Traumatic Loss of the Talus Treated with a Talar Body Prosthesis and Total Ankle Arthroplasty

Magnan, Bruno; Facci, E; Bartolozzi, Pietro

doi:10.2106/00004623-200408000-00024

Cited by 53 publications

(40 citation statements)

References 14 publications

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“…Twelve of the reviewed cases were treated by primary talectomy (see Table 3), meaning that the talus was not reimplanted or preserved in the original surgical management. In several cases, this was because the talus had been completely extruded during the initial trauma and not recovered 14,15,22 . In other cases, the talus was discarded because of concerns regarding contamination or comminution 9,16,[23][24][25] .…”

Section: Primary Talectomymentioning

confidence: 99%

A Systematic Review of Total Dislocation of the Talus

Weston

Liu

Wandtke

et al. 2015

Orthopaedic Surgery

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This review summarizes the treatment and resulting outcomes for total talar dislocation. The PubMed database was searched for articles about humans with total talar dislocation published in the English language in the last twenty years. The following data were entered into a Microsoft Excel spreadsheet: type of dislocation, nature of associated fractures (if any), type of reduction/fixation utilized, immobilization, weight-bearing status, outcome, complications and average follow-up time. Thirty-nine articles reporting a total of 86 cases of total talar dislocation are included in this review. Seventy-three of these were open injuries and 13 closed. Forty-three cases had an associated foot or ankle fracture, 32 of those cases specifically having a fracture of the talus. The talus was preserved in the initial management of 74 cases, whereas the remaining 12 cases were managed by primary talectomy. The mean duration of follow-up was 32 months. Twenty-two cases required a secondary arthrodesis or another additional procedure. A good outcome was achieved in 35% of cases, a fair outcome in 37% and a poor outcome in 27%. The complication of avascular necrosis (AVN) occurred in 22 cases and 14 subjects developed clinically significant osteoarthritis. Generally, the outcome of current treatments associated with total talar dislocation is not ideal, only 1/3 of cases achieving good outcomes. So far, preservation of the talus is the best treatment option. AVN is still a relatively common complication even in the absence of fracture or postoperative infection.

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Section: Primary Talectomymentioning

confidence: 99%

A Systematic Review of Total Dislocation of the Talus

Weston

Liu

Wandtke

et al. 2015

Orthopaedic Surgery

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“…Because arthrodesis of the ankle or the complete rearfoot as well as tibiocalcaneal fusion after talectomy can produce severe disability of the ankle and the foot, different study groups have already developed a prosthesis to replace the talar body[13-16] or even the complete talus[10,17-20]. Lampert et al[12] and Ketz et al[21] combined a custom total talar prosthesis with the tibial component of a standard total ankle prosthesis, and Giannini et al[22] recently reported on a custom-made total talonavicular replacement in a professional rock-climber.…”

Section: Introductionmentioning

confidence: 99%

“…Implantation of a custom made talar body[13-16] or total talar prosthesis[10,17-20] in humans has already shown promising results so far. In 1997 Harnroongroj et al[16] was the first to report on a series of 16 patients treated by use of a quite primitive talar body prosthesis with has been implanted by a medial transmalleolar approach.…”

Section: Introductionmentioning

confidence: 99%

“…However, this type of prosthesis still had a subtalar stem for fixation to the calcaneus by use of bone cement. Magnan et al[13] extended this procedure using a total talar prosthesis and combined it with the standard S.T.A.R. total ankle arthroplasty system (Waldemar Link, Hamburg, Germany) in a 45-year-old professional male skier and rock-climber.…”

Section: Introductionmentioning

confidence: 99%

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Development of an internally braced prosthesis for total talus replacement

Regauer¹,

Lange²,

Soldan³

et al. 2017

WJO

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Total loss of talus due to trauma or avascular necrosis, for example, still remains to be a major challenge in foot and ankle surgery with severely limited treatment options. Implantation of a custom made total talar prosthesis has shown promising results so far. Most important factors for long time success are degree of congruence of articular surfaces and ligamentous stability of the ankle. Therefore, our aim was to develop an optimized custom made prosthesis for total talus replacement providing a high level of primary stability. A custom made hemiprosthesis was developed using computed tomography and magnetic resonance imaging data of the affected and contralateral talus considering the principles and technology for the development of the S.T.A.R. prosthesis (Stryker). Additionally, four eyelets for fixation of artificial ligaments were added at the correspondent footprints of the most important ligaments. Two modifications can be provided according to the clinical requirements: A tri-articular hemiprosthesis or a bi-articular hemiprosthesis combined with the tibial component of the S.T.A.R. total ankle replacement system. A feasibility study was performed using a fresh frozen human cadaver. Maximum range of motion of the ankle was measured and ligamentous stability was evaluated by use of standard X-rays after application of varus, valgus or sagittal stress with 150 N. Correct implantation of the prosthesis was technically possible via an anterior approach to the ankle and using standard instruments. Malleolar osteotomies were not required. Maximum ankle dorsiflexion and plantarflexion were measured as 22-0-28 degrees. Maximum anterior displacement of the talus was 6 mm, maximum varus tilt 3 degrees and maximum valgus tilt 2 degrees. Application of an internally braced prosthesis for total talus replacement in humans is technically feasible and might be a reasonable procedure in carefully selected cases with no better alternatives left.

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“…In contrast, osteochondral injury associated with talar dislocation is said to occur due to shear. 6 Although open talar extrusions have been rarely reported in the literature, [6][7][8] we could find no reports of open osteochondral talar injury in the adult or pediatric population.…”

mentioning

confidence: 99%