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Ankle Joint

Ankle Joint

The ankle is formed by the talocrural joint (crural = leg). It consists of the articulations between the talus bone of the foot and the distal ends of the tibia and fibula of the leg. The superior aspect of the talus bone is square-shaped and has three areas of articulation. The top of the talus articulates with the inferior tibia. This is the portion of the ankle joint that carries the body weight between the leg and foot. The sides of the talus are firmly held in position by the articulations...

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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach

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Total Talar Replacement: Surgical Technique.

Akira Taniguchi¹, Yasuhito Tanaka¹, Takuma Miyamoto¹

¹Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan.

JBJS Essential Surgical Techniques

|January 26, 2024

Summary

This summary is machine-generated.

Total talar replacement offers a salvage option for end-stage osteonecrosis of the talus, preserving ankle mobility. This procedure utilizes custom alumina ceramic implants, showing promising results in maintaining foot function.

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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.