Total Ankle Arthroplasty has become a viable option for selected patient with an end-stage ankle osteoarthritis. This presentation presents the product details of the AAA Triple-A ankle arthroplasty

1. Marten Meesweg 8
3068 AV Rotterdam - Alexander
Netherlands
Phone: + 31 (0) 85 303 61 43
Fax: +31 (0) 84 748 51 76
mail: info@caymedic.com
web: www.caymedic.com

2. AAA-Triple A®
Alpha Ankle Arthroplasty

3. Developed by the Triple A Group:
• Prim. Univ. Doz. Dr. Ernst Orthner
• Prim. Dr. Robert Siorpaes
• Univ. Prof. Dr. Michael Fellinger
• Alphamed Fischer GmbH Austria
Manufactured by
• Implantcast GmbH Germany
Marketing by
• CayMedic The Netherlands

4. Coester LM :”Long-term results following ankle arthrodesis for post-traumatic arthritis”
J Bone Joint Surg Am. 2001;83-A(2):219-28.

6.  The last years TAR’s have been developed with better
short and mid term results:
 Main features:
 Anatomical free movement between components
 Avoid the use of bone cement
 Separate the axial rotation from flexion / extension
( = mobile bearing)
Queen : “Patient Reported Outcomes Fixed vs Mobile Bearing TAR” JBJS 2014 Vol 96 pp 987-
Easly M.E. : “Results of Total Ankle Replacements “ JBJS 2011 Vol 93A no 15 pp 1456-

7. ESKA STAR Hintegra Buchel Papas CCI
Taric Salto Agility AAA

8.  Manufacturers of current TAR prescribe in their
“instructions for use” :
 The ideal patient should have :
 No deformities
 No laxities or instabilities
 Mild osteoarthritis
 This means that 90% of the patients with an end stage Ankle AO
will receive an arthrodesis
Krause FG, Schmid T: Ankle arthrodesis versus total ankle replacement: how do I decide? Foot Ankle Clin.
2012;17(4):529-43.

9. Malaligment
Subsidence
Loosening
Fracture of the PE
Unexplained pain
Talar body collapse
Bone cysts

10.  BOX (Bologna Oxford) Rebalance Infinity(fixed )
Eclipse
 Salto

11.  Zimmer Trabecular MetalTotal Ankle (fixed)

12.  Stress shielding?
 PE-wear reaction?
 Loose component?
 Micro movement?
Dalat F -- Histologic study of periprosthetic osteolytic lesions after AES total ankle replacement
Orth Traum Surge Research 2013 Vol 99 Iss 6 pp S286-
Jensen J “Evaluation of periprosthetic bone cysts in patients with a Scandinavian total ankle replacement”
AJR Am J Roentgenol. 2014 Oct;203(4):863-8. doi: 10.2214/AJR.13.11539.

13. Conclusion:
We suggest that PE particles are not the primary cause of osteolytic cyst formation but a
secondary contributing factor probably accelerating the process of osteolysis. It is likely that
implant design, biomechanical factors and local anatomic-physiological factors play an
important role.

14.  Most designs articulate between tibia and
bearing with two plane (flat) surfaces
 Two flat surface under high load yield
high frictional forces
 In theTriple A most of the movements do
not take place between tibial component
and bearing but between the polyethylene
bearing and the talar component

15.  Use of Image Intensifier is
mandatory for accurate
placement and alignment
over hip-knee-ankle
 Increases the number of
possible indications for
TARs
14-12-2017

16. Slide courtesy of Dr Haverkamp
MC Slotervaart Amsterdam

17.  Problem making the right
posterior talar cut ?
Leave the posterior talus
unresected?
(Taric®, Eclips® EAS® Infinity®)
 AP- Rounded / LM V-shaped
(CCI®, Rebalance®)

18.  Curved in two identical planes
 Makes cylindrical milling possible
 2 Pins of uneven length for primary stability
 Freedom of fine tuning
position followed by
rotational stability

19.  Changing the preparation
for the talar bone from
cutting to a precise
reproducible and
predictable milling
technique over K-wires.

20.  The window for the tibia
stem is used to give
access to the K-wire
 Reamers are guided by
this K-wire

21.  Precise reproducible
and predictable milling
technique under direct
vision
 High initial stability,
reducing chance of
micro motion
 May enable revision of
existing TAR’s

22. Patient 67 years old, Salto TAR implanted in 2001: bearing fracture

25. Full slide presentation of the procedure available

26.  Full stability in extension by full
congruency between Tibia and PE
Bearing
 Rotation between Tibia and PE Bearing
 Dorsiflexion - Plantarflexion between PE
and Talus : “guided gliding”
 Increased LM stability
Why Alpha Ankle Arthroplasty ?

27.  TheTalus matches
the Bearing
 The Bearing will fit
anyTibia (= >)
 2-2-2
 2-2-3 is often
 2-2-4 is possible
 3-3-5 (1 in NL)

28.  3D Printed Talus
component
 Extended stem into
Calcaneus
 Based on CT-scan
 Filling Bone defect
 Customized
instruments
 Porous cpTitanium

31. Xray: 3 months postop

32. 0
10
20
30
40
50
60
70
80
90
100
0-5. 6-10. 11-15. 16-20. 21-25. 26-30. 31-35. 36-40. 41-45. 46-50.
Cases
Slide courtesy of Dr Haverkamp MC Slotervaart Amsterdam

33.  Percutaneus
AchillesTendon
Lengthening (36%)
Slide courtesy of Dr Haverkamp MC Slotervaart Amsterdam

34.  Medial
Malleolus
osteotomy
(30%)
Xrays courtesy of Dr Haverkamp MC Slotervaart Amsterdam

35.  Increasing demand:
 Increasing age
 Increasing weight
 Better informed patients
 Better clinical results

36.  Increasing demand:
 Patient with higher activity levels

37. UK *
2010: 416
2011: 521
2012: 581
2013: 546 (*)
2014: 543
2015: 602
2016: 690
* source: UK National Joint Register 2016
* Mobility® withdrawn from the market
Worldwide growth
 2011 + 9%
 2012 + 15%
 2013 + 5%
 2014 + 30%
 2015 + 33%
 2016 + 36%

38. Netherlands (LROI)
 2014 : 118 (15*)
 2015 : 124 (19*)
 2016 : 163 (37*)
* Revisions

43. Information: https://www.facebook.com/tripleaankle/

44. Marten Meesweg 8
3068 AV Rotterdam - Alexander
Netherlands
Phone: + 31 (0) 85 303 61 43
Fax: +31 (0) 84 748 51 76
mail: info@caymedic.com
web: www.caymedic.com