Ten Year Experience with the STAR Total Ankle Replacement

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Ten Year Experience with the STAR Total Ankle Replacement

  1. 1. Panarab 2010 Marrakech Ten year experience with the STAR total ankle replacement Christian A. Kinast , Johannes Hamel Orthopedic Center Arabellapark Munich www.oza-m.de
  2. 2. STAR – total ankle replacement C.Kinast - Munich Germany Malalignement of the TAR Soft tissue balancing in ankle malalignement
  3. 3. STAR loosening / complications C.Kinast - Munich Germany Literature: 5 – 13 % Kofoed Hintermann Woods Valdeberano <ul><li>OZA Munich Kinast Hamel </li></ul><ul><li>N = 253 </li></ul><ul><li>Exchange </li></ul><ul><li>Fusion ( diabetes ) </li></ul><ul><li>Large subsidence talar component </li></ul><ul><li>skinnecrosis 5 plastic surgery </li></ul><ul><li>revisions: soft tissue balancing , ossifications </li></ul>
  4. 4. C.Kinast - Munich Germany Frohmader 67 mt p.o. STAR periarticular ossifications
  5. 5. STAR tibial plate osseus reactions C.Kinast - Munich Germany Trabeculae centered to the bolts Male 70y 9 y postop ? subsidence of talar component
  6. 6. STAR talar component C.Kinast - Munich Germany Cystic lesions Cystic lesions 61 y male 10y postop
  7. 7. STAR - alignement – additional osteotomies C.Kinast - Munich Germany
  8. 8. STAR soft tissue balancing C.Kinast - Munich Germany Varus : distal advancement of the med. mall. ptt lengthening , n. tibialis release att transfer to the lat cuneiforme per.long. tend. transfer to the fibula
  9. 9. STAR - alignement changes C.Kinast - Munich Germany Angerer calcaneus osteotomy, dorso-med. release, ant tib. tendon transfer , per. Long to brevis transfer
  10. 10. STAR soft tissue balancing C.Kinast - Munich Germany ant tibial tendon transfer n= 32 Hamel J: Fuss & Sprungg 2008
  11. 11. Grgas Balanced foot after attt Lit.: no TAR over 15° varus
  12. 12. STAR soft tissue balancing C.Kinast - Munich Germany Valgus: forefoot plantarisation TN-fusion TC-fusion
  13. 13. STAR soft tissue balancing C.Kinast - Munich Germany Schaller valgus ankle talar cyst
  14. 14. Schaller 1y p.o. Tal-calc fusion bonebloc, plant. Lapidus-Arthrodesis
  15. 15. Conclusions <ul><li>in standard cases the TAR is a surface replacement close to anatomic conditions </li></ul><ul><li>in malalignement additional softtissue balancing is mandatory </li></ul><ul><li>bony and soft tissue additive procedures are nessecary to balance the TAR in a neutral position of muscles, ligaments and tendons </li></ul><ul><li>Early revision is preferable in cases of developing malalignement </li></ul>www.oza-m.de
  16. 16. Orthopedic Center Arabellapark Munich center for foot and ankle center for hip center hand and elbow center for spine and pain therapy www.oza-m.de