Komplikationen und Revisionseingriffe nach OSG-Totalendoprothesen

Total ankle arthroplasty has shown rapidly increasing acceptance in the last five years. Due to the increasing number of implantations, the experience and the learning curve are responsible for the success of these surgical procedure. Nevertheless, a higher rate of pitfalls and failures may be expected. The possible intra- and postoperative complications in total ankle arthroplasty, their sources of failure and the revision options are demonstrated. From 7/97 to 11/03, 147 S.T.A.R. prosthesis in 144 patients (69 f, 75 m) were implanted in our hospital. The mean age at primary surgery was 57.7 years (min. 24, max. 82 years). The necessary revision surgery was performed 1.2 years after primary implantation. Especially preexisting scars due to prior surgical procedures cause intra- and postoperatively complications (De' Orio 2003). Thus, troubles in wound healing (n: 31) are often described in patients, where intraoperatively the soft tissue suffered from an inadequate trauma. In our cohort, late complications included persisting intraarticular synovitis, especially in rheumatoid arthritis patients, an impingement (n: 4) and an above average apparent wear of the PE gliding core (n: 2) with early signs of lucency and a following osteolysis. Revision surgery (3 synovectomies/tenosynovectomies, 2 lengthenings of the Achilles tendon with a dorsal capsulotomy, subtalar arthrodesis, 4 revisions of the PE gliding core, 3 revisions of singular components, 2 complete revisions of the prosthesis, 2 ankle fusions) more than three months after primary implantation was indicated by persisting or acute pain and joint failures. A total of 23 revisions of the 147 patients were performed (15.6%). Only in 10 cases (6.8%) these complications and the following surgical procedures influenced the satisfaction of the patients. The existing midterm results and the review of the data verify that total ankle arthroplasty is more than an alternative to open ankle arthrodesis in the progressive phases of arthritic joint destruction, and as the last salvage procedure it can be followed by a secondary necessary arthrodesis. Die endoprothetische Versorgung des oberen Sprunggelenkes hat in den vergangenen 5 Jahren eine rasante Akzeptanz entwickeln lassen. Die gesteigerten Implantationszahlen und die damit verbundene zunehmende Erfahrung und „learning curve” sind ausschlaggebend für die erzielten Erfolge der OSG-Totalendoprothesen. Gleichzeitig ist mit einem vermehrten Potential an Fehlschlä