“Posterior Talar Shifting in Mobile-Bearing Total Ankle Replacement”, a small but significant result thanks to my team’s collaboration.

Usuelli FG1, Maccario C2, Manzi L3Tan EW4

The theme of this publication is: prosthesis of the ankle.


Dear friends, it is with great pride that I announce the publication this article, drafted in collaboration with my equip, on the “Foot Ankle International”, one of the most important and influential orthopaedic journals.
The theme of this publication is: prosthesis of the ankle.
In detail, we are presenting an analysis of the largest case history pertaining to this field. An important and demanding project, to which the entire equip, with great passion, has dedicated much time and effort including the sacrifice of their own personal time.
Being a surgeon today cannot be reduced to just operating and healing.
The true challenge is that of reaching the scientific demonstration of one’s work. To present and to share one’s work is, in my opinion, not just an obligation but the greatest compensation.
Ideas whose veracity can be proven through characteristics, precise and unequivocal methods, which we hope can be useful to all colleagues interested in comprehending the healing advantage of ankle prosthesis.

The article entitled “Posterior Talar Shifting in Mobile-Bearing Total Ankle Replacement” presents considerations from 66 ankle prosthesis surgeries taken as example from a batch of 80 Hintegra, total ankle replacement prosthesis that I have performed during the last three years. This is certainly the most voluminous group of cases ever to be analysed in Italy. A project of which I am particularly proud of due to the fact that as of today, our publication is one of the few rare texts written in Italy regarding ankle prosthesis.

Furthermore it is, unfortunately, common knowledge that to participate in a science based project is both rare and difficultly published.
Too often, it hurts to confirm this, very little importance is given to a data analysis such as ours. It is especially disappointing to know about the difficulties in recording data in time without loosing follow ups and rigorous in following the patient. Teamwork and much dedication are certainly necessary for succeeding in this intent. And of this we are all very much proud!
Our analysis focuses its attention primarily on all pertaining the ‘behaviour’ of the prosthetic implant through time.
We have found differences between the hintegra mobile-bearing frontal access prosthesis and TM ankle fix bearing through lateral access.
These are the only two implants I normally use in my surgeries. My choice is discerned by the conditions presented in each different case along with the seriousness of the deformities that seek to be realigned.

The characteristics that emerged, and that are described in our article, are something that we have defined as ‘shifting’. By utilizing mobile bearing prosthesis there is a tendency of the talar component of the implant to stabilize itself with time and thus to re-align the biomechanics tibiular axis during the period between the third and sixth month after surgery due to muscular rebalancing. This is the reason why I believe that frontal approach must always be associated with a mobile bearing implant.
Our commitment to this research is not over. We are working on other projects with much passion and dedication also thanks to the important success that has given us vigour and optimism for the future.