Case Series: Allograft Tibiotalocalcaneal Arthrodesis Utilizing Fresh Talus

Abstract

Background: Talar body osteonecrosis can be a difficult condition to treat. Recent reports highlight a high rate of failure with the use of femoral head allograft. Additionally, higher rates of failure have been reported in diabetics and smokers. Our institution attempted a novel technique utilizing fresh allograft talus in attempt to improve on a reported 50% nonunion rate. Methods: Five patients who underwent tibiotalocalcaneal (TTC) fusion utilizing fresh talar allograft were clinically and radiographically reviewed to evaluate fusion rates and functional outcomes. Results: Our case series of 5 patients had a 100% union rate, including 2 former smokers and 2 diabetic patients. There were no infections or complications. Functional outcomes also improved in our series of patients postoperatively as noted by their FAAM and SF-36 scores. Conclusion: TTC fusion using fresh allograft talus has a higher union rate than reported with femoral head allograft. This case series requires further study to evaluate whether this technique can be used beyond patients with osteonecrosis of the talus.Level of Evidence: Level IV, case series.

Avascular Osteonecrosis of the Talus: Current Treatment Strategies

“…38 In a recent 5-case series, including 2 diabetic patients, fresh-frozen talus allograft was supplemented with autologous bone marrow obtained from iliac crest and implanted to supplement tibiocalcaneal arthrodesis due to AVNT. 57 Four of the 5 AVNT patients had TTC union radiographically within 6 months, and the TTC fusion in 1 diabetic patient was evident at 12 months by CT scan.…”

“…Artificial total talus replacement (TTR) is a potentially promising option for the treatment of AVNT as new 15 TTC nail 14 27 85 Abd-Ella (2017) 1 TTC nail + bone grafting 12 23 +37 c Dennison (2001) 13 Ilizarov lengthening 6 32 100 Vaughn (2019) 57 TTC nail+allograft technologies and prosthesis designs evolve (Table 5). TTR aims to relieve pain, preserve hindfoot motion, maintain limb length, prevent adjacent joint arthritis, and is without risk of nonunion.…”

‘Bamboo Hut Technique’ to Bridge Large Defects During Tibiotalocalcaneal Fusion

“…Tibiotalocalcaneal (TTC) arthrodesis can stabilize the ankle and hindfoot and relieve pain at the cost of forgoing ankle movements. Various options have been described to bridge the defect, namely Blair fusion,1 femoral head allografts,2 talar allograft,3 medial femoral condyle flaps,4 titanium trusses or cages,5 vascularized structural fibula,6 or soft tissue-preserved fibular graft,7 augmented with allogenic bone morphogenic protein, mesenchymal stem cells, and other orthobiologics. Intramedullary nail assisted TTC arthrodesis has been well reported and shown to be promising 8,9.…”