LONG-TERM OUTCOMES OF THE HINTEGRA TOTAL ANKLE ARTHROPLASTY: A TEN-YEAR MINIMUM FOLLOW-UP STUDY

Introduction: The HINTEGRA is a third-generation, mobile-bearing total ankle replacement (TAR) that has been popular in the UK. We present the long-term outcomes with a minimum of follow-up period of 10-years. Method: In this prospective single-centre cohort study, all HINTEGRA TARs performed between 2010–2014 were analysed. Demographics, complications (Glazebrook classification), reoperations and revisions (COFAS classification), and patient-reported outcome measures (PROMS) were collected. Survivorship was assessed using Kaplan-Meier analysis. A total of 69 patients (70 ankles) were included. Mean age was 69 years (48-84 years). 21 patients died (30%) and 8 patients were lost to follow-up. Results: Implant survivorship was 81.7% at 5 years (mean 6.4 years), and 71.7% at 10 years (mean 12.3 years, 10.1-14.3 years). Complications included low (12.9%), medium (2.8%), and high-grade events (18.6%), with aseptic loosening being the most common serious complication (12.9%). Revision surgery was performed in 16 ankles (22.9%). Non-revision procedures were carried out in 9 patients (12.9%) with majority being cyst debridement and grafting (n=6, 8.6%). Periprosthetic cysts were identified in 36 patients (51.4%), most were asymptomatic and located in the tibia. Average volumes measured on CT scan for tibial, talar and fibular cysts were 1.5 cm³, 1.9 cm³, and 1.1 cm³ respectively. Indication of grafting of cysts were symptomatic ankles with stable implants, and/or >50% weight-bearing surface and/or expanding in size. (n=6). Graft incorporation was variable, irrespective of impaction autograft or synthetic graft. Loose implants with cysts prompted revision arthroplasty (n=7) and tibiotalar joint fusion (n=1). Conclusion: The 10-year survivorship of the HINTEGRA TAR was 71.7%. We identified high rates of periprosthetic cysts and would recommend a low threshold for radiographic surveillance. Disclosures: The authors declare no competing interests relating to this study. DT, RK, AM are paid consultants for Stryker and Exactech.