Total Ankle Arthroplasty has become a viable option for selected patient with an end-stage ankle osteoarthritis. This presentation presents the product details of the AAA Triple-A ankle arthroplasty
3. Developed by the Triple A Group:
• Prim. Univ. Doz. Dr. Ernst Orthner
• Prim. Dr. Robert Siorpaes
• Univ. Prof. Dr. Michael Fellinger
• Alphamed Fischer GmbH Austria
Manufactured by
• Implantcast GmbH Germany
Marketing by
• CayMedic The Netherlands
4. Coester LM :”Long-term results following ankle arthrodesis for post-traumatic arthritis”
J Bone Joint Surg Am. 2001;83-A(2):219-28.
5.
6. The last years TAR’s have been developed with better
short and mid term results:
Main features:
Anatomical free movement between components
Avoid the use of bone cement
Separate the axial rotation from flexion / extension
( = mobile bearing)
Queen : “Patient Reported Outcomes Fixed vs Mobile Bearing TAR” JBJS 2014 Vol 96 pp 987-
Easly M.E. : “Results of Total Ankle Replacements “ JBJS 2011 Vol 93A no 15 pp 1456-
8. Manufacturers of current TAR prescribe in their
“instructions for use” :
The ideal patient should have :
No deformities
No laxities or instabilities
Mild osteoarthritis
This means that 90% of the patients with an end stage Ankle AO
will receive an arthrodesis
Krause FG, Schmid T: Ankle arthrodesis versus total ankle replacement: how do I decide? Foot Ankle Clin.
2012;17(4):529-43.
12. Stress shielding?
PE-wear reaction?
Loose component?
Micro movement?
Dalat F -- Histologic study of periprosthetic osteolytic lesions after AES total ankle replacement
Orth Traum Surge Research 2013 Vol 99 Iss 6 pp S286-
Jensen J “Evaluation of periprosthetic bone cysts in patients with a Scandinavian total ankle replacement”
AJR Am J Roentgenol. 2014 Oct;203(4):863-8. doi: 10.2214/AJR.13.11539.
13. Conclusion:
We suggest that PE particles are not the primary cause of osteolytic cyst formation but a
secondary contributing factor probably accelerating the process of osteolysis. It is likely that
implant design, biomechanical factors and local anatomic-physiological factors play an
important role.
14. Most designs articulate between tibia and
bearing with two plane (flat) surfaces
Two flat surface under high load yield
high frictional forces
In theTriple A most of the movements do
not take place between tibial component
and bearing but between the polyethylene
bearing and the talar component
15. Use of Image Intensifier is
mandatory for accurate
placement and alignment
over hip-knee-ankle
Increases the number of
possible indications for
TARs
14-12-2017
17. Problem making the right
posterior talar cut ?
Leave the posterior talus
unresected?
(Taric®, Eclips® EAS® Infinity®)
AP- Rounded / LM V-shaped
(CCI®, Rebalance®)
18. Curved in two identical planes
Makes cylindrical milling possible
2 Pins of uneven length for primary stability
Freedom of fine tuning
position followed by
rotational stability
19. Changing the preparation
for the talar bone from
cutting to a precise
reproducible and
predictable milling
technique over K-wires.
20. The window for the tibia
stem is used to give
access to the K-wire
Reamers are guided by
this K-wire
21. Precise reproducible
and predictable milling
technique under direct
vision
High initial stability,
reducing chance of
micro motion
May enable revision of
existing TAR’s
22. Patient 67 years old, Salto TAR implanted in 2001: bearing fracture
26. Full stability in extension by full
congruency between Tibia and PE
Bearing
Rotation between Tibia and PE Bearing
Dorsiflexion - Plantarflexion between PE
and Talus : “guided gliding”
Increased LM stability
Why Alpha Ankle Arthroplasty ?
27. TheTalus matches
the Bearing
The Bearing will fit
anyTibia (= >)
2-2-2
2-2-3 is often
2-2-4 is possible
3-3-5 (1 in NL)
28. 3D Printed Talus
component
Extended stem into
Calcaneus
Based on CT-scan
Filling Bone defect
Customized
instruments
Porous cpTitanium