Long-Term Clinical Outcomes and Implant Survivorship of 151 Total Ankle Arthroplasties Using the HINTEGRA Prosthesis: A Minimum 10-Year Follow-up

J Bone Joint Surg Am. 2022 Aug 17;104(16):1483-1491. doi: 10.2106/JBJS.22.00060. Epub 2022 Jun 20.


Background: Few studies have investigated long-term clinical outcomes of a mobile-bearing total ankle arthroplasty (TAA) system. This study analyzed long-term outcomes of TAA using the HINTEGRA prosthesis at a single, non-developer center.

Methods: Primary TAAs were performed on 213 ankles in 194 patients, and 151 consecutive ankles [71%] in 136 patients with a minimum follow-up of 10 years after the primary TAA were included in this study. Clinical results were assessed using a visual analog scale (VAS) pain score, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale score, the Ankle Osteoarthritis Scale (AOS) pain and disability subscores, and ankle range of motion. Prosthesis survivorship, reoperations, and risk factors were also evaluated.

Results: The mean follow-up was 135.5 months (range, 120.0 to 204.0 months). All clinical scores and ankle range of motion improved significantly from preoperatively to 2 years, 4 to 6 years, and ≥10 years after TAA (p < 0.001). A total of 43 ankles (28.5%) required revision procedures, with the most common reason being periprosthetic osteolysis (32 ankles [21.2%]). The overall implant survivorship was 93.5% in Kaplan-Meier survival analysis at the mean follow-up of 11.3 years after the TAA.

Conclusions: TAA using the HINTEGRA prosthesis with careful follow-up observation and appropriate adjunct procedures for the treatment of end-stage ankle arthritis produced satisfactory clinical results, which were maintained at a follow-up of ≥10 years, and resulted in 93.5% of implant survivorship.

Level of evidence: Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Ankle / surgery
  • Ankle Joint / surgery
  • Arthroplasty, Replacement, Ankle* / methods
  • Follow-Up Studies
  • Humans
  • Joint Prosthesis*
  • Osteoarthritis* / etiology
  • Osteoarthritis* / surgery
  • Pain / etiology
  • Prosthesis Design
  • Retrospective Studies
  • Survivorship
  • Treatment Outcome