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Friedrichstraße 134, 10117 Berlin

Minimal-Invasive Ankle Arthroplasty

Problem definition

The ankle arthroplasty has increased in the recent years however not all problems have been resolved or expectations been met.

The thin soft tissue surrounding the ankle with pre-existing scars from previous injuries or surgeries could lead to critical wound healing and could restrict the possible outcome.

There is a high expectation amongst younger patients regarding a short hospital stay and post-operative treatment. Older patients with additional medical conditions are required to achieve quicker mobilization and uncomplicated further treatments either in their home environment or in rehabilitation.

In addition, all patients expect little post-operative pain intensity and an uncomplicated healing process. Therefore Dr Boack has developed the world’s first Minimal-Invasive Surgical Procedure in TAA, which meets the expectations of the patients.


After the evaluation of 200 conventional inserted ankle prosthesis and an additional 100 endoprosthesis with minimized approach.  This resulted in the development of the new surgical technique.

In 2007 and 2008, approximately 200 ankle prostheses were inserted. 18% of these operations were selected for the keyhole technique and they were all successfully implemented.

With the Minimal-Invasive Surgery (MIS-TAA) the incision is approximately 5-6cm.  This is a 2/3 reduction of the conventional incision. During the soft-tissue preparation, the following criteria are taking into consideration:

The extensor tendon was left in their tendon sheaths.  Exploration of the ankle situs was performed in “moving windows technique“, which means without continuous soft tissue distraction or use of a spreader. With the assistance of special adapted tools and adequate skill, no additional incisions were needed to be made.

The TAA could be inserted through that small incision in press-fit technique. Once the implantation has been inserted, a four-layer wound closure and appropriate post-operative treatment was implemented.


All MIS-TAR-Implantation were performed successfully. A change to conventional surgical technique was not necessary. The number of additional procedures remained the same as in the conventional open technique and total operation time was not extended.

No patient experienced wound complications or infections (Purulent Inflammation) and there were significantly fewer problems than with the conventional technique. Therefore patients could start with mobilization and physical therapy much earlier. Patients were discharged from the 5th day in hospital.

The MIS-TAA in follow-up examination showed a correct prosthetic position of the Ankle mortise. Patients were extremely satisfied with the cosmetic result and achieved a good ankle movement of an average of 47°.


The new Minimal-Invasive Ankle Arthroplasty technique allows Dr Boack to perform additional 2-4 surgeries per week. Due to the improved surgical technique, post-operative complication can be reduced which results in an earlier mobilization and hospital discharge.