Total Talar Replacement: Surgical Technique

Area of Science:

• Orthopedic surgery
• Biomaterials science
• Reconstructive surgery

Background:

• Total talar replacement is a salvage procedure for end-stage osteonecrosis of the talus.
• Customized total talar implants are designed using computed tomography (CT) scans and made of alumina ceramic.
• This procedure is considered for various pathologies including traumatic, steroidal, alcoholic, systemic lupus erythematosus (SLE), hemophilic, and idiopathic conditions.

Purpose of the Study:

• To describe the technique and outcomes of total talar replacement using custom alumina ceramic implants.
• To evaluate the efficacy of total talar replacement as an alternative to arthrodesis for end-stage talar osteonecrosis.
• To highlight the advantages of total talar replacement in preserving hindfoot mobility and facilitating early functional recovery.

Main Methods:

• The procedure involves an anterior ankle approach to exteriorize and resect the talus.
• Customized talar implants are designed based on CT scans of the contralateral healthy talus.
• Alumina ceramic is used for its biocompatibility, congruency, and durability.

Main Results:

• Postoperative results were satisfactory with no failures requiring revision in long-term follow-up.
• The procedure preserved ankle and hindfoot mobility, with a median ankle joint range of motion of 45°.
• Objective evaluation using the Japanese Society for Surgery of the Foot (JSSF) Ankle-Hindfoot Scale yielded a median score of 97/100.
• Subjective evaluation showed significant improvement in the Ankle Osteoarthritis Scale (AOS).

Conclusions:

• Total talar replacement is a viable and effective treatment option for end-stage osteonecrosis of the talus.
• This procedure offers a significant advantage over arthrodesis by preserving joint mobility and allowing for earlier functional recovery.
• Alumina ceramic implants provide a durable and congruent surface, contributing to favorable long-term outcomes.