Endoprothetik am rheumatischen oberen Sprunggelenk: Historie und Zukunftsperspektive

Abstract

Summary Reconstructive surgery with an ankle prosthesis for a painful ankle joint is of extreme benefit for the rheumatoid patient. In contrast to ankle fusion, ankle arthroplasty maintains mobility with early remobilisation of the patient. The success of ankle arthroplasty depends on indication, implant design and surgical technique as well as postoperative treatment. The performance of the first ankle prosthesis generation, developed in the early 1970s, was poor, being plagued by high loosening and revisions rates up to 50%. The two main reasons for failure were constrained designs and cement fixation. Buechel and Pappas, with the BP-ankle prosthesis and H. Kofoed with the S.T. A.R.-prosthesis first developed the second generation of ankle prosthesis. The three-component type consists of amobile polymeric bearing that is interposed between the flat metallic tibial and the metallic talar component. The key of success has been the use of a meniscal bearing device that provides unconstrained motion and stability. In the last 10 years, the ankle prostheses currently used have achieved encouraging midterm results. Despite all the progress in ankle arthroplasty made over the last few years, there remain some drawbacks concerning malleolar fracture, stiff ankle joint and impingement. Based on their experience with the current ankle prosthesis designs, the authors developed a new ankle prosthesis design. The in vitro testing was promising and we hope to report our first clinical results soon.