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Ramses Total Ankle Replacement

The Ramses TAR was developed in 1987 and first implanted in 1989 by a French designer group.1,2 The Ramses TAR is a three-component, semi-constrained prosthesis with a high-density mobile bearing. Initially, cemented fixation of the prosthesis was used between 1980 and 2000.

A total of approximately 350 TARs using the Ramses TAR have been performed by the inventing group. Mendolia et al reported long-term results in 69 patients who underwent Ramses TAR between 1989 and 1993.2 In seven cases, the replaced ankle had to be converted to an ankle arthrodesis (four ankles for pain without loosening and three ankles for clinical and radiographic loosening). In an additional five cases, a second surgery was performed (two cases with mobile bearing ankle replacement and three cases with revision arthroplasties).2

Delagoutte performed a retrospective analysis of 110 TARs between 1991 and 1998.3 This was a multicenter study including 22 hospitals. Three different TAR types were used in this study: Ramses (n=66, 60%), LCS (n=36, 33%), and STAR (n=8, 7%) prosthesis. The follow up varied in this study between 3 and 37 months. In general, the postoperative functional results were less favorable, with no postoperative improvement in dorsiflexion. In two patients with Ramses prostheses, revision surgery was necessary to address prosthesis loosening.3

Use of the Ramses prosthesis has been listed in 11 of 202 TARs mentioned in the New Zealand national joint registry.4 Two failures in this patient cohort were reported.4

In conclusion, the mid- and long-term results in patients who underwent Ramses TAR are not satisfactory due to high revision rates of 18% and 34% at 2 and 10 years, respectively. The number of pain free patients also has equaled the number of patients with remaining pain.5


  1. Mendolia,G. and Talus Group: The Ramses ankel replacement: design-surgical technique result, results in first 38 cases. The French Orthopedic Web Journal (available at: www matrise-orthop com), 2007.
  2. Mendolia,G., Coillard,J.Y., Cermolacce,C., and Determe,P.: Long-term (10 to 14 years) results of the Ramses total ankle arthroplasty. Tech Foot & Ankle, 4:160-173, 2005.
  3. Delagoutte,J.P.: Retrospective analysis of 110 ankle prostheses. Eur J Orthop Surg Traumatol, 12:198-205, 2002.
  4. Hosman,A.H., Mason,R.B., Hobbs,T., and Rothwell,A.G.: A New Zealand national joint registry review of 202 total ankle replacements followed for up to 6 years. Acta Orthop, 78:584-591, 2007.
  5. Michael,J.M., Golshani,A., Gargac,S., and Goswami,T.: Biomechanics of the ankle joint and clinical outcomes of total ankle replacement. J Mech Behav Biomed Mater, 1:276-294, 2008.

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