Revision total ankle total talus replacement with a combined constrained implant: A report on 3 cases

Abstract

A non-salvageable talus, often secondary to avascular necrosis, is a difficult pathology to treat. A standard technique for talar defects includes tibiotalocalcaneal fusion with plating or a hindfoot intramedullary nail. The 21st century has brought about the increasing use of total talus replacements as an alternative procedure for severe osteonecrosis of the talus. As total talus replacement becomes more popular, the need for revision options will increase. The present study's evaluates the viability of revision TTR with a talar component constrained into the navicular and calcaneus. Three consecutive patients undergoing revision total ankle total talus replacement were retrospectively reviewed. Two males ages 62 and 57 and a female aged 55 failed conservative therapy at 41, 34, and 29 months after index total talus replacement. Single Photon Emission Computed Tomography (SPECT) was obtained to confirm uptake in the talonavicular and subtalar joint implant interfaces. At 26, 20, and 14 months postoperatively all patients on computed tomography possessed at least 30 % osseous bridging at hindfoot joints. No patient has had a reoperation, and one complication of medial gutter pain was observed. All patients with revision total talus replacement to a combined constrained implant returned to function and avoided tibiotalocalcaneal fusion or below knee amputation. There is a clear need to standardize reporting and establish the safety and efficacy of TTR. Furthermore, more comparative studies between total talus replacement and tibiotalocalcaneal arthrodesis are needed.