Femoral Head Allografts for Talar Body Defects

Abstract

Background: Large structural bone deficits after a failed ankle arthroplasty or avascular necrosis (AVN) of the talus present a complex reconstruction challenge. The aim of this study was to report the results of patients undergoing an ankle arthrodesis or tibiotalocalcaneal fusion using a femoral head allograft (FHA). Methods: All ankle and tibiotalocalcaneal fusions using FHA between February 2006 and January 2019 were included. Forty-four patients (45 ankles) with a mean follow-up of 42.8 months were studied. Males accounted for 58.1% (25/43 patients). All patients had either failure of primary or revision total ankle arthroplasty (TAA) or AVN of the talus. Pre- and postoperative Veterans RAND Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), Ankle Osteoarthritis Scale (AOS) and visual analog scale (VAS) for pain scores were obtained. A patient satisfaction survey was distributed postoperatively and results were tabulated. Results: Preoperatively to postoperatively, the VR-12 Mental score remained essentially unchanged ( P = .752) and the VR-12 Physical score improved ( P = .007); the FAAM Activities of Daily Living (ADL) and Sport scores improved ( P < .001); the AOS Pain and Disability scores improved ( P < .001); and the man VAS score improved ( P < .001). The overall satisfaction rate was 78.6 on a 100-point scale. At an average of 18.7 weeks, 90.7% of the ankles were substantially fused. Five patients went on to nonunions and revision surgery. Conclusion: The use of FHA to treat talar defects was a viable option. In this complex patient population, the arthrodesis rate was high at 89% with very positive patient-reported outcome scores. Level of Evidence: Level IV, case series.

Biologic Augmentation of Tibiotalocalcaneal Arthrodesis With Allogeneic Bone Block Is Associated With High Rates of Fusion

“…Both PROMIS and FFI data revealed mild to moderate pain and dysfunction at minimum 1-year follow-up. These findings were similar to those reported by Coetzee et al 10 Given this population’s disease severity, comorbidity profile, and limited alternatives for limb salvage, complete restoration of physiologic ankle function is not to be expected, particularly following fusion of the tibiotalar and subtalar joints. 40 Rather, preservation of a viable lower extremity is, in itself, a major endpoint.…”

“…Very recently, Coetzee et al 10 reported a similarly high union rate of 90.7% in a retrospective cohort of 44 patients, with a mean follow-up of 42.8 months, who underwent tibiotalar or TTC arthrodesis with femoral head allograft for failed total ankle arthroplasty or talar avascular necrosis. They describe a unique transfibular approach to TTC arthrodesis with fibulectomy, meticulous cup and cone reamer preparation of congruent allograft surfaces, rigid internal fixation, and bridge grafting, which they attribute to the high rates of fusion.…”

Midterm outcomes of midfoot and hindfoot arthrodesis with strut allograft for Müller–Weiss disease

“…The efficacy and effectiveness of bone allograft use have been confirmed [ 25 , 26 ]. Coetzee et al reported a case series of 44 patients with large talar body defects (after a failed ankle arthroplasty or avascular necrosis) undergoing ankle arthrodesis or tibio-talo-calcaneal fusion by using femoral head allografts [ 27 ]. The overall satisfaction rate was 78.6%, with 90.7% of ankles exhibiting favorable fusion at an average of 18.7 weeks.…”

Improved Pain and Function After TTC Fusion With a Custom Cage

“…Additionally, one patient underwent a below-the-knee amputation (BKA) after a healed TTC fusion because of persistent pain. 7 Additive manufacturing is the ability to down-lay material to create a 3-dimensional (3D) structure of any shape using numerous different materials. Three-dimensional titanium cages have been used to fill defects in the spine and acetabulum for many years, but more recently there has come the ability to custom print these cages to patient-specific needs.…”