Total ankle arthroplasty with ceramic prostheses: A systematic review of medium-term outcomes and failure rates.

Introduction Total ankle arthroplasty (TAA) have been performed in selected patients with end-stage ankle disorders caused by osteoarthritis for over 40 years1. Original implant designs were associated with subsidence and loosening, and failure rates for patients needing reoperation or revision were as high as 8.3–50% over the 5to 12.5-year follow-up1. These failure rates have proposed considerable concern about the long-term results of these prostheses. TAA designs were subsequently developed on the support of several studies of normal ankle biomechanics and a review of earlier implant failures2–4. The present implant designs are either two or three components, with either fixed or mobile bearings, and cementless-type fixation is considered superior by most implant manufacturers and authors2,4–8. In addition, TAA is considered by some to be a reasonable alternative to ankle arthrodesis9,10. Most implants for TAA consist of metallic components11–13. One of these implant designs—HINTEGRA® (Newdeal SA, Lyon, France)—has been implanted since 2000 in Europe, since 2004 in Canada and Korea and since 2005 in Brazil4,14–16 (Figure 1). The treatment with this prosthesis is also reported in National Arthroplasty Registers of Finland17, Sweden18, Norway19 and New Zealand20. The author (CA) and his colleague (TV) performed HINTEGRA® implantation during the cadaveric demonstration in Thailand, January 2013 (Figure 2). The HINTEGRA® prostheses were implanted in a patient in Thailand in 2013. Other implants such as FINE prostheses (Nakashima Medical, Okayama, Japan), which consists of metal tibial and talar components