The history and clinical application of artificial talus in Japan

Artificial talus has been used to treat severe ankle disorders, including avascular necrosis of the talus and ankle osteoarthritis, with favorable clinical outcomes. Consequently, joint-preserving surgery has become a viable treatment option even for hindfoot pathologies that previously required arthrodesis.

In Japan, a novel alumina ceramic artificial talus has been developed, and several case series have demonstrated. The procedure combining an artificial talus with the tibial component of a total ankle arthroplasty (TAA) has been termed "combined TAA." This narrative review summarizes the historical development of the artificial talus and reviews its current clinical applications and surgical techniques.

We reviewed all published articles on artificial talus reported from Japan, as well as articles on metallic artificial talus used worldwide. In addition, we present characteristic cases from our own clinical experience that demonstrate the potential for the artificial talus.

Initially, only a talar body prosthesis was used. However, complications frequently occurred at the junction between the talar body prosthesis and the talar neck, leading to revision surgery using a total talus prosthesis. Because the outcomes were favorable, the total talus prosthesis was adopted for primary surgery. Combined TAA has since been applied to revision TAA and ankle osteoarthritis. Furthermore, combined TAA can result in spontaneous correction of varus hindfoot malalignment, suggesting that combined TAA alone may be a viable treatment option even in cases previously thought to require calcaneal osteotomy or additional procedures.

Procedures using artificial talus are promising. We believe that further innovations may expand the indications of artificial talus.