Total Talus Replacement for Traumatic Bone Loss or Idiopathic Avascular Necrosis of the Talus

摘要

More than a dozen surgical techniques have been described for management of avascular necrosis or traumatic loss of large portions of the talus. The smaller the area of necrosis, the better the outcomes. Procedures to induce revascularization (core decompression/drilling, vascularized bone grafts) have been reported with variable success. Patients with avascular necrosis of large portions of the talus present unique treatment difficulties. These techniques largely focus on pantalar or tibiotalar-calcaneal arthrodesis with large bone blocks. These surgeries eliminate motion, lead to high levels of patient dissatisfaction, and risk the possibility of multiple surgeries with nonunions. Total talus replacement, first described in Southeast Asia, used traditional manufacturing techniques to try to replicate a patient's anatomy while preserving motion and eliminating pain. Modern techniques involve 3D printing technology to identically recreate the patient's native anatomy and preserve tibiotalar, subtalar and talonavicular joint motion. The surgery is reliable, relatively simple technically, and provides another option for treatment of this very difficult problem.