Technique for Use of Trabecular Metal Spacers in Tibiotalocalcaneal Arthrodesis With Large Bony Defects

Abstract

There are many causes of large bone defects in the tibiotalar joint that need to be definitively treated with a tibiotalocalcaneal (TTC) arthrodesis. Some of the challenges of a large defect are its effect on leg length and the complications associated with trying to fill the defect with structural bone graft. We present an operative strategy involving the use of a trabecular metal implant, a TTC nail that utilized 2 forms of compression, and Reamer/Irrigator/Aspirator (RIA) autograft, to address limitations of previous operative approaches and reliably treat this operative challenge.

The Clinical Application of Porous Tantalum and Its New Development for Bone Tissue Engineering

“…In this study, porous Ta spacers were also augmented with autologous bone marrow obtained by Reamer/Irrigator/Aspirator technique from femoral marrow cavity and fixed with tibiotalocalcaneal nail, bone morphogenetic protein 2 (BMP-2) or platelet derived growth factor was further supplemented to boost bony fusion. With the help of this novel method, thorough osseous fusion at the implant-bone interface appeared at early stage of 4-6 weeks post-surgery and no failure cases were observed [142]. In contrast, Aubret et al [147] reported disappointing outcomes after the insertion of porous Ta spacers.…”

“…And the expenditure of single porous Ta spacer (approximately $989.5-1000) has been reported to be comparable with iliac crest autograft (approximately $600-700) and allograft (approximately $850) to some extent; however the latter two may take more time for preparation during the surgery [137][138][139]. Porous Ta spacer will be an optimal choice for reconstruction surgery, which is especially suitable for huge bone defect [141,142]. Because it has adequate structural strength to maintain the restored height and angular correction of ankle joint until the appearance of osseous fusion between porous Ta spacer and adjacent bony tissues [30,138], which is significantly different from bone autograft or allograft, either of which may collapse due to absorption after implantation [41,137,143].…”

“…The clinic results of porous Ta spacers used for the salvage of failed total ankle arthroplasty are also favorable [142,143,146]. More often, accompanied by nonunion, leg shortening, infection or even severe bone defect after debridement, failed total ankle arthroplasty can be a challenge to be reasonably addressed [143,147].…”

“…The mean fusion rate at the average 23-month follow-up was 93.5%, and the vast majority of patients were satisfied with the surgery in terms of pain relief and improved activity, though additional expenditure were entailed in this clinic trail [146]. Similarly, Kreulen et al [142] introduced a new surgical strategy for reconstruction surgery of 2 patients with failed total ankle arthroplasty and 4 patients with ankle collapse post infection. In this study, porous Ta spacers were also augmented with autologous bone marrow obtained by Reamer/Irrigator/Aspirator technique from femoral marrow cavity and fixed with tibiotalocalcaneal nail, bone morphogenetic protein 2 (BMP-2) or platelet derived growth factor was further supplemented to boost bony fusion.…”

Total Ankle Replacement Conversion to Tibiotalocalcaneal Arthrodesis With Bulk Femoral Head Allograft and Pseudoelastic Intramedullary Nail Providing Sustained Joint Compression

“…The pseudoelastic nail contains an internal compressive element made out of nickel titanium (NiTi-NOL), which is stretched during surgery, and has the capacity to maintain postoperative compression for up to 6 mm of bone resorption and/or joint settling. 21,27,30,32,43 This resorption or settling can be quantitatively tracked on radiographs by visualizing changes in the calcaneal screw positions relative to the nail outer body. 27,32 As the NiTi-NOL compressive element contracts to its original unstretched length, the calcaneal screws shift proximally within the nail's outer body.…”