Treatments for Avascular Necrosis of the Talus

Gross, Christopher; Haughom, Bryan D.; Chahal, Jaskarndip; Holmes, George B.

doi:10.1177/1938640014521831

Cited by 54 publications

(69 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the systematic review by Gross et al ., data from 85 patients from 3 studies, all involving atraumatic AVN talus at an average followup of 48 months, showed significant improvement in postoperative functional scores. 33 The combined rate of progression averaged 28%, with benefits seen both in early and late (Stage I/II and Stage II/III) stages of the disease in precollapse stage. Relief of symptoms is usually seen in 3–6 months.…”

Section: Joint-sparing Treatments: When and Which?mentioning

confidence: 98%

“…The outcomes of core decompression in the treatment of early-stage AVN talus have been extremely satisfactory, especially when the cause is non traumatic. 11 12 33 This works by reduction in the intraosseous pressure and enhances revascularization in the necrotic zone, akin to the idiopathic variant of osteonecrosis of femur head. Although it is recommended upto Stage I and II of the disease, we believe that the initial Stage III without significant collapse of the dome (<1 mm) can be given a trial of core decompression because the only alternative may be to go for an arthrodesis or joint-sacrificing treatment.…”

Section: Joint-sparing Treatments: When and Which?mentioning

confidence: 99%

“…In the systematic review by Gross et al ., six studies involved arthrodesis conducted for AVN talus. 33 Although there was wide variability in the outcome measures used among the different studies, the aggregate outcome in the fusion group was reported to be excellent in 11 ankles, good in 10, fair in 3, and poor in 4 patients. The incidence of nonunion was high (up to 18%).…”

Section: Joint-sacrificing Proceduresmentioning

confidence: 99%

“…The age of patient, duration of disease, concomitant peritalar arthritis, degree of disability, and surgeon preference/experience may be other factors affecting treatment and outcomes. 11 12 14 33 The literature seems to be inconclusive regarding the ideal modality of treatment of the condition, and the factors that should guide such treatment have not been well elucidated.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Management Options in Avascular Necrosis of Talus

Dhillon

Rana

Panda

et al. 2018

IJOO

View full text Add to dashboard Cite

Avascular necrosis (AVN) of the talus can be a cause of significant disability and is a difficult problem to treat. The most common cause is a fracture of the talus. We have done a systematic review of the literature with the following aims: (1) identify and summarize the available evidence in literature for the treatment of talar AVN, (2) define the usefulness of radiological Hawkins sign and magnetic resonance imaging in early diagnosis, and (3) provide patient management guidelines. We searched MEDLINE and PUBMED using keywords and MESH terminology. The articles' abstracts were read by two of the authors. Forty-one studies met the inclusion criteria of the 335 abstracts screened. The interventions of interest included hindfoot fusion, conservative measures, bone grafting, vascularized bone graft, core decompression, and talar replacement. All studies were of Level IV evidence. We looked to identify the study quality, imprecise and sparse data, reporting bias, and the quality of evidence. Based on the analysis of available literature, we make certain recommendations for managing patients of AVN talus depending on identified disease factors such as early or late presentation, extent of bone involvement, bone collapse, and presence or absence of arthritis. Early talar AVN seems best treated with protected weight bearing and possibly in combination with extracorporeal shock wave therapy. If that fails, core decompression can be considered. Arthrodesis should be saved as a salvage procedure in late cases with arthritis and collapse, and a tibiotalocalcaneal fusion with bone grafting may be needed in cases of significant bone loss. Role of vascularized bone grafting is still not defined clearly and needs further investigation. Future prospective, randomized studies are necessary to guide the conservative and surgical management of talar AVN.

show abstract

Section: Joint-sparing Treatments: When and Which?mentioning

confidence: 98%

Section: Joint-sparing Treatments: When and Which?mentioning

confidence: 99%

Section: Joint-sacrificing Proceduresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Management Options in Avascular Necrosis of Talus

Dhillon

Rana

Panda

et al. 2018

IJOO

View full text Add to dashboard Cite

show abstract

“…Osteonecrosis may occur throughout the skeletal system, including temporal bone (Vudiniabola et al , ), ribs (Nicholls et al , ), femoral head (Camporesi et al , ), humeral head (Gruson and Kwon, ), lunate (Lutsky and Beredjiklian, ), and bones of the foot (Gross et al , ; Callachand et al , ). The epidemiology of many types of osteonecrosis is less well characterized than for ORN, although non‐traumatic femoral head osteonecrosis cases are estimated to occur at an annual incidence of 1.91/100 000 in Japan with a male‐to‐female ratio of 2.1:1 (Ikeuchi et al , ).…”

Section: Non‐mandibular Osteonecrosismentioning

confidence: 99%

Hyperbaric oxygen therapy and osteonecrosis

et al. 2016

View full text Add to dashboard Cite

Osteonecrosis of the jaw may be caused by radiation, medication, or infection. Optimal therapy requires a multimodal approach that combines surgery with adjuvant treatments. This review focuses on the use of adjunctive hyperbaric oxygen therapy for this condition. In addition to evidence regarding the basic and clinical science behind hyperbaric oxygen therapy, controversies in the field and economic implications are discussed. Oral Diseases (2017) 23, 141-151

show abstract

The stability of total talar prosthesis—How stable to dislocation? Cadaveric study

Sato

Saengsin

Sornsakrin

et al. 2021

Journal Orthopaedic Research

View full text Add to dashboard Cite

The aim of this study was to characterize ankle stability of total talar prosthesis (TTP) and to determine the effect of implant sizes on stability as well as the resistance to TTP dislocation. Twelve below‐knee cadaveric specimens were divided into two groups. Group 1 received a size matched implant and Group 2 received downsized implant by 5%. The stability assessment under fluoroscopy was performed for each cadaver in its native state. Following TTP insertion process, each then underwent evaluation of the TTP ankle stability. The stability of pre‐ and post‐TTP was compared. (1) Anterior drawer distance. (2) Talar tilt angle under varus and valgus stress. (3) Subtalar tilt angle under varus stress was measured. Finally, the dislocation test was performed using the aforementioned testing conditions, then the stress force was slowly increased from 0 to 350 N, during which time it was observed on fluoroscopy all the time. Compared to pre TTP ankles, varus and anterior drawer stress showed significant instability (p < 0.001–0.031). Only anterior drawer stress in smaller sized implants showed significant instability when compared to identical sized implants (p = 0.008). No dislocation was seen under varus, valgus, and subtalar stress. However, anterior dislocation was observed in all cases of smaller size implant group (p = 0.045). TTP implant was stable under valgus and subtalar stress. However, clinicians should pay attention to anterior instability. Notably, downsized implants should be considered carefully to minimize the chance of anterior dislocation.

show abstract

Treatments for Avascular Necrosis of the Talus

Abstract: Level II.

Cited by 54 publications

References 21 publications

Management Options in Avascular Necrosis of Talus

Management Options in Avascular Necrosis of Talus

Hyperbaric oxygen therapy and osteonecrosis

The stability of total talar prosthesis—How stable to dislocation? Cadaveric study

Contact Info

Product

Resources

About