Introduction by Ernst Orthner, Univ Prof MD in Wells Austria

AAA Triple A® Ankle replacement

" Stimulated by the success with hip- and knee replacement Total Ankle Replacements was first tried in the early 1970's. The high failure rate (1,2,3) of 72% revisions and arthrodeses lead to the conclusion that arthrodesis was the choice for the patient with an osteoarthritic ankle. When in the late 1980's more anatomical ankle designs with mobile bearings were introduced (4,5) it showed that Total Ankle Arthroplasty can be a viable option in selected patients"

" Based on our experiences with other Total Ankle Designs (6) I formed a design team with my colleagues and we came to the conclusion that there was room for substantial improvement in design, instrumentation and surgical technique.

Our goal was to provide a Total Ankle Replacement with the following criteria:

  • Wider range of indications. To date the application of many designs is limited to those patients with correct alignment, no ligamentous laxity, a good range of motion, and no pronounced deformation In my patient population that would have meant that around 90% of my patients would have received an arthrodesis. The reality is that 90% of my patients have received an AAA Triple A® Total Ankle Replacement and 10% were arthrodesed.
  • Increasing the joint stability in extension without compromising the free anatomical movements or the plantar- and dorsiflexion
  • Referencing the bone cuts and the ligamentous balancing not from the tibia, but from the full leg length to allow the use of TAR also in patient with bone deformation.
  • Reduce or change the talar cuts to improve the possibilities of revision arthroplasty and improve the possible outcome of an arthrodesis in case this would be the choice for the revision

" Between 1999 and June 2011, I performed 456 Total Ankle Replacements ( 283 Salto , 48 Star, Hintegra and Buechel Pappas and 125 AAA Triple A® ) . To date my records of the AAA Triple A® show close to 250 AAA Triple A® implantations with up to 5 years follow-up. This website is designed to inform, give you the design rationale, the description of the surgical technique and information about our clinical experiences."

Ernst Orthner , Univ Prof. MD
Footcentre Wels and Klagenfurt
Vogelweiderstrasse 3B
4600 Wels


(1) Bolton-Maggs B.G. et al: "Total Ankle Arthoplasty A Long Term review of the London Hosptal Experience" J Bone Jpoint Surg 1985 Vol 67B no 5 pp 785-790

(2) Gougoulias N. et al : "How Succesfull are Current Ankle Replacements? A systemic Review of the Literature"Clin Orthop Relat 2010 Vol 468 pp 199-208
(3) Newton S.E,. "Total Akle Arthroplasty, Clinical Study of fifty cases"J. Bone Joint Surg 1982 Vol 64A no 1 pp 104-111
(4) Pappas M. et al : "Cylindrical Total Ankle Replacement, Surgical and Biomechanical Rationale "Clin Orthop Relat 1976 Numbr 118 pp 82-92
(5) Beuchel F.F. et al : "10 Year evaluation of Cementless Buechel-Pappas Meniscal Bearing Total Ankle Replacement" Foot & Ankle International 2003 Vol 24 no 6 pp 462-472

(6) Orthner E. : "Complications after Total Ankle Arthroplasty" (article in German) Fuss & Sprunggelenk 2001 Vol 9 pp 202-215