. Mean final follow-up scores were total AOS 35 (range: 0–97), MOX-FQ 36 (range: 2–93), pain VAS 34.6 (range: 0–100) and EQ-5D 3L Index 0.69 (range: 0.08–1.00).

Conclusion

Our experience demonstrates implant survivorship similar to other TAR studies. We have identified a high incidence of periprosthetic cysts and would recommend ongoing surveillance of these patients.